title: Comparison of ß-lactam plus aminoglycoside versus ß-lactam plus fluoroquinolone empirical therapy in serious nosocomial infections due to Gram-negative bacilli.
abstract: We sought to compare clinical cure on day 7 and a 28-day all-cause mortality in patients who received an anti-pseudomonal ß-lactam with a fluoroquinolone or an aminoglycoside for treatment of nosocomial bacteremia or pneumonia due to Gram-negative bacilli while in the ICU. This retrospective cohort study was conducted in critically ill patients at an academic medical centre from January 2005 to August 2011. A total of 129 patients (83 receiving aminoglycoside and 46 receiving fluoroquinolone combinations) were included. Seven-day clinical cure rates were 74% and 72% for fluoroquinolone and aminoglycoside groups, respectively (p = 0.84). There was no significant difference in the odds of clinical cure with a fluoroquinolone as compared to an aminoglycoside combination (adjusted odds ratio 2.4, 95% confidence interval [CI] 0.7-9.0). There was no significant difference in 28-day mortality in patients who received a fluoroquinolone or an aminoglycoside combination (22% vs. 18%, adjusted hazard ratio 0.82, 95% CI 0.29-2.28).
authors.affiliation: a Department of Pharmacy Services , UK HealthCare , Lexington , KY , USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Ereshefsky
authors.affiliation: b Division of Infectious Diseases, UK HealthCare , Lexington , KY , USA.
authors.forename: Majdi N
authors.initials: MN
authors.lastname: Al-Hasan
authors.affiliation: c Department of Pharmacy Practice and Science , University of Kentucky College of Pharmacy , Lexington , KY , USA.
authors.forename: Yevgeniya
authors.initials: Y
authors.lastname: Gokun
authors.affiliation: a Department of Pharmacy Services , UK HealthCare , Lexington , KY , USA.|c Department of Pharmacy Practice and Science , University of Kentucky College of Pharmacy , Lexington , KY , USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000617:Aminoglycosides / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage*; D005839:Gentamicins / Q000008:administration & dosage; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D064704:Levofloxacin / Q000008:administration & dosage; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014031:Tobramycin / Q000008:administration & dosage; D016896:Treatment Outcome; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D005839:Gentamicins; D047090:beta-Lactams; D064704:Levofloxacin; D014031:Tobramycin
keywords: Antibiotic therapy; Bacteremia; Combination therapy; Gram-negative bacilli; Nosocomial infection; Pneumonia