Impact of adequate empirical combination therapy on mortality from bacteremic Pseudomonas aeruginosapneumonia

作者：So-Youn Park, Hyun Jung Park, Song Mi Moon, Ki–Ho Park, Yong Pil Chong, Mi‐Na Kim, Sung‐Han Kim, Sang‐Oh Lee, Yang Soo Kim, Jun Hee Woo, Sang‐Ho Choi · 发表于：BMC Infectious Diseases · 年份：2012 · DOI：10.1186/1471-2334-12-308 · 被引用次数：93 · 研究领域：Nosocomial Infections in ICU、Antibiotic Resistance in Bacteria、Pneumonia and Respiratory Infections

BACKGROUND: Pseudomonas aeruginosa has gained an increasing amount of attention in the treatment of patients with pneumonia. However, the benefit of empirical combination therapy for pneumonia remains unclear. We evaluated the effects of adequate empirical combination therapy and multidrug-resistance in bacteremic Pseudomonas pneumonia on the mortality. METHODS: A retrospective cohort study was performed at the 2,700-bed tertiary care university hospital. We reviewed the medical records of patients with bacteremic pneumonia between January 1997 and February 2011. Patients who received either inappropriate or appropriate empirical therapy were compared by using marginal structural model. Furthermore, we investigated the direct impact of combination therapy on clinical outcomes in patients with monomicrobial bacteremic pneumonia. RESULTS: Among 100 consecutive patients with bacteremic Pseudomonas pneumonia, 65 patients were classified in the adequate empirical therapy group, 32 of whom received monotherapy and 33 combination therapy. In the marginal structural model, only inadequate therapy was significantly associated with 28-day mortality (p = 0.02), and multidrug-resistance was not a significant risk factor.To examine further the direct impact of combination therapy, we performed a subgroup analysis of the 65 patients who received adequate therapy. Multivariate logistic regression analysis identified absence of septic shock at the time of bacteremia (OR, 0.07; 95% CI, 0.01-0...