What is it about?
Prior studies of combination antimicrobial therapy for gram-negative bloodstream infections have yielded mixed results. Some demonstrating survival benefit, particularly in critically ill patients, and most demonstrating no benefit over beta-lactam monotherapy. Methodological differences between various studies make comparisons of results a real challenge.
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Why is it important?
This study used a novel design of matching patients with gram-negative bloodstream infections by predicted prognosis at initial presentation using the bloodstream infection mortality risk score. In addition, the multivariate model adjusted for the propensity of receiving combination therapy. This is pretty much as experimental as a cohort study can be. The final model demonstrated no difference in mortality between combination and monotherapy regardless of prognosis.
Perspectives
The pendulum seems to be swinging towards beta-lactam monotherapy for gram-negative bloodstream infections. The quick answer to the combination therapy question appears to be a solid "no" for the average patient with gram-negative bloodstream infection. However, combination therapy may still have a role in a small proportion of patients with high predicted risk of antimicrobial resistance at initial presentation. This is going to be the focus of an upcoming study. Please stay tuned.
Prof. Majdi Al-Hasan
University of South Carolina School of Medicine
Read the Original
This page is a summary of: Combination versus monotherapy for gram-negative bloodstream infections: matching by predicted prognosis, International Journal of Antimicrobial Agents, September 2017, Elsevier,
DOI: 10.1016/j.ijantimicag.2017.09.007.
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