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Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis
Nasia Safdar1, Jo Handelsman, Dennis G Maki
1Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, USA.
The Lancet. Infectious Diseases
|August 4, 2004
Summary
Combination antimicrobial therapy for Gram-negative bacteraemia does not reduce mortality. However, combination therapy showed a mortality benefit for Pseudomonas aeruginosa bacteraemia.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- The efficacy of combination antimicrobial therapy for Gram-negative bacteraemia is debated.
- Current guidelines lack consensus on its routine use.
Purpose of the Study:
- To determine if combination antimicrobial therapy reduces mortality in Gram-negative bacteraemia.
- To analyze data from published studies via meta-analysis.
Main Methods:
- Meta-analysis of 17 analytic studies comparing monotherapy and combination therapy for Gram-negative bacteraemia.
- Pooled odds ratio calculated using a random effects model.
- Heterogeneity assessed and explored.
Main Results:
- Overall summary odds ratio was 0.96 (95% CI 0.70-1.32), indicating no mortality benefit.
- Subgroup analyses by publication year, study design, and illness severity did not alter results.
- Significant mortality benefit observed for Pseudomonas aeruginosa bacteraemias (OR 0.50, 95% CI 0.30-0.79).
Conclusions:
- Routine combination antimicrobial therapy is not supported for Gram-negative bacteraemia.
- Combination therapy may be beneficial for Pseudomonas aeruginosa infections or when in-vitro efficacy needs assurance.