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Extended Infusion of Beta-Lactams Is Associated With Improved Outcomes in Pediatric Patients

Tracy N Zembles, Rachael Schortemeyer, Evelyn M Kuhn

    The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG
    |February 19, 2021
    PubMed

    Insights

    Extended infusion beta-lactam antibiotics showed similar outcomes in children overall. However, critically ill children had lower mortality, and bone marrow transplant patients had reduced readmissions with extended infusions.

    Area of Science:

    • Pediatric pharmacology
    • Infectious disease management
    • Clinical pharmacy

    Background:

    • Beta-lactam antibiotics' pharmacokinetics support extended infusions.
    • Limited pediatric data exist for extended infusion practices.
    • Adult studies support extended infusion, but pediatric guidance is lacking.

    Purpose of the Study:

    • To compare clinical outcomes of extended versus standard infusions in pediatric patients.
    • To evaluate the efficacy of extended infusion beta-lactams in children.
    • To provide evidence for pediatric extended infusion antibiotic therapy.

    Main Methods:

    • Retrospective chart analysis of hospitalized children (0-18 years).
    • Inclusion criteria: ≥72 hours of cefepime, piperacillin-tazobactam, or meropenem.
    • Outcomes assessed: hospital length of stay, 30-day readmission, all-cause mortality.

    Main Results:

    • 551 patients evaluated (258 extended, 293 standard infusion).
    • Overall clinical outcomes were similar between infusion groups.
    • Subgroup analysis: decreased mortality in critical care (2.1% vs 19.6%) and reduced 30-day readmission in bone marrow transplant (0% vs 50%) patients with extended infusion.

    Conclusions:

    • Extended and standard infusions yielded similar outcomes in the general pediatric population.
    • Extended infusions may offer a mortality benefit for critically ill children.
    • Extended infusions may reduce readmission rates in pediatric bone marrow transplant recipients.
    Abstract

    Keywords:
    beta-lactamextended infusionoutcomespediatricspharmacokinetics

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