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Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III
Joel M Dulhunty1,2,3, Stephen J Brett4,5, Jan J De Waele6
1Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
JAMA
|June 12, 2024
Summary
Continuous infusion of beta-lactam antibiotics for sepsis did not significantly reduce 90-day mortality compared to intermittent infusion. However, continuous infusion showed a trend toward improved clinical cure rates in critically ill patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Sepsis management involves optimizing antibiotic delivery.
- The optimal infusion strategy for beta-lactam antibiotics in sepsis remains debated.
Purpose of the Study:
- To compare continuous versus intermittent infusion of beta-lactam antibiotics (piperacillin-tazobactam or meropenem) in critically ill sepsis patients.
- To determine the effect on 90-day all-cause mortality.
Main Methods:
- International, open-label, randomized clinical trial in 104 ICUs.
- Critically ill adults with sepsis received continuous or intermittent infusions of piperacillin-tazobactam or meropenem.
- Primary outcome: 90-day all-cause mortality.
Main Results:
- No statistically significant difference in 90-day mortality between continuous (24.9%) and intermittent (26.8%) infusion groups (P=.08).
- Clinical cure rates were higher with continuous infusion (55.7%) versus intermittent infusion (50.0%).
- No significant differences in other secondary outcomes, including infections with multiresistant organisms.
Conclusions:
- Continuous infusion of beta-lactam antibiotics did not significantly reduce 90-day mortality in sepsis patients.
- A trend towards improved clinical cure suggests potential benefits of continuous infusion.
- Further research may clarify the role of continuous infusion in specific sepsis populations.
