A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis
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摘要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.
著者DULHUNTY Joel M., ROBERTS Jason A., DAVIS Joshua S., WEBB Steven A. R., BELLOMO Rinaldo, GOMERSALL Charles David, SHIRWADKAR Charudatt, EASTWOOD Glenn M., MYBURGH John, PATERSON David L., STARR Therese, PAUL Sanjoy K., LIPMAN Jeffrey
期刊名稱American Journal of Respiratory and Critical Care Medicine
出版年份2015
月份12
日期1
卷號192
期次11
出版社American Thoracic Society
頁次1298 - 1305
國際標準期刊號1073-449X
電子國際標準期刊號1535-4970
語言英式英語
關鍵詞antibiotic, clinical outcome, intensive care

上次更新時間 2020-17-09 於 03:22