SESSION TITLE: ICU Infections Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: Pneumonia caused by Pseudomonas aeruginosa carries a higher morbidity and mortality. Current guidelines advocate the early use of a combination of empiric antibiotics against P aeruginosa. There is controversy regarding this strategy because of potential disadvantages, including drug toxicity, increased costs, and superinfection. The objective of this study was to determine the clinical effectiveness of monotherapy vs. combination antibiotic therapy in patients with P aeruginosa community acquired pneumonia (CAP).
METHODS: We performed a retrospective population-based study of >150 hospitals in the US Veterans Health Administration. Patients were included if they had a diagnosis of CAP and P aeruginosa was identified as the causative pathogen. These patients were stratified according to the number of anti-pseudomonal antibiotics received within the first 48 hours of admission. The primary outcome was 30-day mortality.
RESULTS: 359 patients with the diagnosis of a P aeruginosa CAP were identified. Of these, 49 (13.6%) were treated with a single antibiotic and 310 (86.4%) were treated with a combination of antibiotics with antipseudomonal properties. Admissions to the ICU were more frequent in patients that received combination therapy, 110 (35.5%) vs. 3 (6.1%), p = <0.01. Patients that received combination antibiotic therapy were admitted to hospital for longer periods of time compared antibiotic monotherapy (22.2 ± 32.0 vs. 9.1 ± 13.5, p = <0.01). Cox proportional hazards modeling showed that the use of combination antibiotic therapy was associated with increased 30-day mortality (HR 2.40, 95% CI 1.04-5.56, p = 0.04).
CONCLUSIONS: Combination antibiotic therapy is independently associated with higher 30-day mortality among patients diagnosed with Pseudomonas CAP. Higher severity of the disease influences the selection of antimicrobial agents and may have an impact in the results.
CLINICAL IMPLICATIONS: The empiric use of combination antibiotic therapy for P aeruginosa CAP should be used with caution.
DISCLOSURE: The following authors have nothing to disclose: Diego Maselli, Juan Fernandez, Oriol Sibila, Elena Laserna, Eric Mortensen, A. Anzueto, Grant Waterer, Marcos Restrepo
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