Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis

Critical Care Medicine
Anand KumarCooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group

Abstract

Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broadening coverage when resistant pathogens are a concern. To evaluate the therapeutic benefit of early combination therapy comprising at least two antibiotics of different mechanisms with in vitro activity for the isolated pathogen in patients with bacterial septic shock. Retrospective, propensity matched, multicenter, cohort study. Intensive care units of 28 academic and community hospitals in three countries between 1996 and 2007. A total of 4662 eligible cases of culture-positive, bacterial septic shock treated with combination or monotherapy from which 1223 propensity-matched pairs were generated. The primary outcome of study was 28-day mortality. Using a Cox proportional hazards model, combination therapy was associated with decreased 28-day mortality (444 of 1223 [36.3%] vs. 355 of 1223 [29.0%]; hazard ratio, 0.77; 95% confidence interval, 0.67-0.88; p = .0002). The beneficial impact of combination therapy applied to bot...Continue Reading

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