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Combination Antibiotic Therapy Lowers Mortality among Severely Ill Patients with Pneumococcal Bacteremia

Mayo Clinic, Rochester, New York; Division of Infectious Disease, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of International Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Respiratory and Meningeal Pathogens Research Unit and Pulmonary Division, Department of Medicine, Johannesburg Hospital, University of the Witwatersrand/Medical Research Council/National Health Laboratory Service, Johannesburg, South Africa; Department of Communicable Disease Control and Prevention, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden; University Hospital Joan XXIII, University Rovira and Virgili, Tarragona, Spain; Clinical Microbiology Laboratory, Auckland Hospital, Auckland, New Zealand; Division of Pulmonary Medicine, Hospital de Clinicas, Universidad de Buenos Aires, Buenos Aires, Argentina; Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts; Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong; Division of Infectious Diseases, National Cheng Kung University Hospital, Tainan, and Department of Pediatrics, Veterans General Hospital-Kaohsiung, National Yang Ming University, Taipei, Taiwan; Postgraduate Program in Pulmonology, Federal University of Rio Grande do Sul, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil; Laboratory of Bacteriology, Hôpital Bichat-Claude Bernard, Assistance Publique Hôpitaux de Paris, Paris, France

Correspondence and requests for reprints should be addressed to Victor L. Yu, M.D., VA Medical Center, Infectious Disease Section, University Drive C, Pittsburgh, PA 15240. E-mail: vly+{at}pitt.edu

Retrospective studies have suggested that combination antibiotic therapy for severe bacteremic pneumococcal pneumonia may reduce mortality. We assessed this issue in a prospective, multicenter, international observational study of 844 adult patients with bacteremia due to Streptococcus pneumoniae. The effect of combination antibiotic therapy versus monotherapy on mortality was examined by univariate analyses and by logistic regression models. The 14-day mortality was not significantly different for the two groups. However, among critically ill patients, combination antibiotic therapy was associated with lower 14-day mortality (23.4 versus 55.3%, p = 0.0015). This improvement in survival was independent of country of origin, intensive care unit support, class of antibiotics, or in vitro activity of the antibiotics prescribed. Combination antibiotic therapy improved survival among critically ill patients with bacteremic pneumococcal illness.

Key Words: bacteremia • community-acquired pneumonia • Streptococcus pneumoniae

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