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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Continuous versus intermittent β-lactam infusion in severe sepsis: A meta-analysis of individual patient data from randomized trials
American Journal of Respiratory and Critical Care Medicine, Volume 194, No. 6, Year 2016
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Description
Rationale: Optimization of β-lactam antibiotic dosing for critically ill patients is an intervention that may improve outcomes in severe sepsis. Objectives: In this individual patient data meta-analysis of critically ill patients with severe sepsis, we aimed to compare clinical outcomes of those treated with continuous versus intermittent infusion of β-lactam antibiotics. Methods: We identified relevant randomized controlled trials comparing continuous versus intermittent infusion of β-lactam antibiotics in critically ill patients with severe sepsis. We assessed the quality of the studies according to four criteria. We combined individual patient data from studies and assessed data integrity for common baseline demographics and study endpoints, including hospital mortality censored at 30 days and clinical cure. We then determined the pooled estimates of effect and investigated factors associated with hospital mortality in multivariable analysis. Measurements and Main Results: We identified three randomized controlled trials in which researchers recruited a total of 632 patients with severe sepsis. The two groups were well balanced in terms of age, sex, and illness severity. The rates of hospital mortality and clinical cure for the continuous versus intermittent infusion groups were 19.6% versus 26.3% (relative risk, 0.74; 95% confidence interval, 0.56-1.00; P = 0.045) and 55.4% versus 46.3% (relative risk, 1.20; 95% confidence interval, 1.03-1.40; P = 0.021), respectively. In a multivariable model, intermittent β-lactam administration, higher Acute Physiology and Chronic Health Evaluation II score, use of renal replacement therapy, and infection by nonfermenting gram-negative bacilli were significantly associated with hospital mortality. Continuous β-lactam administration was not independently associated with clinical cure. Conclusions: Compared with intermittent dosing, administration of β-lactamantibioticsby continuous infusionincritically ill patientswith severe sepsis is associated with decreased hospital mortality. © Copyright 2016 by the American Thoracic Society.
Authors & Co-Authors
Roberts, Jason A.
Australia, Brisbane
Royal Brisbane and Women's Hospital
Australia, Brisbane
The University of Queensland
Davis, Joshua S.
Australia, Darwin
Charles Darwin University
Australia, Newcastle
John Hunter Hospital
Dulhunty, Joel M.
Australia, Brisbane
Royal Brisbane and Women's Hospital
Australia, Brisbane
The University of Queensland
Australia, Redcliffe
Redcliffe Hospital
Cotta, Menino Osbert
Australia, Brisbane
Royal Brisbane and Women's Hospital
Australia, Brisbane
The University of Queensland
Myburgh, John A.
Australia, Sydney
George Institute for Global Health
Australia, Sydney
Unsw Sydney
Bellomo, Rinaldo
Australia, Melbourne
Austin Hospital
Australia, Clayton
Monash University
Lipman, Jeffrey
Australia, Brisbane
Royal Brisbane and Women's Hospital
Australia, Brisbane
The University of Queensland
Statistics
Citations: 284
Authors: 7
Affiliations: 10
Identifiers
Doi:
10.1164/rccm.201601-0024OC
ISSN:
1073449X
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Study Approach
Systematic review