Early use of combination antibiotics improves survival for patients with septic shock
Early use of combined antibacterial therapy improves the survival of patients with septic shock in the intensive care unit and the intensive care unit (ICU).
Septic shock is the leading cause of death associated with infections in intensive care and intensive care (ICU) patients. The results of numerous studies have shown that the appointment of adequate antibacterial therapy (ABT) can reduce mortality in patients with serious and potentially fatal infections and sepsis. Adequate ABT means appointing at least one antibiotic to the patient to whom the selected pathogen is sensitive. At the same time, information on the comparative efficacy in such cases of combined ABT versus monotherapy is contradictory, and it has not yet been established whether starting combined ABT improves treatment results for patients with septic shock. Existing standards for the management of patients with sepsis and septic shock recommended the use of combined ABT only in the event of infection, likely caused by a resistant pathogen.
A team of researchers led by a renowned intensive care specialist, Dr. A. Kumar, conducted a retrospective cohort study from 1996 to 2007 in 28 intensive care units to determine the presence or absence of the benefits of early use of the ABT combination to improve the survival of patients with sepsis. shock compared to monotherapy.
The study analyzed 4662 microbiologically confirmed cases of bacterial septic shock in patients receiving a starting mono- or combined ABT. From these cases, 1223 case-control pairs were created which were equivalent for all prognostic factors of mortality, which made it possible to compare the effect of combined ABT and monotherapy on patient survival.
In this study, the 28-day mortality rate was considered the main result analyzed. Analyzed using Cox's proportional risk model, it turned out that, compared to monotherapy, combined ABT causes a reduction in mortality rates at 28 days (36.3% vs 29.0%; risk ratio - RR = 0.77; 95% confidence interval - CI 0.67 to 0.88; p = 0.0002). The benefits of combined ABT have been noted in infections caused by Gram positive and Gram negative microorganisms; however, they only occurred with the appointment of a combined ABT, which included β-lactams in combination with aminoglycosides, fluoroquinolones, macrolides or clindamycin. Combined ABT also led to a reduction in the mortality of ICU patients (28.8% vs 35.7%; RR = 0.75; 95% CI 0.63-0, 92; p = 0.0006) and hospital mortality (37.4% vs 47.8%; RR = 0.69; 95% CI 0.59-0.81; p less than 0.0001). In the group of patients receiving a combined ABT, there was a significant increase in the number of days without mechanical ventilation (17 vs 10; p = 0.008) and days without inotropic support (25 vs 23; p = 0.007) for a period of 30 days.
Based on the results, the authors conclude that early use of combined antibiotic therapy improves the survival of patients with septic shock. To confirm the results obtained, prospective randomized clinical trials are necessary.