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Published ahead of print on June 7, 2004, doi:10.1164/rccm.200311-1578OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 440-444

A more recent version of this article appeared on August 15, 2004
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Submitted on December 24, 2003
Accepted on May 21, 2004

Combination Antibiotic Therapy Lowers Mortality in Severly Ill Patients with Pneumococcal Bacteremia

Larry M Baddour1, Victor L Yu2*, Keith P Klugman3, Charles Feldman4, Ake Ortqvist5, Jordi Rello6, Arthur J Morris7, Carlos M Luna8, David R Snydman9, Wen Chien Ko10, M. Bernadete F Chedid11, David S Hui12, Antoine Andremont13, Christine C.C. Chiou14, and The International Pneumococcal Study Group1

1 Mayo Clinic, Rochester, MN, USA, 2 Division of Infectious Disease, University of Pittsburgh, Pittsburgh, PA, USA, 3 Department of International Health, Emory University, Rollins School of Public Health, Atlanta, GA, USA; Wits/MRC/NHLS Respiratory and Meningeal Pathogens, Johannesburg, South Africa, 4 Department of Medicine, Pulmonology Division, Johannesburg Hospital and the University of the Witwaterstrand, Johannesburg, South Africa, 5 Department of Communicable Diseases, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden, 6 University Hospital Joan XXIII, University Rovira and Virgili, Tarragona, Spain, 7 Clinical Microbiology Laboratory, Auckland Hospital, Auckland, New Zealand, 8 Division of Pulmonary Medicine, Universidad de Buenos Aires, Hospital de Clinicas, Buenos Aires, Argentina, 9 Division of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine, Tufts - New England Medical Center, Boston, MA, USA, 10 Division of Infectious Diseases, National Cheng Kung University Hospital, Tainan, Taiwan, 11 Postgraduate Program in Pulmonology, Federal University of RS, Hospital de Clinicas de Porto Alegre (RS) Brazil, Porto Alegre, Brazil, 12 Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, 13 Laboratorie de bacteriologie, Hopital Bichat - Claude Bernard AP-HP, Paris, France, 14 Department of Pediatrics, Veterans General Hospital - Kaohsiung, National Yang Ming University, Taipei, Taiwan

* To whom correspondence should be addressed. 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 vs monotherapy on mortality was examined by univariate analyses and by logistic regression models. The 14-day mortality was not significantly different for the 2 groups. However, in critically-ill patients, combination antibiotic therapy was associated with lower 14-day mortality (23.4% vs. 55.3%, P = .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: Community-acquired pneumonia, Streptococcus pneumoniae, bacteremia




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