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

TLDR

Retrospective studies suggest that combination antibiotic therapy may reduce mortality in severe bacteremic pneumococcal pneumonia. This study prospectively evaluated the effect of combination versus monotherapy in 844 adults with Streptococcus pneumoniae bacteremia. Mortality outcomes were compared using univariate analyses and logistic regression models. Among critically ill patients, combination therapy lowered 14‑day mortality (23.4 % vs 55.3 %, p = 0.0015) independent of country, ICU support, antibiotic class, or in vitro activity, thereby improving survival.

Abstract

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.