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Extended Infusion β-Lactams for the Treatment of Gram-Negative Bacteremia in Children
Tracy N Zembles1, Evelyn M Kuhn2, Nathan E Thompson3
1Department of Enterprise Safety (TNZ), Children's Wisconsin, Milwaukee, WI.
Insights
Extended infusion beta-lactam antibiotics in children with Gram-negative bacteremia led to shorter treatment durations. This method is preferred for feasible administration, showing similar safety outcomes to standard infusions.
Area of Science:
- Pediatric Infectious Diseases
- Pharmacokinetics and Pharmacodynamics
- Antimicrobial Stewardship
Background:
- Beta-lactam antibiotics exhibit pharmacokinetics favoring extended infusion.
- Limited pediatric data exist for extended infusion beta-lactams, particularly in bacteremia cases.
Purpose of the Study:
- To compare clinical outcomes of extended versus standard infusions of beta-lactam antibiotics in pediatric patients with Gram-negative bacteremia.
Main Methods:
- Retrospective chart analysis of hospitalized patients (0-18 years) receiving cefepime, meropenem, or piperacillin-tazobactam for ≥72 hours.
- Evaluated outcomes: antibiotic duration, hospital stay, readmission, mortality, blood culture clearance, and inflammatory marker normalization.
Main Results:
- 124 patients analyzed (51 extended infusion, 73 standard infusion).
- Extended infusion group had significantly shorter antibiotic therapy duration (6.6 vs. 10.2 days; p=0.01).
- No significant differences observed in hospital length of stay, readmission rates, mortality, or time to clinical resolution.
Conclusions:
- Extended infusion beta-lactams in pediatric Gram-negative bacteremia shorten therapy duration.
- Extended infusion should be the preferred administration method when clinically feasible.
Objective:
The pharmacokinetics of β-lactam antibiotics favor administration via an extended infusion. Although literature to support extended infusion β-lactams exists for adults, few data are available in pediatrics, especially among patients with bacteremia. The purpose of this study was to compare clinical outcomes between extended and standard infusions in children with Gram-negative bacteremia.
Methods:
This retrospective chart analysis included hospitalized patients ages 0 to 18 years who received at least 72 hours of cefepime, meropenem, or piperacillin-tazobactam between January 1, 2013 and July 30, 2021. Clinical outcomes included duration of antibiotic therapy, hospital length of stay, readmission within 30 days, all-cause mortality, time to blood culture clearance, and time to normalization of inflammatory markers.
Results:
A total of 124 patients (51 extended infusion, 73 standard infusion) met criteria for evaluation. Duration of antibiotic therapy was shorter in the extended infusion group (6.6 days versus 10.2 days; p = 0.01). There were no differences in hospital length of stay, readmission rates, all-cause mortality, time to normalization of inflammatory markers, or time to blood culture clearance.
Conclusions:
Use of extended infusion β-lactam antibiotics in children with Gram-negative bacteremia was associated with shorter durations of therapy and should be the preferred method of administration when feasible.
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