A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis Academic Article uri icon

abstract

  • Rationale

    Continuous infusion of β-lactam antibiotics may improve outcomes because of time-dependent antibacterial activity compared with intermittent dosing.

    Objectives

    To evaluate the efficacy of continuous versus intermittent infusion in patients with severe sepsis.

    Methods

    We conducted a randomized controlled trial in 25 intensive care units (ICUs). Participants commenced on piperacillin-tazobactam, ticarcillin-clavulanate, or meropenem were randomized to receive the prescribed antibiotic via continuous or 30-minute intermittent infusion for the remainder of the treatment course or until ICU discharge. The primary outcome was the number of alive ICU-free days at Day 28. Secondary outcomes were 90-day survival, clinical cure 14 days post antibiotic cessation, alive organ failure-free days at Day 14, and duration of bacteremia.

    Measurements and main results

    We enrolled 432 eligible participants with a median age of 64 years and an Acute Physiology and Chronic Health Evaluation II score of 20. There was no difference in ICU-free days: 18 days (interquartile range, 2-24) and 20 days (interquartile range, 3-24) in the continuous and intermittent groups (P = 0.38). There was no difference in 90-day survival: 74.3% (156 of 210) and 72.5% (158 of 218); hazard ratio, 0.91 (95% confidence interval, 0.63-1.31; P = 0.61). Clinical cure was 52.4% (111 of 212) and 49.5% (109 of 220); odds ratio, 1.12 (95% confidence interval, 0.77-1.63; P = 0.56). There was no difference in organ failure-free days (6 d; P = 0.27) and duration of bacteremia (0 d; P = 0.24).

    Conclusions

    In critically ill patients with severe sepsis, there was no difference in outcomes between β-lactam antibiotic administration by continuous and intermittent infusion. Australian New Zealand Clinical Trials Registry number (ACT RN12612000138886).

authors

  • Bone, Allison
  • Dulhunty, Joel M
  • Roberts, Jason A
  • Davis, Joshua S
  • Webb, Steven AR
  • Bellomo, Rinaldo
  • Gomersall, Charles
  • Shirwadkar, Charudatt
  • Eastwood, Glenn M
  • Myburgh, John
  • Paterson, David L
  • Starr, Therese
  • Paul, Sanjoy K
  • Lipman, Jeffrey

publication date

  • December 2015