Table 3.
Comparison of the groups given monotherapy and dual therapy
| |
Monotherapy (β-lactam) |
Dual therapy |
||
|---|---|---|---|---|
| Parameters | Total population (n = 471) | Total population (n = 394) | β-lactam + Macrolide (n = 164) | β-lactam + Fluoroquino-lone (n = 230) |
|
Variables at admission |
|
|
|
|
| Male, n (%) |
301 (63.9) |
274 (69.5) |
110 (67.1) |
164 (71.3) |
| Age in years, median [IQR] |
60 [45; 75] |
64 [48; 77] |
64 [49; 79] |
64 [47; 76] |
|
Scores, n (%) |
|
|
|
|
| SAPSII*£ |
47 [34; 60] |
39.5 [28; 57] |
37 [28.5; 51] |
43[28; 63] |
| SOFA score£ |
6 [4; 9] |
6 [3; 9] |
5 [3; 8] |
7 [4; 10] |
| LOD score*£ |
5 [3; 7] |
4 [2; 7] |
3 [2; 5.5] |
4 [2; 8] |
| Coma Glasgow Scale*£ |
8 [4; 15] |
15 [8.5; 15] |
15 [11;15] |
14 [7; 15] |
|
McCabe, n (%) |
|
|
|
|
| 1 |
326 (69.2) |
284 (72.4) |
119 (73.5) |
165 (71.7) |
| 2 |
124 (26.3) |
98 (25.0) |
40 (24.7) |
58 (25.2) |
| 3 |
21 (4.5) |
10 (2.6) |
3 (1.9) |
7 (3.0) |
|
CURB-65,* n (%) |
|
|
|
|
| 0 |
3 (0.6) |
7 (1.8) |
1 (0.6) |
6 (2.6) |
| 1 |
20 (4.2) |
38 (9.6) |
15 (9.1) |
23 (10.0) |
| 2 |
88 (18.7) |
71 (18.0) |
34 (20.7) |
37 (16.1) |
| 3 |
157 (33.3) |
107 (27.2) |
42 (25.6) |
65 (28.3) |
| 4 |
122 (25.9) |
107 (27.2) |
46 (28.0) |
61 (26.5) |
| 5 |
81 (17.2) |
64 (16.2) |
26 (15.9) |
38 (16.5) |
|
Co-morbidities (Knaus definitions), n (%) | ||||
| Chronic hepatic failure£ |
23 (4.9) |
17 (4.3) |
3 (1.8) |
14 (6.1) |
| Chronic heart failure |
47 (10.0) |
48 (12.2) |
25 (15.2) |
23 (10.0) |
| Chronic respiratory failure*£ |
65 (13.8) |
86 (21.8) |
52 (31.7) |
34 (14.8) |
| Chronic renal failure |
9 (1.9) |
7 (1.8) |
3 (1.8) |
4 (1.7) |
| Diabetes |
58 (12.3) |
48 (12.2) |
16 (9.8) |
32 (13.9) |
| ≥One co-morbidity* |
153 (32.5) |
161 (40.9) |
75 (45.7) |
86 (37.4) |
| Smokers (>20 pack-years), n (%) |
114 (31.1) |
97 (28.1) |
41 (29.3) |
56 (27.3) |
| Alcohol (>80 g/d)* n (%) |
101 (27.6) |
73 (21.2) |
31 (22.1) |
42 (20.5) |
| Sepsis, n (%) |
458 (97.2) |
383 (97.2) |
158 (96.3) |
225 (97.8) |
| Severe sepsis, n (%) * |
395 (83.9) |
360 (91.4) |
146 (89) |
214 (93.0) |
| Septic shock, n (%)* |
146 (31.0) |
152(38.6) |
55 (33.5) |
97(42.2) |
|
Treatments, n (%) unless otherwise stated | ||||
| Invasive ventilation*£ |
340 (72.2) |
207 (52.5) |
73 (44.5 |
134 (58.3) |
| Noninvasive ventilation* |
40 (8.5) |
58 (14.7) |
27 (16.5) |
31 (13.5) |
| Inotropes or vasoactive agents*£ |
189 (40.1) |
191 (48.5) |
67 (40.9) |
124 (53.9) |
| Corticosteroids* |
69 (14.6) |
96 (24.4) |
40 (24.4) |
56 (24.3) |
| Hemodialysis/Hemofil-tration |
23 (4.9) |
31 (7.9) |
11 (637) |
20 (8.7) |
| Antibiotic therapy duration in days, median [IQR]* |
7 [4; 13] |
8 [4; 14] |
7 [4; 13] |
8 [4; 15] |
|
Organisms, n (%) |
|
|
|
|
|
Streptococcus pneumoniae*£ |
125 (26.5) |
69 (17.5) |
42 (25.6) |
27 (11.7) |
|
Staphylococcus aureus*£ |
65 (13.8) |
25 (6.3) |
5 (3.0) |
20 (8.7) |
|
Streptococcus spp. |
22 (4.7) |
9 (2.3) |
2 (1.2) |
7 (3.0) |
|
Enterocococcus spp. |
3 (0.6) |
0 (0) |
0 (0) |
0 (0) |
|
Hemophilus influenzae* |
57 (12.1) |
29 (7.4) |
15 (9.1) |
14 (6.1) |
|
Klebsiella pneumoniae |
16 (3.4) |
8 (2.0) |
3 (1.8) |
5 (2.2) |
|
Escherichia coli |
23 (4.9) |
10 (2.5) |
2 (1.2) |
8 (3.5) |
|
Enterobacteriaceae spp.* |
11 (2.3) |
2 (0.5) |
1 (0.6) |
1 (0.4) |
|
Serratia marescens |
3 (0.6) |
1 (0.3) |
0 (0) |
1 (0.4) |
|
Proteus mirabilis |
7 (1.5) |
1 (0.3) |
0 (0) |
1 (0.4) |
|
Pseudomonas aeruginosa |
13 (2.8) |
14 (3.6) |
5 (3.0) |
9 (3.9) |
|
Legionella pneumophila* |
1 (0.2) |
9 (2.3) |
5 (3.0) |
4 (1.7) |
|
Mycoplasma pneumoniae |
0 (0) |
0 (0) |
0 (0) |
0 (0) |
|
Chlamydia pneumoniae |
0 (0)) |
2 (0.5) |
0 (0) |
2 (0.9) |
|
Mycobacterium tuberculosis£ |
3 (0.6) |
6 (1.5) |
5 (3.0) |
1 (0.4) |
|
Aspergillus fumigatus |
0 (0) |
3 (0.8) |
2 (1.2) |
1 (0.4) |
| Viruses* |
6 (1.3) |
15 (3.8) |
7 (4.3) |
8 (3.5) |
| Other |
6 (1.3) |
6 (1.5) |
1 (06) |
5 (2.2) |
| Multiple organisms* |
62 (13.2) |
22 (5.6) |
8 (4.9) |
14 (6.1) |
| None identified* |
182 (38.6) |
207 (52.5) |
77 (47.0) |
130 (56.5) |
| Bacteremia* |
74 (15.7) |
42 (10.7) |
15 (9.1) |
27 (11.7) |
|
Acquisition of MDR pathogens or nosocomial pneumonia, n (%) | ||||
| MDR bacteria |
52 (11.0) |
44 (11.2) |
19 (11.6) |
25 (10.9) |
| MRSA |
12 (2.5) |
12 (3.0) |
5 (3.0) |
7 (3) |
|
Enterobacteriaceae ESBL |
22 (4.7) |
12 (3.0) |
5 (3.0) |
7 (3) |
| Nonfermentative GNB |
25 (5.3) |
25 (6.3) |
14 (8.5) |
11 (4.8) |
|
Clostridium difficile |
6 (1.3) |
2 (0.5) |
0 (0) |
2 (0.9) |
| Nosocomial pneumonia |
58 (12.3) |
54 (13.7) |
23 (14) |
31 (13.5) |
|
ICU stay in days, median [IQR] |
6 [3; 15] |
7 [3; 16] |
7 [3.5; 15.5] |
8 [3; 17] |
|
Hospital stay in days, median [IQR] |
15 [8; 33] |
18 [10; 31] |
17.5 [10.5; 35] |
18 [9; 30] |
| Patients who died within 60 days, £ n (%) | 123 (26.1) | 107 (27.2) | 35 (21.3) | 72 (31.3) |
ESBL, extended-spectrum beta-lactamase; LOD, Logistic Organ Dysfunction Score; MDR, multidrug resistant; MRSA, methicillin-resistant Staphylococcus aureus; Nonfermentative GNB, nonfermentative Gram-negative bacilli (Pseudomonas spp., Acinetobacter baumannii, Stenotrophomonas maltophilia).
*P <0.05 for monotherapy (n = 471) versus dual therapy (n = 394); £P <0.05 for β-lactam + macrolide (n = 164) vs. β-lactam + fluoroquinolone (n = 230).