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Antimicrobial Agents and Chemotherapy, April 2009, p. 1386-1394, Vol. 53, No. 4
0066-4804/09/$08.00+0     doi:10.1128/AAC.01231-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

β-Lactam and Fluoroquinolone Combination Antibiotic Therapy for Bacteremia Caused by Gram-Negative Bacilli{triangledown}

Majdi N. Al-Hasan,1,2* John W. Wilson,2 Brian D. Lahr,3 Kristine M. Thomsen,3 Jeanette E. Eckel-Passow,3 Emily A. Vetter,4 Imad M. Tleyjeh,2,5 and Larry M. Baddour2

Department of Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky,1 Department of Medicine, Division of Infectious Diseases,2 Department of Health Sciences Research, Division of Biomedical Statistics and Informatics,3 Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, College of Medicine, Mayo Clinic, Rochester, Minnesota,4 Research Center, King Fahd Medical City, Riyadh, Saudi Arabia5

Received 16 September 2008/ Returned for modification 8 December 2008/ Accepted 14 January 2009

The role of combination antibiotic therapy with a beta-lactam and a fluoroquinolone for bacteremia caused by gram-negative bacilli, to our knowledge, has not been previously described. Much of the previous study of combination therapy has included beta-lactams and aminoglycosides. We conducted a large retrospective cohort study to evaluate 28-day all-cause mortality in patients with monomicrobial bacteremia due to aerobic gram-negative bacilli who received either a combination of beta-lactams and fluoroquinolones or beta-lactam monotherapy. We enrolled adult patients admitted to Mayo Clinic hospitals from 1 January 2001 to 31 October 2006 in the study. After stratification of patients by Pitt bacteremia scores, we used Cox regression models to estimate the hazard ratios (HR) for 28-day all-cause mortality after adjusting for the propensity to receive combination therapy. We identified 398 and 304 unique patients with bacteremia caused by gram-negative bacilli who received single and combination antibiotic therapy, respectively. In less severely ill patients with Pitt bacteremia scores of <4, combination therapy was associated with lower 28-day mortality than single therapy (4.2% [9 of 214] versus 8.8% [28 of 319]; adjusted HR, 0.44; 95% confidence interval [CI], 0.20 to 0.98; P = 0.044). In critically ill patients with Pitt bacteremia scores of ≥4, there was no difference in 28-day mortality between combination and single therapy (25.6% [23 of 90] versus 27.8% [22 of 79]; adjusted HR, 0.87; 95% CI, 0.47 to 1.62; P = 0.660). These findings were consistent for 14-day all-cause mortality. In this large cohort, we found for the first time that combination therapy with beta-lactams and fluoroquinolones was associated with a reduction in 28-day all-cause mortality among less severely ill patients with bacteremia caused by gram-negative bacilli.

* Corresponding author. Mailing address: University of Kentucky Chandler Medical Center, 800 Rose Street, Room MN 672, Lexington, KY 40536. Phone: (859) 323-8178. Fax: (859) 323-8926. E-mail: majdi.alhasan{at}uky.edu

{triangledown} Published ahead of print on 21 January 2009.

Antimicrobial Agents and Chemotherapy, April 2009, p. 1386-1394, Vol. 53, No. 4
0066-4804/09/$08.00+0     doi:10.1128/AAC.01231-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

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  • Al-Hasan, M. N., Lahr, B. D., Eckel-Passow, J. E., Baddour, L. M. (2009). Antimicrobial resistance trends of Escherichia coli bloodstream isolates: a population-based study, 1998-2007. J Antimicrob Chemother 64: 169-174 [Abstract] [Full Text]  


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