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Antimicrobial Agents and Chemotherapy, September 2003, p. 2756-2764, Vol. 47, No. 9
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.9.2756-2764.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Effectiveness of Combination Antimicrobial Therapy for Pseudomonas aeruginosa Bacteremia

Eric Chamot,1,{dagger} Emmanuelle Boffi El Amari,2 Peter Rohner,3 and Christian Van Delden4*

Institute of Social and Preventive Medicine,1 Department of Microbiology and Genetics, University of Geneva,4 Department of Medicine,2 Laboratory of Clinical Microbiology, University Hospital Geneva, Geneva, Switzerland3

Received 9 December 2002/ Returned for modification 25 February 2003/ Accepted 2 June 2003

It remains controversial whether combination therapy, given empirically or as definitive treatment, for Pseudomonas aeruginosa bacteremia is associated with a better outcome than monotherapy. The aim of the present study was to compare the rates of survival among patients who received either combination therapy or monotherapy for P. aeruginosa bacteremia. We assembled a historical cohort of 115 episodes of P. aeruginosa bacteremia treated with empirical antipseudomonal therapy between 1988 and 1998. On the basis of susceptibility testing of the bacteremic P. aeruginosa isolate, we defined categories of empirical treatment, including adequate combination therapy, adequate monotherapy, and inadequate therapy, as well as corresponding categories of definitive therapy. Neither the adequacy of the empirical treatment nor the use of combination therapy predicted survival until receipt of the antibiogram. However, the risk of death from the date of receipt of the antibiogram to day 30 was higher for both adequate empirical monotherapy (adjusted hazard ratio [aHR], 3.7; 95% confidence interval [CI], 1.0 to 14.1) and inadequate empirical therapy (aHR, 5.0; 95% CI, 1.2 to 20.4) than for adequate empirical combination therapy. Compared to adequate definitive combination therapy, the risk of death at 30 days was also higher with inadequate definitive therapy (aHR, 2.6; 95% CI, 1.1 to 6.7) but not with adequate definitive monotherapy (aHR, 0.70; 95% CI, 0.30 to 1.7). In this retrospective analysis the use of adequate combination antimicrobial therapy as empirical treatment until receipt of the antibiogram was associated with a better rate of survival at 30 days than the use of monotherapy. However, adequate combination antimicrobial therapy given as definitive treatment for P. aeruginosa bacteremia did not improve the rate of survival compared to that from the provision of adequate definitive monotherapy.

* Corresponding author. Mailing address: Department of Microbiology and Genetics, Medical School of the University of Geneva, CMU, 9 av. Champel, CH-1211 Geneva 14, Switzerland. Phone: (4122) 702 56 39. Fax: (4122) 702 57 02. E-mail: Christian.vanDelden{at}medecine.unige.ch.

{dagger} Present address: Department of Epidemiology and International Health, University of Alabama, Birmingham, AL 35294-0022.

Antimicrobial Agents and Chemotherapy, September 2003, p. 2756-2764, Vol. 47, No. 9
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.9.2756-2764.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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