San Raffaele Hospital, Department of Infectious and Tropical Diseases, Via Stamira D'Ancona, 20, 20127 Milan, Italy.
Hospital Clínic de Barcelona, Service of Infectious Diseases, Carrer de Villarroel, 170, 08036 Barcelona, Spain.
J Antimicrob Chemother. 2017 Dec 1;72(12):3443-3452. doi: 10.1093/jac/dkx315.
To evaluate the influence on mortality of empirical double-active combination antimicrobial therapy (DACT) compared with active monotherapy (AM) in septic shock patients.
A retrospective study was performed of monomicrobial septic shock patients admitted to a university centre during 2010-15. A propensity score (PS) was calculated using a logistic regression model taking the assigned therapy as the dependent variable, and used as a covariate in multivariate analysis predicting 7, 15 and 30 day mortality and for matching patients who received DACT or AM. Multivariate models comprising the assigned therapy group and the PS were built for specific patient subgroups.
Five-hundred and seventy-six patients with monomicrobial septic shock who received active empirical antimicrobial therapy were included. Of these, 340 received AM and 236 DACT. No difference in 7, 15 and 30 day all-cause mortality was found between groups either in the PS-adjusted multivariate logistic regression analysis or in the PS-matched cohorts. However, in patients with neutropenia, DACT was independently associated with a better outcome at 15 (OR 0.29, 95% CI 0.09-0.92) and 30 (OR 0.25, 95% CI 0.08-0.79) days, while in patients with Pseudomonas aeruginosa infection DACT was associated with lower 7 (OR 0.12, 95% CI 0.02-0.7) and 30 day (OR 0.26, 95% CI 0.08-0.92) mortality.
All-cause mortality at 7, 15 and 30 days was similar in patients with monomicrobial septic shock receiving empirical double-active combination therapy and active monotherapy. However, a beneficial influence of empirical double-active combination on mortality in patients with neutropenia and those with P. aeruginosa infection is worthy of further study.
评估经验性双联活性联合抗菌治疗（DACT）与活性单药治疗（AM）对脓毒性休克患者死亡率的影响。
对 2010 年至 2015 年期间在一所大学中心收治的单一致病菌性脓毒性休克患者进行回顾性研究。使用逻辑回归模型计算倾向评分（PS），将分配的治疗方法作为因变量，并在多变量分析中用作预测 7、15 和 30 天死亡率的协变量，并对接受 DACT 或 AM 的患者进行匹配。为特定患者亚组构建了包含分配治疗组和 PS 的多变量模型。
共纳入 576 例接受活性经验性抗菌治疗的单一致病菌性脓毒性休克患者。其中 340 例接受 AM，236 例接受 DACT。在 PS 调整后的多变量逻辑回归分析或 PS 匹配队列中，两组之间在 7、15 和 30 天全因死亡率方面均无差异。然而，在中性粒细胞减少症患者中，DACT 与 15 天（OR 0.29，95%CI 0.09-0.92）和 30 天（OR 0.25，95%CI 0.08-0.79）的更好结局独立相关，而在铜绿假单胞菌感染患者中，DACT 与较低的 7 天（OR 0.12，95%CI 0.02-0.7）和 30 天死亡率（OR 0.26，95%CI 0.08-0.92）相关。
接受经验性双联活性联合治疗和活性单药治疗的单一致病菌性脓毒性休克患者在 7、15 和 30 天的全因死亡率相似。然而，经验性双联活性对中性粒细胞减少症和铜绿假单胞菌感染患者死亡率的有益影响值得进一步研究。
