***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract . Objective : To compare clinical and bacteriological efficacy as well as tolerability of two regimens of broad-spectrum antibiotics ( ceftazidime versus piperacillin/tazobactam ) combined with amikacin in the treatment of nosocomial pneumonia in intensive care patients . Design : Open label , prospect i ve , multicenter , and r and omized phase III clinical trial . Setting : Medical or surgical intensive care units ( ICUs ) of nine acute-care teaching hospitals in Spain . Patients and participants : One hundred and twenty-four ICU patients with nosocomial pneumonia and requiring mechanical ventilation were included . They were r and omized to receive amikacin ( 15 mg/day divided into two doses ) combined with either piperacillin ( 4 g every 6 h ) and tazobactam ( 0.5 g every 6 h ) ( n = 88 ) or ceftazidime ( 2 g every 8 h ) ( n = 36 ) . Measurements and results : The causative pathogen was determined in 60.2 % of patients in the group of amikacin plus piperacillin/tazobactam and in 76.9 % in the group of amikacin plus ceftazidime . A total of 94 bacterial organisms were isolated among which gram-negative bacilli predominated , Pseudomonas aeruginosa being the most frequent . Clinical response at the end of antibiotic therapy was considered satisfactory ( cure and /or improvement ) in 63.9 % of patients in the amikacin plus piperacillin/tazobactam group and in 61.5 % in the amikacin plus ceftazidime ( odds ratio 1.1 ; 95 % confidence interval 0.44–2.75 ) . Eradication or presumptive eradication rates for each pathogen and for either gram-negative or gram-positive bacteria were similar in both antibiotic combinations ( odds ratio 1.2 ; 95 % confidence interval 0.39–3.66 ) . A total of 21 adverse effects ( 23.9 % ) occurred in the amikacin plus piperacillin and tazobactam group and six ( 16.7 % ) in the amikacin plus ceftazidime group , thrombocytosis , renal dysfunction , and hepatic cytolysis being the most common . The efficacy and tolerability of the two therapeutic regimens were similar not only in the whole study population , but also in the subset of P. aeruginosa-related pneumonia ( odds ratio 1 ; 95 % confidence interval 0.08–13.37 ) . Conclusions : Amikacin associated with either ceftazidime or piperacillin and tazobactam has shown comparable efficacy and tolerability in the treatment of ICU patients with nosocomial pneumonia An open , r and omized , multicenter study was conducted to compare the efficacy and safety of piperacillin/tazobactam and co-amoxiclav plus aminoglycoside in the treatment of hospitalized patients with severe community-acquired or nosocomial pneumonia . Of the 89 patients who entered the study , 84 ( 94 % ) were clinical ly evaluable . A favorable clinical response was observed in 90 % of the piperacillin/ tazobactam group and in 84 % of the co-amoxiclav/aminoglycoside group ( not significant ) . The bacteriological efficacy was comparable in both groups ( 96 % vs. 92 % ; not significant ) . There was only one fatal outcome in the piperacillin/tazobactam group compared to six in the co-amoxiclav/aminoglycoside group regimenP=0.058 ) . The adverse event rate was non-significantly lower in the piperacillin/ tazobactam group compared to the co-amoxiclav/aminoglycoside group ( 2 % vs. 7%;P=0.32 ) . Piperacillin/tazobactam is safe and highly efficacious in the treatment of serious pneumonia in hospitalized patients . It compares favorably with the combination of co-amoxiclav/aminoglycoside The aim of the present study was to test whether the combination of a beta-lactam drug plus an aminoglycoside has advantage over monotherapy for severe gram-negative infections . Of 2,124 patients with gram-negative bacteremia surveyed prospect ively , 670 were given inappropriate empirical antibiotic treatment  and the mortality rate in this group was 34 % , whereas the mortality rate was 18 % for 1,454 patients given appropriate empirical antibiotic treatment  ( P = 0.0001 ) . The mortality rates for patients given appropriate empirical antibiotic treatment  were 17 % for 789 patients given a single beta-lactam drug  , 19 % for 327 patients given combination treatment  , 24 % for 249 patients given a single aminoglycoside  , and 29 % for 89 patients given other antibiotics ( P = 0.0001 ) . When patients were stratified according to risk factors for mortality other than antibiotic treatment , combination therapy showed no advantage over treatment with a single beta-lactam drug except for neutropenic patients ( odds ratio [ OR ] for mortality , 0.5 ; 95 % confidence interval [ 95 % CI ] , 0.2 to 1.3 ) and patients with Pseudomonas aeruginosa bacteremia ( OR , 0.7 ; 95 % CI , 0.3 to 1.8 ) . On multivariable logistic regression analysis including all risk factors for mortality , combination therapy had no advantage over therapy with a single beta-lactam drug . The mortality rate for patients treated with a single appropriate aminoglycoside was higher than that for patients given a beta-lactam drug in all strata except for patients with urinary tract infections . When the results of blood cultures were known , 1,878 patients were available for follow-up . Of these , 816 patients were given a single beta-lactam drug , 442 were given combination treatment , and 193 were given a single aminoglycoside . The mortality rates were 13 , 15 , and 23 % , respectively ( P = 0.0001 ) . Both on stratified and on multivariable logistic regression analyses , combination treatment showed a benefit over treatment with a single beta-lactam drug only for neutropenic patients ( OR , 0.2 ; 95 % CI , 0.05 to 0.7 ) . In summary , combination treatment showed no advantage over treatment with an appropriate beta-lactam drug in nonneutropenic patients with gram-negative bacteremia Ninety-four cases of pyelonephritis including 20 who had concurrent bacteremia were treated with cefam and ole alone or in combination with either gentamicin or tobramycin . Doses of cefam and ole ranged from 1 - -2 g by intermittent intravenous ( VI ) infusion every 4 to 8 h ; gentamicin and tobramycin doses ranged from 1 - -1.7 mg/kg every 8 h also by intermittent IV infusion . Duration of therapy ranged from 5 to 23 days ( mean 7.3 days ) . Both single and combination therapy successfully treated acute pyelonephritis and bacteremia in all patients . Seven strains of E. coli and one of Klebsiella pneumoniae responsible for initial infection were resistant to cephalothin but sensitive to cefam and ole .  Relapse with cefam and ole sensitive bacteria occurred in 27 % of patients receiving only cefam and ole and 8 % of those patients receiving combination therapy . Reinfection with cefam and ole resistant organisms , predominantly Pseudomonas aeruginosa occurred in five patients . One patient had an intrarenal abscess due to E. coli which was successfully treated with 23 days of cefam and ole . One patient died . However , death was due to acute pulmonary embolism , not infection . None of the patients receiving cefam and ole plus gentamicin or tobramycin experienced a significant decrease in creatinine clearance during or after therapy . Skin rash , mild thrombophlebitis at the IV site and transient elevation of alkaline phosphatase and SGOT were the only side effects noted A prospect i ve , r and omized clinical trial was conducted to compare the efficacy of piperacillin/tazobactam and amikacin combination with carbapenem monotherapy for the empirical treatment of febrile neutropenic episodes of children with acute lymphoblastic leukemia or acute myeloblastic leukemia . Patients aged 2–16 years with hematological malignancies who had febrile neutropenia were r and omly assigned to receive piperacillin/tazobactam ( 80 mg/kg piperacillin/10 mg/kg tazobactam , q6h ) combined with amikacin ( PTA ) ( 7.5 mg/kg , q12h ) or meropenem or imipenem ( 20 mg/kg , q8h ) ( C ) . Response to antimicrobial therapy , evaluated for etiological agents , was measured . Duration of fever , neutropenia , and hospitalization , mortality , and the need for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups . Out of 87 febrile neutropenic episodes that were evaluable for comparison , 46 patients received PTA and 41 patients were treated with carbapenems ( imipenem or meropenem ) . Overall , the microbiologically documented infection rate was 21.9 % , with Staphylococcus epidermidis as the most common cause of bacteremia . The rate of treatment modification was 56.5 % in the PTA group and 53.6 % in the carbapenem group with no statistical difference ( p > . 05 ) . There was no infection-related mortality during the study period . There was no difference between the two regimens for duration s of fever , neutropenia , and hospitalization ( p > . 05 for all categories ) . PTA was as effective as carbapenem monotherapy as an initial empirical regimen in febrile neutropenic episodes of pediatric hematological malignancies Pneumonia accounts for 15 % of all nosocomial infections , and mortality case rates are as high as 60 % . Aspiration of oropharyngeal flora is the most common antecedent to nosocomial pneumonia . Patients with chronic lung disease , depressed levels of consciousness , or who are intubated are at increased risk of developing pneumonia . We conducted two comparative , prospect i ve studies using monotherapy with third-generation cephalosporins -- the first comparing cefoperazone with combination therapy , and the second comparing cefoperazone monotherapy with ceftazidime monotherapy -- for the treatment of nosocomial pneumonia in mildly to moderately ill patients . We found that both cefoperazone monotherapy and ceftazidime monotherapy were as effective as st and ard two-drug combinations  ( clindamycin/gentamicin or cefazolin/gentamicin ) . When total antibiotic costs were compared , cefoperazone monotherapy was the least expensive regimen To evaluate the cost-effectiveness of cefotaxime sodium at a dosage of 12 g/day vs nafcillin sodium and tobramycin sulfate for the treatment of serious infection , the hospital and physician charges of patients enrolled in a prospect i ve , r and omized , clinical trial were analyzed . For 187 patients receiving therapy empirically , mean hospital charges for the interval in which the trial antibiotics were used were $ 3,550 + /- $ 1,740 for cefotaxime and $ 3,160 + /- $ 1,990 for nafcillin and tobramycin . After adjusting for cost-generating factors , charges for cefotaxime were greater than for nafcillin and tobramycin , but the difference was not significant . For 107 patients with clinical ly or bacteriologically documented infection , mean charges were $ 3,980 + /- $ 1,800 for cefotaxime and $ 4,170 + /- $ 1,780 for nafcillin and tobramycin . Adjusted charges did not differ . Incremental charges for cefotaxime per additional response were $ 1,630 in all patients and -$820 in patients with clinical ly or bacteriologically documented infections We compared the efficacy of ceftazidime and cefazolin in combination with tobramycin in the treatment of lower respiratory tract infections .  Bacterial pathogens were isolated from sputum or bronchial secretions from 92 patients . The clinical results were identical in both groups : All patients showed an improvement of the clinical symptoms or were cured . 88 % of the patients in the ceftazidime-group and 76 % of the patients in the cefazolin/tobramycin-group showed an eradication of the pathogens without superinfection . This difference was not statistically significant ( p = 0.095 ) . Monotherapy with ceftazidime was clinical ly and bacteriologically as effective as a combination therapy with cefazolin and tobramycin A multicentre , open , r and omised , parallel group study was carried out to assess the efficacy and safety of meropenem monotherapy versus the combination of ceftazidime plus amikacin in the treatment of serious bacterial infections . Adult , hospitalised patients ( n = 237 ) were included if they had infections at one or more of the following sites : lower respiratory tract ( 89 community- 
    Output:
    
No significant disparities emerged from subgroup and sensitivity analyses , including assessment of participants with Gram-negative infection .
The subgroup of Pseudomonas aeruginosa infections was underpowered to examine effects .
All-cause mortality rates are unchanged .
Combination treatment carries a significant risk of nephrotoxicity