title: Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia.
abstract: Retrospective studies have suggested that combination antibiotic therapy for severe bacteremic pneumococcal pneumonia may reduce mortality. We assessed this issue in a prospective, multicenter, international observational study of 844 adult patients with bacteremia due to Streptococcus pneumoniae. The effect of combination antibiotic therapy versus monotherapy on mortality was examined by univariate analyses and by logistic regression models. The 14-day mortality was not significantly different for the two groups. However, among critically ill patients, combination antibiotic therapy was associated with lower 14-day mortality (23.4 versus 55.3%, p = 0.0015). This improvement in survival was independent of country of origin, intensive care unit support, class of antibiotics, or in vitro activity of the antibiotics prescribed. Combination antibiotic therapy improved survival among critically ill patients with bacteremic pneumococcal illness.
authors.affiliation: Mayo Clinic, Rochester, NY, USA.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Victor L
authors.initials: VL
authors.lastname: Yu
authors.forename: Keith P
authors.initials: KP
authors.lastname: Klugman
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.forename: Ake
authors.initials: A
authors.lastname: Ortqvist
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Morris
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Luna
authors.forename: David R
authors.initials: DR
authors.lastname: Snydman
authors.forename: Wen Chien
authors.initials: WC
authors.lastname: Ko
authors.forename: M Bernadete F
authors.initials: MB
authors.lastname: Chedid
authors.forename: David S
authors.initials: DS
authors.lastname: Hui
authors.forename: Antoine
authors.initials: A
authors.lastname: Andremont
authors.forename: Christine C C
authors.initials: CC
authors.lastname: Chiou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000401:mortality*; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents