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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: A propensity-matched analysis
Critical Care Medicine, Volume 38, No. 9, Year 2010
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Description
Background: Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broadening coverage when resistant pathogens are a concern. Objective: To evaluate the therapeutic benefit of early combination therapy comprising at least two antibiotics of different mechanisms with in vitro activity for the isolated pathogen in patients with bacterial septic shock. Design: Retrospective, propensity matched, multicenter, cohort study. SETTING: Intensive care units of 28 academic and community hospitals in three countries between 1996 and 2007. SUBJECTS: A total of 4662 eligible cases of culture-positive, bacterial septic shock treated with combination or monotherapy from which 1223 propensity-matched pairs were generated. MEASUREMENTS AND MAIN RESULTS: The primary outcome of study was 28-day mortality. Using a Cox proportional hazards model, combination therapy was associated with decreased 28-day mortality (444 of 1223 [36.3%] vs. 355 of 1223 [29.0%]; hazard ratio, 0.77; 95% confidence interval, 0.67-0.88; p =.0002). The beneficial impact of combination therapy applied to both Gram-positive and Gram-negative infections but was restricted to patients treated with β-lactams in combination with aminoglycosides, fluoroquinolones, or macrolides/clindamycin. Combination therapy was also associated with significant reductions in intensive care unit (437 of 1223 [35.7%] vs. 352 of 1223 [28.8%]; odds ratio, 0.75; 95% confidence interval, 0.63-0.92; p =.0006) and hospital mortality (584 of 1223 [47.8%] vs. 457 of 1223 [37.4%]; odds ratio, 0.69; 95% confidence interval, 0.59-0.81; p <.0001). The use of combination therapy was associated with increased ventilator (median and [interquartile range], 10 [0-25] vs. 17 [0-26]; p =.008) and pressor/inotrope-free days (median and [interquartile range], 23 [0-28] vs. 25 [0-28]; p =.007) up to 30 days. Conclusion: Early combination antibiotic therapy is associated with decreased mortality in septic shock. Prospective randomized trials are needed. © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.
Authors & Co-Authors
Kumar, Anand
Canada, Winnipeg
University of Manitoba
United States, Camden
Cooper University Hospital
Zarychanski, Ryan
Canada, Winnipeg
University of Manitoba
Light, R. Bruce
Canada, Winnipeg
University of Manitoba
Parrillo, Joseph E.
United States, Camden
Cooper University Hospital
Maki, Dennis George
United States, Madison
University of Wisconsin-madison
Simon, David M.
United States, Chicago
Rush University
Laporta, Denny P.
Canada, Montreal
Sir Mortimer B. Davis Jewish General Hospital
Lapinsky, Stephen Earl
Canada, Toronto
University of Toronto
Ellis, Paul
Canada, Toronto
University Health Network University of Toronto
Mirzanejad, Yazdan
Canada, Surrey
Surrey Memorial Hospital
Martinka, Greg
Canada, Vancouver
Richmond General Hospital
Keenan, Sean Patrick
Canada, New Westminster
Royal Columbian Hospital, new Westminster
Wood, Gordon G.
Canada, Vancouver
The University of British Columbia
Arabi, Yaseen M.
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Feinstein, Daniel
United States, Greensboro
The Moses H. Cone Memorial Hospital
Kumar, Aseem C.Ramesh
Canada, Sudbury
Université Laurentienne
Dodek, Peter M.
Canada, Vancouver
The University of British Columbia
Kravetsky, Laura B.
Canada, Winnipeg
University of Manitoba
Doucette, Steve Paul
Canada, Ottawa
Ottawa Hospital Research Institute
Statistics
Citations: 19
Authors: 19
Affiliations: 15
Identifiers
Doi:
10.1097/CCM.0b013e3181eb3ccd
ISSN:
00903493
e-ISSN:
15300293
Research Areas
Environmental
Health System And Policy
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative