Outcome of Appropriate Empiric Combination versus Monotherapy for Pseudomonas aeruginosa Bacteremia.
Antimicrob Agents Chemother. 2012 Dec 21;
Authors: Bowers DR, Liew YX, Lye DC, Kwa AL, Hsu LY, Tam VH
Pseudomonas aeruginosa bacteremia is associated with high hospital mortality. Empiric combination therapy is commonly used to increase the likelihood of appropriate therapy, but the benefits of employing >1 active agent have yet to be established. The purpose of this study was to compare outcomes of patients receiving appropriate empiric combination versus monotherapy for P. aeruginosa bacteremia. This was a retrospective, multi-center, cohort study of hospitalized adult patients with P. aeruginosa bacteremia from 2002 - 2011. The primary endpoint (30-day mortality) was assessed using multivariate logistic regression, adjusting for underlying confounding variables. Secondary endpoints of hospital mortality and time to mortality following were assessed by Fisher's exact test and Cox proportional hazards model, respectively. A total of 384 patients were analyzed. Thirty-day mortality was higher in patients receiving inappropriate compared with appropriate empiric therapy (43.8% vs 21.5%; p=0.03). However, there were no statistical differences in 30-day mortality following appropriate empiric combination versus monotherapy, after adjusting for baseline APACHE II score and length of hospital stay prior to the onset of bacteremia (p=0.55). Observed hospital mortality was 36.6% of patients administered combination therapy compared with 28.7% monotherapy patients (p=0.17). After adjusting for baseline APACHE II score, the relationship between time to mortality and combination therapy was not statistically significant (p=0.59). Overall, no significant differences were observed for 30-day, hospital and time to mortality between combination and monotherapy for P. aeruginosa bacteremia. Empiric combination therapy did not appear to offer additional benefit, as long as the isolate was susceptible to >1 antimicrobial agent.
PMID: 23263001 [PubMed - as supplied by publisher]