szlig;-lactam and fluoroquinolone combination antibiotic therapy for bacteremia caused by gram-negative bacilli

Majdi N. AI-Hasan, John W. Wilson, Brian D. Lahr, Kristine M. Thomsen, Jeanette E. Eckel-Passow, Emily A. Vetter, Imad M. Tleyjeh, Larry M. Baddour

Research output: Contribution to journalArticle

54 Scopus citations

Abstract

The role of combination antibiotic therapy with a beta-lactam and a fluoroquinolone for bacteremia caused by gram-negative bacilli, to our knowledge, has not been previously described. Much of the previous study of combination therapy has included beta-lactams and aminoglycosides. We conducted a large retrospective cohort study to evaluate 28-day all-cause mortality in patients with monomicrobial bacteremia due to aerobic gram-negative bacilli who received either a combination of beta-lactams and fluoroquinolones or beta-lactam monotherapy. We enrolled adult patients admitted to Mayo Clinic hospitals from 1 January 2001 to 31 October 2006 in the study. After stratification of patients by Pitt bacteremia scores, we used Cox regression models to estimate the hazard ratios (HR) for 28-day all-cause mortality after adjusting for the propensity to receive combination therapy. We identified 398 and 304 unique patients with bacteremia caused by gram-negative bacilli who received single and combination antibiotic therapy, respectively. In less severely ill patients with Pitt bacteremia scores of <4, combination therapy was associated with lower 28-day mortality than single therapy (4.2% [9 of 214] versus 8.8% [28 of 319]; adjusted HR, 0.44; 95% confidence interval [CI], 0.20 to 0.98; P = 0.044). In critically ill patients with Pitt bacteremia scores of ž4, there was no difference in 28-day mortality between combination and single therapy (25.6% [23 of 90] versus 27.8% [22 of 79]; adjusted HR, 0.87; 95% CI, 0.47 to 1.62; P = 0.660). These findings were consistent for 14-day all-cause mortality. In this large cohort, we found for the first time that combination therapy with beta-lactams and fluoroquinolones was associated with a reduction in 28-day all-cause mortality among less severely ill patients with bacteremia caused by gram-negative bacilli.

Original languageEnglish (US)
Pages (from-to)1386-1394
Number of pages9
JournalAntimicrobial Agents and Chemotherapy
Volume53
Issue number4
DOIs
StatePublished - Apr 2009

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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    AI-Hasan, M. N., Wilson, J. W., Lahr, B. D., Thomsen, K. M., Eckel-Passow, J. E., Vetter, E. A., Tleyjeh, I. M., & Baddour, L. M. (2009). szlig;-lactam and fluoroquinolone combination antibiotic therapy for bacteremia caused by gram-negative bacilli. Antimicrobial Agents and Chemotherapy, 53(4), 1386-1394. https://doi.org/10.1128/AAC.01231-08