Abstract
In order to determine whether combination antibiotic therapy decreases mortality after severe pneumococcal infection, a retrospective study of a cohort of 1,840 adult patients with severe sepsis or septic shock enrolled in two multicenter clinical trials between 1994 and 1999 was conducted. Among 107 patients with monobacterial pneumococcal sepsis, the case-fatality rate was 20% (five of 25) for patients who received antibiotic monotherapy compared with 19.5% (16 of 82) for patients who received combination therapy (adjusted hazard ratio, 1.1; 95% CI, 0.4–3.1). Similarly, monotherapy did not increase the risk of death (adjusted hazard ratio, 1.0; 95% CI, 0.2–4.8) among bacteremic patients (n=75). However, the latter analysis may have been underpowered (power, 58%) to detect a difference in mortality. Overall, in contrast to recently published reports, these results suggest that combination antibiotic therapy does not decrease mortality after severe pneumococcal sepsis.
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Acknowledgments
We are grateful to the many investigators and staff who were involved in enrolling patients into the clinical trial and whose detailed record-keeping facilitated the analysis reported here. In particular, we would like to thank R. Sudan for editorial assistance and the other members of the Geneva Sepsis Network (J.C. Chevrolet, J.M. Dayer, D. Lew, B. Ricou, and P.M. Suter) for their help and collaboration. The original clinical trial was supported by F.Hoffmann-La Roche Ltd., Basel, Switzerland.
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Harbarth, S., Garbino, J., Pugin, J. et al. Lack of effect of combination antibiotic therapy on mortality in patients with pneumococcal sepsis. Eur J Clin Microbiol Infect Dis 24, 688–690 (2005). https://doi.org/10.1007/s10096-005-0018-6
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DOI: https://doi.org/10.1007/s10096-005-0018-6