The following is a summary of “Single-drug versus combination antimicrobial therapy in critically ill patients with hospital-acquired pneumonia and ventilator-associated pneumonia due to Gram-negative pathogens: a multicenter retrospective cohort study,” published in the January 2024 issue of Critical Care by Barbier et al.
The controversy persists over the benefits and risks of combination antimicrobial therapy for Gram-negative pneumonia in critically ill patients with hospital-acquired pneumonia (HAP), ventilated HAP (vHAP), or ventilator-associated pneumonia (VAP).
Researchers conducted a retrospective study to assess the benefits of combo therapy in Gram-negative pneumonia.
They analyzed data from the OutcomeRea database, including patients with the first HAP, vHAP, or VAP caused by a single Gram-negative bacterium. Those treated with initial adequate single-drug or combination therapy were assessed for Day-28 all-cause mortality (primary endpoint), Day-14 clinical cure rate, and Day-7 composite outcome of death or treatment-emergent acute kidney disease ( AKI). Inverse probability of treatment-weighted and multivariable regression models examined the average effects of combination therapy on endpoints. Subgroup analyses considered resistance phenotype, pivotal (carbapenems or others) and companion (aminoglycosides/polymyxins or others) drug classes, duration of combination therapy (<3 or ≥3 days), SOFA score at pneumonia onset (<7 or ≥7 points), and specific conditions like pneumonia due to non-fermenting Gram-negative bacteria, pneumonia-related bloodstream infection, or septic shock.
The result showed 391 patients who received single-drug vs combination therapy therapy, 151 (38.6%)& 240 (61.4%), with equal distribution of VAP (67.3%), vHAP (16.4%) and HAP (16.4%) in both groups. Day-28 all-cause mortality ( Overall,31.2%), Day-14 clinical cure rate (43.7%), and death or AKI at Day 7 (41.2%) showed no significant differences. In inverse probability of treatment-weighted analyses, combination therapy was not independently associated with Day-28 all-cause death (aOR, 1.14; 95% CI 0.73–1.77; P=0.56), Day-14 clinical cure (aOR, 0.79; 95% CI 0.53–1.20; P=0.27), or death or AKI at Day 7 (aOR, 1.07; 95% CI 0.71–1.63; P=0.73). Similar results were obtained in multivariable regression models and subgroup analyses.
Investigators concluded that combo therapy doesn’t affect outcomes in Gram-negative pneumonia.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04792-0