Impact of combination therapy with aminoglycosides on the outcome of ICU-acquired bacteraemias

• Published in: European journal of clinical microbiology & infectious diseases 2012-09, Vol.31 (9), p.2293-2299
• Main Authors: Delannoy, P.-Y., Boussekey, N., Devos, P., Alfandari, S., Turbelin, C., Chiche, A., Meybeck, A., Georges, H., Leroy, O.
• Format: Article
• Language: English
• Subjects: Aged; Aminoglycosides - therapeutic use; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Bacteremia - drug therapy; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Chronic obstructive pulmonary disease; Creatinine; Cross Infection - drug therapy; Drug dosages; Drug resistance; Drug Therapy, Combination - methods; Female; Human bacterial diseases; Humans; Indexing in process; Infectious diseases; Intensive care; Intensive Care Units; Internal Medicine; Male; Medical Microbiology; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Nosocomial infections; Regression analysis; Survival Analysis; Toxicity; Treatment Outcome; Ventilators
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1568-z

Pharmacodynamic studies report on the rapid bactericidal activity of aminoglycosides, conferring them as being of theoretical interest for bacteraemia treatment. We assessed this issue in a retrospective study of patients with intensive care unit (ICU)-acquired bacteraemias. To determine the impact of aminoglycosides in antimicrobial combination on the outcome of patients with bacteraemia, we performed a monovariate analysis and a logistic regression analysis comparing patients treated with or without aminoglycosides. Forty-eight bacteraemias in 48 patients were included. Eighteen patients received aminoglycosides. Baseline characteristics as well as adaptation and adequation of antibiotherapy did not differ in patients who did or did not receive aminoglycosides. Patients who received aminoglycosides had longer time alive away from the ICU (11.3 ± 8.9 (10 [0–20]) vs. 3.2 ± 6.6 (0 [0–2] days; p  = 0.002) and free from mechanical ventilation (12.5 ± 9.3 (14 [0–21] vs. 5.5 ± 9.2 (0 [0–10] days; p  = 0.02) on day 28. The ICU mortality was 16% in the aminoglycoside group versus 46% ( p  = 0.03). In the multivariate analysis, patients treated with aminoglycosides were 6 times less likely to die than those treated without aminoglycosides (confidence interval [CI] = [1.3–28.9]; p  = 0.02). Our study supports the hypothesis that combination short-term antibiotherapy with an aminoglycoside for ICU-acquired bacteraemias could increase survival.