• J W Timotëus Deelen, W C Rottier, A G M Buiting, J W Dorigo-Zetsma, KluytmansJ A J WJAJWLaboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands., P D van der Linden, ThijsenS F TSFTDepartment of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the Netherlands., B J M Vlaminckx, A J L Weersink, H S M Ammerlaan, BontenM J MMJMJulius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands., and C H van Werkhoven.
• Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands. Electronic address: j.w.t.deelen@umcutrecht.nl.
• Clin. Microbiol. Infect. 2021 Feb 1; 27 (2): 269-275.

ObjectiveShort-course aminoglycosides as adjunctive empirical therapy to β-lactams in patients with a clinical suspicion of sepsis are used to broaden antibiotic susceptibility coverage and to enhance bacterial killing. We quantified the impact of this approach on 30-day mortality in a subset of sepsis patients with a Gram-negative bloodstream infection.MethodsFrom a prospective cohort study conducted in seven hospitals in the Netherlands between June 2013 and November 2015, we selected all patients with Gram-negative bloodstream infection (GN-BSI). Short-course aminoglycoside therapy was defined as tobramycin, gentamicin or amikacin initiated within a 48-hour time window around blood-culture obtainment, and prescribed for a maximum of 2 days. The outcome of interest was 30-day all-cause mortality. Confounders were selected a priori for adjustment using a propensity score analysis with inverse probability weighting.ResultsA total of 626 individuals with GN-BSI who received β-lactams were included; 156 (24.9%) also received aminoglycosides for a median of 1 day. Patients receiving aminoglycosides more often had septic shock (31/156, 19.9% versus 34/470, 7.2%) and had an eight-fold lower risk of inappropriate treatment (3/156, 1.9% versus 69/470, 14.7%). Thirty-day mortality was 17.3% (27/156) and 13.6% (64/470) for patients receiving and not receiving aminoglycosides, respectively; yielding crude and adjusted odds ratios for 30-day mortality for patients treated with aminoglycosides of 1.33 (95% CI 0.80-2.15) and 1.57 (0.84-2.93), respectively.ConclusionsShort-course adjunctive aminoglycoside treatment as part of empirical therapy with β-lactam antibiotics in patients with GN-BSI did not result in improved outcomes, despite better antibiotic coverage of pathogens.Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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