• Alejandro Rodríguez, Angel Mendia, Josep-María Sirvent, Fernando Barcenilla, María Victoria de la Torre-Prados, Jordi Solé-Violán, Jordi Rello, and CAPUCI Study Group.
• Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain.
• Crit. Care Med. 2007 Jun 1;35(6):1493-8.

ObjectiveTo assess whether combination antibiotic therapy improves outcome of severe community-acquired pneumonia in the subset of patients with shock.DesignSecondary analysis of a prospective observational, cohort study.SettingThirty-three intensive care units (ICUs) in Spain.PatientsPatients were 529 adults with community-acquired pneumonia requiring ICU admission.InterventionsNone.Measurement And Main ResultsTwo hundred and seventy (51%) patients required vasoactive drugs and were categorized as having shock. The effects of combination antibiotic therapy and monotherapy on survival were compared using univariate analysis and a Cox regression model. The adjusted 28-day in-ICU mortality was similar (p = .99) for combination antibiotic therapy and monotherapy in the absence of shock. However, in patients with shock, combination antibiotic therapy was associated with significantly higher adjusted 28-day in-ICU survival (hazard ratio, 1.69; 95% confidence interval, 1.09-2.60; p = .01) in a Cox hazard regression model. Even when monotherapy was appropriate, it achieved a lower 28-day in-ICU survival than an adequate antibiotic combination (hazard ratio, 1.64; 95% confidence interval, 1.01-2.64).ConclusionsCombination antibiotic therapy does not seem to increase ICU survival in all patients with severe community-acquired pneumonia. However, in the subset of patients with shock, combination antibiotic therapy improves survival rates.

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