Early combination antibiotic therapy yields improved survival compared with monotherapy in septic shock: a propensity-matched analysis.


BACKGROUND:Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broadening coverage when resistant pathogens are a concern. OBJECTIVE:To evaluate the therapeutic benefit of early combination therapy comprising at least two antibiotics of different mechanisms with in vitro activity for the isolated pathogen in patients with bacterial septic shock. DESIGN:Retrospective, propensity matched, multicenter, cohort study. SETTING:Intensive care units of 28 academic and community hospitals in three countries between 1996 and 2007. SUBJECTS:A total of 4662 eligible cases of culture-positive, bacterial septic shock treated with combination or monotherapy from which 1223 propensity-matched pairs were generated. MEASUREMENTS AND MAIN RESULTS:The primary outcome of study was 28-day mortality. Using a Cox proportional hazards model, combination therapy was associated with decreased 28-day mortality (444 of 1223 [36.3%] vs. 355 of 1223 [29.0%]; hazard ratio, 0.77; 95% confidence interval, 0.67-0.88; p = .0002). The beneficial impact of combination therapy applied to both Gram-positive and Gram-negative infections but was restricted to patients treated with beta-lactams in combination with aminoglycosides, fluoroquinolones, or macrolides/clindamycin. Combination therapy was also associated with significant reductions in intensive care unit (437 of 1223 [35.7%] vs. 352 of 1223 [28.8%]; odds ratio, 0.75; 95% confidence interval, 0.63-0.92; p = .0006) and hospital mortality (584 of 1223 [47.8%] vs. 457 of 1223 [37.4%]; odds ratio, 0.69; 95% confidence interval, 0.59-0.81; p < .0001). The use of combination therapy was associated with increased ventilator (median and [interquartile range], 10 [0-25] vs. 17 [0-26]; p = .008) and pressor/inotrope-free days (median and [interquartile range], 23 [0-28] vs. 25 [0-28]; p = .007) up to 30 days. CONCLUSION:Early combination antibiotic therapy is associated with decreased mortality in septic shock. Prospective randomized trials are needed.


Crit Care Med


Critical care medicine


Kumar A,Zarychanski R,Light B,Parrillo J,Maki D,Simon D,Laporta D,Lapinsky S,Ellis P,Mirzanejad Y,Martinka G,Keenan S,Wood G,Arabi Y,Feinstein D,Kumar A,Dodek P,Kravetsky L,Doucette S,Cooperative Antimicrobial Thera




Has Abstract


2010-09-01 00:00:00












  • Critical care for the severely ill head and neck patient.

    abstract:OBJECTIVE:To delineate the frequency and causes of admission to a critical care environment for patients undergoing head and neck surgery at Memorial Sloan-Kettering Cancer Center. DESIGN:Retrospective clinical investigation. SETTING:Adult intensive care unit of a tertiary referral cancer center. PATIENTS:All head a...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Downey RJ,Friedlander P,Groeger J,Kraus D,Schantz S,Spiro R,Strong E,Shaha A,Shah J

    更新日期:1999-01-01 00:00:00

  • Randomized Feasibility Trial of a Low Tidal Volume-Airway Pressure Release Ventilation Protocol Compared With Traditional Airway Pressure Release Ventilation and Volume Control Ventilation Protocols.

    abstract:OBJECTIVES:Low tidal volume (= tidal volume ≤ 6 mL/kg, predicted body weight) ventilation using volume control benefits patients with acute respiratory distress syndrome. Airway pressure release ventilation is an alternative to low tidal volume-volume control ventilation, but the release breaths generated are variable ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Hirshberg EL,Lanspa MJ,Peterson J,Carpenter L,Wilson EL,Brown SM,Dean NC,Orme J,Grissom CK

    更新日期:2018-12-01 00:00:00

  • Investigating conflict in ICUs-is the clinicians' perspective enough?

    abstract:OBJECTIVE:Most studies have assessed conflict between clinicians and surrogate decision makers in ICUs from only clinicians' perspectives. It is unknown if surrogates' perceptions differ from clinicians'. We sought to determine the degree of agreement between physicians and surrogates about conflict and to identify pre...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schuster RA,Hong SY,Arnold RM,White DB

    更新日期:2014-02-01 00:00:00

  • Biomarkers increase detection of active smoking and secondhand smoke exposure in critically ill patients.

    abstract:OBJECTIVES:The association between tobacco smoke exposure and critical illness is not well studied, largely because obtaining an accurate smoking history from critically ill patients is difficult. Biomarkers can provide quantitative data on active and secondhand cigarette smoke exposure. We sought to compare cigarette ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Hsieh SJ,Ware LB,Eisner MD,Yu L,Jacob P 3rd,Havel C,Goniewicz ML,Matthay MA,Benowitz NL,Calfee CS

    更新日期:2011-01-01 00:00:00

  • How Do You Feel? Subjective Perception of Recovery as a Reliable Surrogate of Cognitive and Functional Outcome in Cardiac Arrest Survivors.

    abstract:OBJECTIVES:To show that subjective estimate of patient's condition is related to objective cognitive and functional outcome in cardiac arrest survivors. DESIGN:Longitudinal cohort study. SETTING:ICU and Neuropsychology Service in two hospitals in Switzerland. PATIENTS:Fifty survivors included from a prospective coho...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Juan E,De Lucia M,Beaud V,Oddo M,Rusca M,Viceic D,Clarke S,Rossetti AO

    更新日期:2018-04-01 00:00:00

  • American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock.

    abstract:OBJECTIVES:The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shoc...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Davis AL,Carcillo JA,Aneja RK,Deymann AJ,Lin JC,Nguyen TC,Okhuysen-Cawley RS,Relvas MS,Rozenfeld RA,Skippen PW,Stojadinovic BJ,Williams EA,Yeh TS,Balamuth F,Brierley J,de Caen AR,Cheifetz IM,Choong K,Conway E Jr,Cor

    更新日期:2017-06-01 00:00:00

  • Private attending physician status and the withdrawal of life-sustaining interventions in a medical intensive care unit population.

    abstract:OBJECTIVE:To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within a medical intensive care unit (ICU). DESIGN:Retrospective cohort analysis. SETTING:An academic tertiary care center. PATIENTS:One hundred fifty-nine consecutive patie...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Kollef MH

    更新日期:1996-06-01 00:00:00

  • Sepsis-associated changes of the arachidonic acid metabolism and their diagnostic potential in septic patients.

    abstract:OBJECTIVES:Sepsis-associated changes of the arachidonic acid metabolism and the utility of arachidonic acid metabolites for the diagnosis of sepsis have been poorly investigated so far. Therefore, the primary objective of our study was to screen for differentially regulated arachidonic acid metabolites in septic patien...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Bruegel M,Ludwig U,Kleinhempel A,Petros S,Kortz L,Ceglarek U,Holdt LM,Thiery J,Fiedler GM

    更新日期:2012-05-01 00:00:00

  • Nonphysician transport of intubated pediatric patients: a system evaluation.

    abstract:OBJECTIVE:To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. DESIGN:Retrospective chart review. SETTING:A 600-bed...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Beyer AJ 3rd,Land G,Zaritsky A

    更新日期:1992-07-01 00:00:00

  • Theaflavin, a black tea extract, is a novel anti-inflammatory compound.

    abstract:OBJECTIVE:Tea has been around for centuries, and its medicinal properties have been purported in the literature but never fully confirmed. Interleukin-8 is a principle neutrophil chemoattractant and activator in humans. We determined the effects of theaflavin, a black tea-derived polyphenol, on tumor necrosis factor-al...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Aneja R,Odoms K,Denenberg AG,Wong HR

    更新日期:2004-10-01 00:00:00

  • External ventricular drainage. A technical note.

    abstract::The disadvantages of external ventricular drainage are the threat of sepsis and the nuisance of dislodging a precarious system in routine care. The experience of the authors with nearly 200 cases using a long ventricular catheter demonstrates that a subgaleal tunnel can be easily made for the ventricular catheter usin...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Saunders RL,Lyons TA

    更新日期:1979-12-01 00:00:00

  • Noninvasive positive-pressure ventilation in acute respiratory failure outside clinical trials: experience at the Massachusetts General Hospital.

    abstract:BACKGROUND:Noninvasive positive-pressure ventilation (NPPV) has been shown to be effective in select patients enrolled in clinical trials. However, few data are available on the use of NPPV as routine standard medical care for patients with respiratory failure outside of controlled trials. MEASUREMENTS AND MAIN RESULT...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schettino G,Altobelli N,Kacmarek RM

    更新日期:2008-02-01 00:00:00

  • Mechanical ventilation in fiberoptic-bronchoscopy: comparison between high frequency positive pressure ventilation and normal frequency positive pressure ventilation.

    abstract::High frequency positive pressure ventilation (HFPPV) was compared with normal frequency positive pressure ventilation (NFPPV) during diagnostic fiberoptic-bronchoscopy. HFPPV was achieved by a simple modification of the Minivent, and gave satisfactory alveolar ventilation and oxygenation. In all 11 patients and over p...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Flatau E,Lewinsohn G,Konichezky S,Lev A,Barzilay E

    更新日期:1982-11-01 00:00:00

  • Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital.

    abstract:OBJECTIVE:The benefit of continuous on-site presence by a staff academic critical care specialist in the intensive care unit of a teaching hospital is not known. We compared the quality of care and patient/family and provider satisfaction before and after changing the staffing model from on-demand to continuous 24-hr c...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章


    authors: Gajic O,Afessa B,Hanson AC,Krpata T,Yilmaz M,Mohamed SF,Rabatin JT,Evenson LK,Aksamit TR,Peters SG,Hubmayr RD,Wylam ME

    更新日期:2008-01-01 00:00:00

  • Guidelines for critical care medicine training and continuing medical education.

    abstract:OBJECTIVE:Critical care medicine trainees and faculty must acquire and maintain the skills necessary to provide state-of-the art clinical care to critically ill patients, to improve patient outcomes, optimize intensive care unit utilization, and continue to advance the theory and practice of critical care medicine. Thi...

    journal_title:Critical care medicine

    pub_type: 指南,杂志文章,实务指引


    authors: Dorman T,Angood PB,Angus DC,Clemmer TP,Cohen NH,Durbin CG Jr,Falk JL,Helfaer MA,Haupt MT,Horst HM,Ivy ME,Ognibene FP,Sladen RN,Grenvik AN,Napolitano LM,American College of Critical Care Medicine.

    更新日期:2004-01-01 00:00:00

  • Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn.

    abstract:OBJECTIVE:We previously reported improved oxygenation, but no change, in rates of extracorporeal membrane oxygenation (ECMO) use or death among infants with persistent pulmonary hypertension of the newborn who received inhaled nitric oxide (NO) with conventional ventilation, irrespective of lung disease. The goal of ou...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Christou H,Van Marter LJ,Wessel DL,Allred EN,Kane JW,Thompson JE,Stark AR,Kourembanas S

    更新日期:2000-11-01 00:00:00

  • Predictors of patients who present to the emergency department with sepsis and progress to septic shock between 4 and 48 hours of emergency department arrival.

    abstract:OBJECTIVES:Approximately one in every four patients who present to the emergency department with sepsis progresses to septic shock within 72 hours of arrival. In this study, we describe key patient characteristics present within 4 hours of emergency department arrival that are associated with developing septic shock be...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Capp R,Horton CL,Takhar SS,Ginde AA,Peak DA,Zane R,Marill KA

    更新日期:2015-05-01 00:00:00

  • Continuous breathing circuit flow and tracheal tube cuff leak: sources of error during pediatric indirect calorimetry.

    abstract:OBJECTIVE:To determine whether continuous gas flow in the breathing circuit or an airleak around the tracheal tube cuff will introduce errors into the measurement of oxygen consumption (VO2) with indirect calorimetry. DESIGN:Nonrandomized, controlled trial. SETTING:Experimental laboratory. SUBJECTS:Ten healthy, anes...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Räsänen J

    更新日期:1992-09-01 00:00:00

  • Nalbuphine reversal of respiratory depression after epidural sufentanil.

    abstract::The use of epidural opioids for postoperative analgesia has been associated with respiratory depression. This report demonstrates the ability of nalbuphine to rapidly reverse the respiratory depression caused by epidural sufentanil while maintaining postoperative pain relief. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Cheng EY,May J

    更新日期:1989-04-01 00:00:00

  • Circadian rhythm of blood glucose values in critically ill patients.

    abstract:OBJECTIVE:To test whether there is a circadian rhythm of blood glucose control in critically ill patients and whether morning blood glucose is an accurate surrogate of overall blood glucose control. DESIGN:Retrospective multiple-center observational study. SETTING:Intensive care units of three tertiary hospitals and ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Egi M,Bellomo R,Stachowski E,French CJ,Hart G,Stow P

    更新日期:2007-02-01 00:00:00

  • Funding resuscitation research.

    abstract::The present trend in managed care has meant downsizing expectations concerning the availability of support for resuscitation research. This trend applies to funding possibilities from industry, governmental agencies, and nongovernmental agencies (Table 1). There will be increasing barriers to making innovations. Truth...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Thompson WL,Bellamy R,Cummins RO,Delooz HH,Dick W,Kochanek PM,Ornato JP,Ricci EM,Weil MH,Winter PM

    更新日期:1996-02-01 00:00:00

  • Neuronal nitric oxide synthase and its interaction with soluble guanylate cyclase is a key factor for the vascular dysfunction of experimental sepsis.

    abstract:OBJECTIVE:Vascular dysfunction plays a central role in sepsis, and it is characterized by hypotension and hyporesponsiveness to vasoconstrictors. Nitric oxide is regarded as a central element of sepsis vascular dysfunction. The high amounts of nitric oxide produced during sepsis are mainly derived from the inducible is...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Nardi GM,Scheschowitsch K,Ammar D,de Oliveira SK,Arruda TB,Assreuy J

    更新日期:2014-06-01 00:00:00

  • Mechanical ventilators optimized for pediatric use decrease work of breathing and oxygen consumption during pressure-support ventilation.

    abstract:OBJECTIVES:a) To investigate whether the patient work of breathing needed to trigger inspiration is affected by the type of ventilator delivering pressure-support ventilation for mechanically ventilated pediatric patients. b) To determine whether changes in oxygen consumption (VO2) trend with changes in work of breathi...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: el-Khatib MF,Chatburn RL,Potts DL,Blumer JL,Smith PG

    更新日期:1994-12-01 00:00:00

  • Noninvasive PtcO2 initial slope index and invasive PtcO2 arterial index as diagnostic criterion of the state of peripheral circulation.

    abstract::Transcutaneous PO2 (PtcO2), PaO2, PtcO2 arterial index (ARI; PtcO2/PaO2), and the initial slope index (ISI; [delta PO2/min]/starting PtcO2) were measured in 42 healthy volunteers, 12 patients with stable circulation and respiratory insufficiency, and ten patients with insufficient peripheral circulation in cardiogenic...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lemke R,Klaus D,Lübbers DW,Oevermann G

    更新日期:1988-04-01 00:00:00

  • Mechanical influences on the capnogram.

    abstract::We found that altering aspirating flow rate (ASR) and sample tubing length (STL) affected the response time and capnogram of 2 different side-stream capnometers. Increased flow rate shortened rise time, transit time, and total delay time (TDT), whereas increased STL increased transit and TDTs but not rise time. Increa...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schena J,Thompson J,Crone RK

    更新日期:1984-08-01 00:00:00

  • Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life.

    abstract:OBJECTIVE:To describe the long-term health-related quality of life (HRQL) of survivors of sepsis and to evaluate the reliability and validity of the medical outcomes study Short Form-36 (SF-36) in this population. STUDY DESIGN:Cross-sectional survey. SETTING:University intensive care unit. PATIENTS:Surviving patient...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Heyland DK,Hopman W,Coo H,Tranmer J,McColl MA

    更新日期:2000-11-01 00:00:00

  • Up-regulation of the parathyroid calcium-sensing receptor after burn injury in sheep: a potential contributory factor to postburn hypocalcemia.

    abstract:OBJECTIVE:To test the hypothesis that the hypocalcemia and hypoparathyroidism that follow severe burn injury are related to up-regulation of the parathyroid gland calcium-sensing receptor (CaR), which may reduce the set-point for suppression of circulating parathyroid hormone by blood calcium. DESIGN:A controlled but ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Murphey ED,Chattopadhyay N,Bai M,Kifor O,Harper D,Traber DL,Hawkins HK,Brown EM,Klein GL

    更新日期:2000-12-01 00:00:00

  • Mechanisms of sepsis-induced cardiac dysfunction.

    abstract:OBJECTIVES:To review mechanisms underlying sepsis-induced cardiac dysfunction in general and intrinsic myocardial depression in particular. DATA SOURCE:MEDLINE database. DATA SYNTHESIS:Myocardial depression is a well-recognized manifestation of organ dysfunction in sepsis. Due to the lack of a generally accepted defi...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Rudiger A,Singer M

    更新日期:2007-06-01 00:00:00

  • Severe acute respiratory syndrome and critical care medicine: the Toronto experience.

    abstract:BACKGROUND:The 2003 global outbreak of severe acute respiratory syndrome (SARS) provided numerous challenges to the delivery of critical care. The Toronto critical care community has learned important lessons from SARS, which will help in preparation for future disease outbreaks. OBJECTIVES:The objectives of this stud...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Booth CM,Stewart TE

    更新日期:2005-01-01 00:00:00

  • Economic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the Dressing Study.

    abstract:BACKGROUND:The randomized two-way factorial Dressing Study (1,636 patients, 28,931 catheter days) showed that a chlorhexidine-impregnated sponge decreased the incidence of major catheter-related infections from 1.4‰ to 0.6‰ catheter days, and that scheduled dressing changes every 7 days was not inferior to scheduled ch...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Schwebel C,Lucet JC,Vesin A,Arrault X,Calvino-Gunther S,Bouadma L,Timsit JF

    更新日期:2012-01-01 00:00:00