title: Infections in patients in intensive care units: can the combination of a monobactam and a penicillin replace the classic combination of a beta-lactam agent and an aminoglycoside?
abstract: An open, comparative, randomized study was performed in two medical intensive care units to compare the efficacy of the combination of aztreonam and either cloxacillin or oxacillin [(cl)oxacillin] with that of the combination of tobramycin and a cephalosporin. Of the 92 patients who were included in the study, 76 were evaluable. All patients suffered from severe, mostly pulmonary, infections and received ventilatory support. The aztreonam combination yielded an 80% rate of clinical cure; mortality was 15%. Use of the aminoglycoside combination resulted in a 51% rate of clinical cure; mortality was 23%. The difference in cure rate between the two combinations was statistically significant. Adverse effects were negligible in patients who received the aztreonam combination, and superinfection was seen in only 2%. Of the patients who received the aminoglycoside combination, 20% developed a superinfection and 11% developed a new renal insufficiency. Therefore, the combination of aztreonam and (cl)oxacillin is a valuable alternative to the combination of an aminoglycoside and a cephalosporin.
authors.affiliation: Department of Intensive Care, University Hospital, Gent, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Colardyn
authors.forename: J L
authors.initials: JL
authors.lastname: Gala
authors.forename: G
authors.initials: G
authors.lastname: Verschraegen
authors.forename: G
authors.initials: G
authors.lastname: Wauters
authors.forename: D
authors.initials: D
authors.lastname: Vogelaers
authors.forename: A
authors.initials: A
authors.lastname: Dive
authors.forename: G
authors.initials: G
authors.lastname: Claeys
authors.forename: A
authors.initials: A
authors.lastname: Magis
authors.forename: B
authors.initials: B
authors.lastname: Vandercam
authors.forename: P
authors.initials: P
authors.lastname: Mahieu
mesh_terms: D000328:Adult; D000368:Aged; D001398:Aztreonam / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002439:Cefotaxime / Q000009:adverse effects / Q000627:therapeutic use*; D002444:Cefuroxime / Q000009:adverse effects / Q000627:therapeutic use; D003023:Cloxacillin / Q000009:adverse effects / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010068:Oxacillin / Q000009:adverse effects / Q000627:therapeutic use*; D015163:Superinfection / Q000209:etiology; D014031:Tobramycin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D001398:Aztreonam; D002439:Cefotaxime; D002444:Cefuroxime; D003023:Cloxacillin; D010068:Oxacillin; D014031:Tobramycin