Combination Antibiotic Therapy Improves Survival in Patients With Community-Acquired Pneumonia and Shock
Rodriquez A, Mendia A, Sirvent J-M, et al
Crit Care Med. 2007;35:1493-1498
Community-acquired pneumonia (CAP) remains one of the most common infectious diseases requiring hospitalization, and severe cases continue to carry a high mortality rate. Early institution of antibiotics has been shown to improve survival in this condition as well as in septic shock. The authors of the current study sought to confirm the findings of previous studies[4-6] that suggested that additional (eg, "dual" or "combination") antibiotic coverage may also improve outcomes for patients with severe CAP. This study examined data from a prior observational cohort study of 529 critically ill patients with CAP in Spain. There was no difference in mortality rate between single and combination antibiotic therapy overall, but for patients with shock, combination therapy was associated with a survival advantage (hazard ratio [HR] 1.69 for single antibiotic therapy). Because it was possible that this finding was due to inappropriate antibiotic coverage for pneumonia pathogens, the authors repeated the analysis in patients with appropriate antibiotic therapy and found a persistent increase in mortality for patients treated with single antibiotic therapy (HR 1.64).