BACKGROUND: The routine use of empiric combination therapy with aminoglycosides during critical illness is associated with uncertain benefit and increased risk of acute kidney injury. This study aimed to assess the benefits of aminoglycosides in immunocompromised patients with suspected bacterial pneumonia and sepsis. METHODS: Secondary analysis of a prospective multicenter study. Adult immunocompromised patients with suspected bacterial pneumonia and sepsis or septic shock were included. Primary outcome was hospital mortality. Secondary outcomes were needed for renal replacement therapy (RRT). Mortality was also assessed in neutropenic patients and in those with confirmed bacterial pneumonia. Results were further analyzed in a cohort matched on risk of receiving aminoglycosides combination. RESULTS: Five hundred thirty-five patients were included in this analysis, of whom 187 (35%) received aminoglycosides in addition to another antibiotic effective against gram-negative bacteria. Overall hospital mortality was 59.6% (58.3% vs. 60.3% in patients receiving and not receiving combination therapy; P = 0.71). Lack of association between mortality and aminoglycosides was confirmed after adjustment for confounders and center effect (adjusted OR 1.14 [0.69-1.89]) and in a propensity matched cohort (adjusted OR = 0.89 [0.49-1.61]). No association was found between aminoglycosides and need for RRT (adjusted OR = 0.83 [0.49-1.39], P = 0.477), nor between aminoglycoside use and outcome in neutropenic patients or in patients with confirmed bacterial pneumonia (adjusted OR 0.66 [0.23-1.85] and 1.25 [0.61-2.57], respectively). CONCLUSION: Aminoglycoside combination therapy was not associated with hospital mortality or need for renal replacement therapy in immunocompromised patients with pulmonary sepsis.

Agostino Gemelli University Hospital Università Cattolica del Sacro Cuore Rome Italy

Anesthesiology Department CHU Nîmes University of Nîmes Montpellier Nîmes France

Centro de Investigación Biomédica en Red en enfermedades respiratorias Instituto Salud Carlos 3 Barcelona Spain

Department of Anesthesiology and Intensive Care Medicine and Institute for Medical Humanities 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

Department of Critical Care King's College Hospital NHS Foundation Trust London UK

Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Intensive Care Hôpital Erasme Université Libre de Bruxelles Brussels Belgium

Department of Intensive Care Hospital Copa d'Or Rio de Janeiro Brazil

Department of Intensive Care Hospital Santa Rita Santa Casa de Misericordia Porte Allegre Brazil

Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization and Department of Clinical Medicine Trinity College Wellcome Trust HRB Clinical Research Facility St James Hospital Dublin Ireland

Department of Medical Intensive Care Medicine University Hospital of Angers Angers France

Department of Medicine and Interdepartmental Division of Critical Care Medicine Sinai Health System University of Toronto Toronto ON Canada

Division of Pulmonary and Critical Care Penn State University College of Medicine Hershey Pennsylvania

Infectious Area Vall d'Hebron Institute of Research Barcelona Spain

Medical ICU Nantes University Hospital Nantes France

Medical Intensive Care Unit APHP Hôpital Cochin and University Paris Descartes Paris France

Medical Intensive Care Unit APHP Hôpital Saint Louis Famirea Study Group ECSTRA team and Clinical Epidemiology UMR 1153 Center of Epidemiology and Biostatistics Sorbonne Paris Cité CRESS INSERM Paris Diderot Sorbonne University Paris France

Medical Intensive Care Unit La Source Hospital CHR Orléans Orléans France

Medical Intensive Care Unit Montpellier University Hospital Montpellier France

Medical Surgical ICU Paoli Calmette Institute Marseille France

Medical Surgical Intensive Care Unit Andre Mignot Hospital Versailles France

Pulmonary and Critical Care Medicine Mayo Clinic Rochester Minnesota

The Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands

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