Abstract | RATIONALE: OBJECTIVES: 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:
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Authors | Jason A Roberts, Mohd-Hafiz Abdul-Aziz, Joshua S Davis, Joel M Dulhunty, Menino O Cotta, John Myburgh, Rinaldo Bellomo, Jeffrey Lipman |
Journal | American journal of respiratory and critical care medicine
(Am J Respir Crit Care Med)
Vol. 194
Issue 6
Pg. 681-91
(09 15 2016)
ISSN: 1535-4970 [Electronic] United States |
PMID | 26974879
(Publication Type: Comparative Study, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Bacterial Agents
- beta-Lactams
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Topics |
- Aged
- Anti-Bacterial Agents
(administration & dosage, therapeutic use)
- Drug Administration Schedule
- Female
- Humans
- Infusions, Intravenous
(methods)
- Male
- Middle Aged
- Proportional Hazards Models
- Randomized Controlled Trials as Topic
- Sepsis
(drug therapy, mortality)
- beta-Lactams
(administration & dosage, therapeutic use)
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