The following is a summary of “Prolonged vs intermittent intravenous infusion of β-lactam antibiotics for patients with sepsis: a systematic review of randomized clinical trials with meta-analysis and trial sequential analysis,” published in the December 2023 issue of Critical Care by Li et al.

Prolonged β-lactam antibiotic infusion has gained traction for severe infections due to its ability to maintain stable drug levels and prolong the time above the minimum inhibitory concentration (MIC).

Researchers conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized clinical trials (RCTs) to compare the efficacy and safety of prolonged versus intermittent intravenous infusion of β-lactam antibiotics for patients with sepsis.

They registered the PROSPERO database (CRD42023447692). Eligible studies were identified from EMBASE, PubMed, and the Cochrane Library. Any study meeting the inclusion and exclusion criteria was considered. The primary outcome assessed was all-cause mortality within 30 days. Two authors separately screened studies and extracted data. If the I² values were below 50%, they applied the fixed-effect model; otherwise, the random effects model was used. TSA was performed to assess the risk of false-positive or false-negative results.

The results showed 4,355 studies, with 9 studies and 1,762 patients. Pooled results indicated that, in patients with sepsis, prolonged intravenous infusion of beta-lactam antibiotics significantly reduced all-cause mortality within 30 days compared to intermittent intravenous infusion (RR 0.82; 95%CI 0.70–0.96; P=0.01; TSA-adjusted CI 0.62–1.07). The certainty of evidence was rated low, and TSA suggested the need for more studies to confirm the conclusion. It was linked to lower hospital and ICU mortality and higher clinical cures, but no significant change in 90-day mortality or the emergence of resistant bacteria between the groups.

They concluded that prolonged β-lactam antibiotic infusion in sepsis patients showed short-term benefits, but long-term outcomes need further evaluation.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-023-01222-w