Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia
Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia
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DOI：
10.1128/aac.47.9.2756-2764.2003
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发表时间：
2003-09-01
影响因子：
4.9
通讯作者：
Van Delden, C
中科院分区：
文献类型：
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作者：
Chamot, E;El Amari, EB;Van Delden, C
对于铜绿假单胞菌菌血症的经验性或确定性联合治疗是否比单药治疗具有更好的结局仍存在争议。本研究的目的是比较接受联合治疗或单药治疗铜绿假单胞菌菌血症患者的生存率。我们收集了115例在1988年至1998年期间接受经验性抗假单胞菌治疗的铜绿假单胞菌菌血症的历史队列。根据菌血症铜绿假单胞菌分离株的药敏试验，我们定义了经验性治疗的类别，包括充分的联合治疗、充分的单药治疗和不充分的治疗，以及相应的确定性治疗类别。经验性治疗的充分性和联合治疗的使用都不能预测患者在接受脑电图检查前的生存率。然而，从接受放射性核素扫描之日起至第30天的死亡风险，无论是充分的经验性单药治疗（校正风险比[aHR]，3.7; 95%置信区间[CI]，1.0 - 14.1）还是不充分的经验性治疗（aHR，5.0; 95% CI，1.2 - 20.4），均高于充分的经验性联合治疗。与充分的确定性联合治疗相比，不充分的确定性治疗（aHR，2.6; 95% CI，1.1 - 6.7）的30天时死亡风险也更高，但不充分的确定性单药治疗（aHR，0.70; 95% CI，0.30 - 1.7）。在这项回顾性分析中，使用适当的联合抗生素治疗作为经验性治疗，直到接受放射免疫分析，与使用单药治疗相比，30天生存率更高。然而，与提供充分的确定性单药治疗相比，作为铜绿假单胞菌菌血症的确定性治疗给予充分的联合抗菌药物治疗并不能提高生存率。
It remains controversial whether combination therapy, given empirically or as definitive treatment, for Pseudomonas aeruginosa bacteremia is associated with a better outcome than monotherapy. The aim of the present study was to compare the rates of survival among patients who received either combination therapy or monotherapy for P. aeruginosa bacteremia. We assembled a historical cohort of 115 episodes of P. aeruginosa bacteremia treated with empirical antipseudomonal therapy between 1988 and 1998. On the basis of susceptibility testing of the bacteremic P. aeruginosa isolate, we defined categories of empirical treatment, including adequate combination therapy, adequate monotherapy, and inadequate therapy, as well as corresponding categories of definitive therapy. Neither the adequacy of the empirical treatment nor the use of combination therapy predicted survival until receipt of the antibiogram. However, the risk of death from the date of receipt of the antibiogram to day 30 was higher for both adequate empirical monotherapy (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.0 to 14.1) and inadequate empirical therapy (aHR, 5.0; 95% CI, 1.2 to 20.4) than for adequate empirical combination therapy. Compared to adequate definitive combination therapy, the risk of death at 30 days was also higher with inadequate definitive therapy (aHR, 2.6; 95% CI, 1.1 to 6.7) but not with adequate definitive monotherapy (aHR, 0.70; 95% CI, 0.30 to 1.7). In this retrospective analysis the use of adequate combination antimicrobial therapy as empirical treatment until receipt of the antibiogram was associated with a better rate of survival at 30 days than the use of monotherapy. However, adequate combination antimicrobial therapy given as definitive treatment for P. aeruginosa bacteremia did not improve the rate of survival compared to that from the provision of adequate definitive monotherapy.