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Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock*

Rodríguez, Alejandro MD, PhD; Mendia, Angel MD; Sirvent, Josep-María MD, PhD; Barcenilla, Fernando MD; de la Torre-Prados, María Victoria MD, PhD; Solé-Violán, Jordi MD, PhD; Rello, Jordi MD, PhD

doi: 10.1097/01.CCM.0000266755.75844.05
Continuing Medical Education Article

Objective: To assess whether combination antibiotic therapy improves outcome of severe community-acquired pneumonia in the subset of patients with shock.

Design: Secondary analysis of a prospective observational, cohort study.

Setting: Thirty-three intensive care units (ICUs) in Spain.

Patients: Patients were 529 adults with community-acquired pneumonia requiring ICU admission.

Interventions: None.

Measurement and Main Results: Two hundred and seventy (51%) patients required vasoactive drugs and were categorized as having shock. The effects of combination antibiotic therapy and monotherapy on survival were compared using univariate analysis and a Cox regression model. The adjusted 28-day in-ICU mortality was similar (p = .99) for combination antibiotic therapy and monotherapy in the absence of shock. However, in patients with shock, combination antibiotic therapy was associated with significantly higher adjusted 28-day in-ICU survival (hazard ratio, 1.69; 95% confidence interval, 1.09–2.60; p = .01) in a Cox hazard regression model. Even when monotherapy was appropriate, it achieved a lower 28-day in-ICU survival than an adequate antibiotic combination (hazard ratio, 1.64; 95% confidence interval, 1.01–2.64).

Conclusions: Combination antibiotic therapy does not seem to increase ICU survival in all patients with severe community-acquired pneumonia. However, in the subset of patients with shock, combination antibiotic therapy improves survival rates.

Attending Physician, Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain (AR); Attending Physician, Intensive Care Unit, Hospital Nuertra Señora de Aranzazu, San Sebastian, Spain (AM); Attending Physician, Department of Intensive Care, Hospital Universitaro de G’Rona, Girona, Spain (J-MS); Director, Infection Control Unit, Attending Physician, Arnau De Vilanova Hospital, Ueida, Spain (FB); Subdirector of Intensive Care Medicine, Hospital Universitario Virgen de la Victoria, Málaga, Associate Professor, Medicine Department, Málaga University, Málaga, Spain (MVT-P); Medical Doctor, Hospital Universitario de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain (JS-V); Chief, Critical Care Department, Joan XXIII University Hospital, Associate Professor of Critical Care, Rovira and Virgili University, Tarragona, Spain (JR).

Supported, in part, by SGR 05/920, FIS 05/2410, FIS 04/1500, and CIBERes 06/06/0036.

Presented, in part, at the ESICM Annual Congress, Barcelona, Spain, September 24–27, 2006.

The authors have not disclosed any potential conflicts of interest.

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© 2007 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins