title: Impact of combination therapy with aminoglycosides on the outcome of ICU-acquired bacteraemias.
abstract: Pharmacodynamic studies report on the rapid bactericidal activity of aminoglycosides, conferring them as being of theoretical interest for bacteraemia treatment. We assessed this issue in a retrospective study of patients with intensive care unit (ICU)-acquired bacteraemias. To determine the impact of aminoglycosides in antimicrobial combination on the outcome of patients with bacteraemia, we performed a monovariate analysis and a logistic regression analysis comparing patients treated with or without aminoglycosides. Forty-eight bacteraemias in 48 patients were included. Eighteen patients received aminoglycosides. Baseline characteristics as well as adaptation and adequation of antibiotherapy did not differ in patients who did or did not receive aminoglycosides. Patients who received aminoglycosides had longer time alive away from the ICU (11.3 ± 8.9 (10 [0-20]) vs. 3.2 ± 6.6 (0 [0-2] days; p = 0.002) and free from mechanical ventilation (12.5 ± 9.3 (14 [0-21] vs. 5.5 ± 9.2 (0 [0-10] days; p = 0.02) on day 28. The ICU mortality was 16% in the aminoglycoside group versus 46% (p = 0.03). In the multivariate analysis, patients treated with aminoglycosides were 6 times less likely to die than those treated without aminoglycosides (confidence interval [CI] = [1.3-28.9]; p = 0.02). Our study supports the hypothesis that combination short-term antibiotherapy with an aminoglycoside for ICU-acquired bacteraemias could increase survival.
authors.affiliation: Intensive Care and Infectious Disease Unit, Tourcoing Hospital, University of Lille, 135, rue du Président Coty, BP 619, Tourcoing Cedex, 59208, France.
authors.forename: P-Y
authors.initials: PY
authors.lastname: Delannoy
authors.forename: N
authors.initials: N
authors.lastname: Boussekey
authors.forename: P
authors.initials: P
authors.lastname: Devos
authors.forename: S
authors.initials: S
authors.lastname: Alfandari
authors.forename: C
authors.initials: C
authors.lastname: Turbelin
authors.forename: A
authors.initials: A
authors.lastname: Chiche
authors.forename: A
authors.initials: A
authors.lastname: Meybeck
authors.forename: H
authors.initials: H
authors.lastname: Georges
authors.forename: O
authors.initials: O
authors.lastname: Leroy
mesh_terms: D000368:Aged; D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D003428:Cross Infection / Q000188:drug therapy*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents