Clinical Outcomes of combination antimicrobial therapy in Patients with biofilm-associated infection

Divya Nair; S. Rao; V. Kapoor

doi:10.5281/zenodo.22812793

Authors

Divya Nair Department of Medical Microbiology, Tigris Academy of Medical Microbiology Author https://orcid.org/6787-1717-9440-3289
S. Rao Division of Clinical Bacteriology, Godavari Institute for Advanced Medical Microbiology Author https://orcid.org/4318-9229-8691-4241
V. Kapoor Division of Clinical Bacteriology, Ob Institute for Advanced Medical Microbiology Author https://orcid.org/5017-0796-0014-1066

DOI:

https://doi.org/10.5281/zenodo.22812793

Keywords:

biofilm, combination therapy, antimicrobial resistance, device-associated infection, clinical outcomes

Abstract

Graphical abstract

Background: Biofilm formation is a major driver of treatment failure in chronic and device-associated bacterial infections, and combination antimicrobial regimens are increasingly used to overcome the reduced antibiotic penetration and heightened tolerance that biofilms confer.

Objective: This study evaluated clinical outcomes of combination antimicrobial therapy compared with monotherapy in patients with culture-confirmed biofilm-associated infection.

Methods: We conducted a retrospective cohort analysis of adult patients with biofilm-associated infections, including prosthetic joint infection, catheter-related bloodstream infection, and chronic wound infection, comparing clinical cure, relapse, and time to resolution between combination and monotherapy groups.

Results: Combination therapy was associated with a higher rate of clinical cure and a lower rate of relapse at 90 days than monotherapy, with the largest absolute benefit observed in prosthetic-device-associated infections and in regimens that paired a biofilm-active agent such as rifampicin with a companion antibiotic.

Conclusions: Combination antimicrobial therapy improves clinical outcomes in biofilm-associated infection relative to monotherapy, supporting its use particularly where source control is incomplete or a retained device cannot be removed.

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