ArticleJAMA pediatrics2013
Less is more: combination antibiotic therapy for the treatment of gram-negative bacteremia in pediatric patients.
Article in JAMA pediatrics, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
15 citing papers in PubMed, 2 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.Intensive care medicine · 2020Guideline
- Reviewing the WHO guidelines for antibiotic use for sepsis in neonates and children.Paediatrics and international child health · 2018Pooled it
- Real-world outcomes and safety of colistin therapy in children with multidrug-resistant gram-negative infections: a nine-year experience.European journal of pediatrics · 2026Article
- "Dusting Off the Cobwebs": Rethinking How We Use New Antibiotics.Antibiotics (Basel, Switzerland) · 2025Review
- Numbers and narratives: how qualitative methods can strengthen the science of paediatric antimicrobial stewardship.JAC-antimicrobial resistance · 2022Review
- Characteristics and Outcomes of Bloodstream Infections in a Tertiary-Care Pediatric Hematology-Oncology Unit: A 10-Year Study.Journal of clinical medicine · 2022Article
- Antibiotics in critically ill children-a narrative review on different aspects of a rational approach.Pediatric research · 2022Review
- Which Type of Empiric Antibiotic Therapy is Appropriate? A 20-Year Retrospective Study of Bloodstream Infections in Childhood Cancer.Infectious diseases and therapy · 2021Article
- Aminoglycoside use in paediatric febrile neutropenia - Outcomes from a nationwide prospective cohort study.PloS one · 2020Article
- Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors: a retrospective cohort study.American journal of infection control · 2019Article
- Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child: A case report.Medicine · 2017Article
- Previous aminoglycoside use and acute kidney injury risk in non-critically ill children.Pediatric nephrology (Berlin, Germany) · 2017Article
- Aminoglycoside use in a pediatric hospital: there is room for improvement-a before/after study.European journal of pediatrics · 2016Article
- Low-dose Gentamicin for Uncomplicated Enterococcus faecalis Bacteremia May be Nephrotoxic in Children.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2015Observational
- Determinants of Blood Culture Use in Critically Ill Children: A Multicenter Qualitative Study.Pediatric quality & safetyArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
importanceDefinitive combination antibiotic therapy with a β-lactam and an aminoglycoside for the treatment of gram-negative bacteremia is commonly prescribed in pediatric patients; however, its efficacy and toxicity relative to β-lactam monotherapy are unknown.
objectiveTo determine whether definitive combination antibiotic therapy affects mortality and nephrotoxicity in pediatric patients with gram-negative bacteremia. DESIGN, SETTING, AND
participantsRetrospective cohort study including pediatric patients (aged ≤18 years) with gram-negative bacteremia hospitalized at the Johns Hopkins Children's Center between 2002 and 2011. MAIN OUTCOMES AND MEASURES: Outcomes included 30-day mortality and nephrotoxicity classified according to the pediatric RIFLE (risk for renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage renal disease) criteria. To account for nonrandom assignment of combination therapy, propensity score weighting was combined with multivariable logistic regression to estimate the effect of combination therapy on mortality and nephrotoxicity.
resultsOf the 879 eligible pediatric patients with bacteremia, 537 (61.1%) received combination therapy. After propensity score adjustment, baseline demographic and clinical characteristics between the groups were well balanced. There was no association between combination therapy and 30-day mortality (odds ratio, 0.98; 95% CI, 0.93-1.02; P = .27). There were 170 patients (19.3%) with evidence of acute kidney injury, including 135 (25.1%) and 35 (10.2%) in the combination therapy and monotherapy arms, respectively. Patients receiving combination therapy had approximately twice the odds of nephrotoxicity compared with those receiving monotherapy (odds ratio, 2.15; 95% CI, 2.09-2.21). CONCLUSIONS AND RELEVANCE: The use of β-lactam monotherapy for gram-negative bacteremia in pediatric patients reduces subsequent nephrotoxicity without compromising survival.
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Registered trials
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