title: Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock.
abstract: OBJECTIVE
  To assess whether combination antibiotic therapy improves outcome of severe community-acquired pneumonia in the subset of patients with shock.
  
  
  METHODS
  Secondary analysis of a prospective observational, cohort study.
  
  
  METHODS
  Thirty-three intensive care units (ICUs) in Spain.
  
  
  METHODS
  Patients were 529 adults with community-acquired pneumonia requiring ICU admission.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two hundred and seventy (51%) patients required vasoactive drugs and were categorized as having shock. The effects of combination antibiotic therapy and monotherapy on survival were compared using univariate analysis and a Cox regression model. The adjusted 28-day in-ICU mortality was similar (p = .99) for combination antibiotic therapy and monotherapy in the absence of shock. However, in patients with shock, combination antibiotic therapy was associated with significantly higher adjusted 28-day in-ICU survival (hazard ratio, 1.69; 95% confidence interval, 1.09-2.60; p = .01) in a Cox hazard regression model. Even when monotherapy was appropriate, it achieved a lower 28-day in-ICU survival than an adequate antibiotic combination (hazard ratio, 1.64; 95% confidence interval, 1.01-2.64).
  
  
  CONCLUSIONS
  Combination antibiotic therapy does not seem to increase ICU survival in all patients with severe community-acquired pneumonia. However, in the subset of patients with shock, combination antibiotic therapy improves survival rates.
authors: Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain.
authors: Alejandro
authors: A
authors: Rodríguez
authors: Angel
authors: A
authors: Mendia
authors: Josep-María
authors: JM
authors: Sirvent
authors: Fernando
authors: F
authors: Barcenilla
authors: María Victoria
authors: MV
authors: de la Torre-Prados
authors: Jordi
authors: J
authors: Solé-Violán
authors: Jordi
authors: J
authors: Rello
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D012769:Shock / Q000188:drug therapy* / Q000209:etiology; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents