The following is a summary of “Prolonged versus intermittent β-lactam infusion in sepsis: a systematic review and meta-analysis of randomized controlled trials,” published in the February 2024 issue of Critical Care by Zhao al.

Researchers performed a retrospective analysis to assess the effectiveness and safety of extending β-lactam antibiotic infusions for adult sepsis patients compared to the standard intermittent approach.

They searched PubMed, EMBASE, and Cochrane Library databases for original RCTs comparing prolonged and intermittent β-lactam infusion in sepsis patients. Employing a random-effects model, mortality, clinical success, microbiological success, and adverse events were accessed. Subgroup analyses were done to assess the impact of various factors on mortality rates. Relative risk (RR) and corresponding 95% CIs determined overall effect sizes for dichotomous outcomes. 

The results showed 15 studies involving 2,130 patients with a significant reduction in all-cause mortality (RR, 0.83; 95% CI 0.72–0.97; P=0.02) and a notable improvement in clinical success (RR, 1.16; 95% CI 1.03–1.31; P=0.02) in the prolonged infusion group compared to intermittent infusion. Microbiological success did not yield statistically significant results (RR, 1.10; 95% CI 0.98–1.23; P=0.11). No notable adverse event change was observed between the two groups (RR, 0.91; 95% CI 0.64–1.29; P=0.60). Remarkable conclusions were drawn from subgroup analyses including studies with sample sizes exceeding 20 individuals per group (RR, 0.84; 95%CI 0.72–0.98; P=0.03), research conducted post-2010 (RR, 0.84; 95%CI 0.72–0.98; P=0.03), cases involving infections predominantly caused by Gram-negative bacteria (RR, 0.81; 95%CI 0.68–0.96; P=0.02), as well as the administration of a loading dose (RR, 0.84; 95% CI 0.72–0.97; P=0.02) and the use of penicillin (RR, 0.61; 95% CI 0.38–0.98; P=0.04).

Investigators concluded that prolonged β-lactam infusion in sepsis patients cut mortality and improved outcomes, with no rise in side effects compared to intermittent dosing.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01263-9