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
Main finding · All-cause mortalityResult — go to the resultAdjusted odds ratio 1.14 95% CI 0.73–1.77Authors' conclusion
Initial combination therapy exerts no independent impact on Day-28 mortality, clinical cure rate at Day 14, and the hazard of death or AKI at Day 7 in critically ill patients with mono-bacterial HAP, vHAP or VAP due to Gram-negative bacteria.
Study context
- Population
- Critically ill patients with a first hospital-acquired pneumonia (HAP), ventilated HAP (vHAP) or ventilator-associated pneumonia (VAP) due to a single Gram-negative bacterium, OutcomeRea database
- Participants
- 391 patients
- Exposure
- Combination vs single-drug initial adequate antimicrobial therapy
- Combination therapyn = 240
- Single-drug therapyn = 151reference
- Outcome
- All-cause mortality
- Follow-up
- Day 28
Methodological detailsmulticentre, inverse probability of treatment-weighted analysis
- Multicentre
- Inverse probability of treatment-weighted analysis
Main finding
As reported in the abstract
Adjusted odds ratio
1.14
95% CI 0.73–1.77
P = 0.56
Combination therapy vs Single-drug therapy
aOR 1.14 (95% CI 0.73–1.77); P = 0.56
- Overall all-cause mortality; no significant difference between groups
- 31.2%
Observational data: associations, not effects.
Secondary outcomes
| Outcome | aOR (95% CI) | P value | |
|---|---|---|---|
| Clinical cure · Day 14Inverse probability of treatment-weighted analysis | 0.79 (0.53–1.20) | P = 0.27 | |
| Death or AKI (composite) · Day 7Inverse probability of treatment-weighted analysis | 1.07 (0.71–1.63) | P = 0.73 | |
| 0.512Adjusted odds ratio (log scale) |
- Clinical cure — Overall clinical cure rate; no significant difference between groups
- 43.7%
- Death or acute kidney injury (AKI) (composite) — Overall rate of death or AKI; no significant difference between groups
- 41.2%
Subgroup analyses and multivariable models
- Multivariable regression models and subgroup analyses provided similar results
Original publication
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. Crit Care. Published 3 January 2024. doi:10.
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