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Combination treatment shows no reduced mortality in P. aeruginosa
Treatment with combination antimicrobial did not reduce the mortality risk in patients with Pseudomonas aeruginosa bloodstream infections, researchers from the Spanish Network for Research in Infectious Diseases have found.
“The most recent ‘Surviving Sepsis’ guidelines recommend empirical combination therapy, particularly for patients with known or suspected Pseudomonas infections, as a means to decrease the likelihood of administering inadequate empirical antimicrobial therapy,” the researchers wrote in Clinical Infectious Diseases. “However, it has not been clearly established whether adequate empirical antimicrobial therapy truly improves survival in cases of suspected P. aeruginosa bacteremia.”
The researchers conducted a post hoc analysis that included 593 patients who had a single episode of P. aeruginosa. They were recruited prospectively from 10 hospitals in Spain during a 2-year time frame. Of these patients, 332 received adequate empirical antimicrobial therapy and 261 received inadequate therapy. Those who received adequate therapy were further stratified: 266 patients received single-drug therapy and 66 received combination therapy.
Overall, the 30-day mortality rate was 30%. The unadjusted 30-day mortality was similar for both single-drug and combination therapy. There also was no difference in 30-day mortality between the groups after multivariate analysis. The researchers also evaluated differences in 30-day mortality between patients who received definitive single-drug therapy and definitive combination therapy, and also found no difference between the groups.
“Treatment with combined therapy did not reduce overall mortality risk compared with single-drug therapy,” the researchers wrote. “However, a survival advantage cannot be ruled out, because the sample size is not large enough to identify small differences between the types of treatment. This information could help prevent the overuse of antibiotics and may also guide antibiotic policy by allowing a more judicious use of the few antimicrobial options available.”
Disclosure: The researchers report financial relationships with AstraZeneca, Gilead, GlaxoSmithKline, Janssen-Cilag, Merck Sharp & Dohme, Novartis, Pfizer and Wyeth.