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Prolonged infusion of β-lactam antibiotics decreases short-term mortality in critically ill patients: A meta-analysis
Baofang Liang1, Jianwei Su2, Ya Wang3
1Department of Healthcare-associated Infection Management, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, People's Republic of China.
Objectives:
The aim of this study was to ascertain the clinical efficacy of prolonged infusion of β-lactam antibiotics in critically ill patients and to provide additional evidence.
Methods:
This meta-analysis was prospectively registered on the PROSPERO database (CRD42024614894). We searched PubMed, Web of Science, Scopus, and Clinical Trials.gov to identify eligible randomized control trials (RCTs) for conducting a meta-analysis and trial sequential analysis (TSA) comparing mortality between prolonged vs. intermittent infusion of β-lactam antibiotics in adult critically ill patients. The Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE) was used to evaluate the certainty of evidence for all outcomes.
Results:
Twenty-four RCTs involving 9558 adult critically ill patients were finally included in this meta-analysis. Compared with intermittent infusion of β-lactam antibiotics, the pooled results demonstrated that prolonged infusion was associated with lower short-term mortality (OR = 0.87, 95% confidence interval [CI] = 0.79-0.95; high certainty), but not 90-d mortality statistically (OR = 0.91, 95% CI = 0.83-1.01; moderate certainty), which was supported by TSA. Regression analysis found no significant factors affecting short-term mortality. For other outcomes, prolonged infusion could significantly improve clinical cure (OR = 1.31, 95% CI = 1.20-1.42; low certainty) and microbiological eradication (OR = 2.29, 95% CI = 1.61-3.25; moderate certainty).
Conclusions:
Despite no benefit in 90-d mortality statistically, prolonged infusion of β-lactam antibiotics was associated with significant benefits in short-term mortality, clinical cure, and microbiological eradication. TSA supported the short-term survival benefit of prolonged infusion in critically ill patients.
Insights
Prolonged infusion of beta-lactam antibiotics significantly lowers short-term mortality and improves clinical outcomes in critically ill patients. Trial sequential analysis supports these survival benefits, enhancing treatment efficacy.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Beta-lactam antibiotics are crucial for treating severe infections.
- Optimizing antibiotic administration in critically ill patients is essential for improving outcomes.
- The optimal infusion strategy for beta-lactams in critically ill patients remains under investigation.
Purpose of the Study:
- To evaluate the clinical efficacy of prolonged infusion versus intermittent infusion of beta-lactam antibiotics.
- To provide evidence on the impact of prolonged infusion on mortality and other clinical outcomes in critically ill patients.
- To assess the certainty of evidence using the GRADE approach and trial sequential analysis (TSA).
Main Methods:
- A systematic meta-analysis and trial sequential analysis (TSA) of randomized control trials (RCTs).
- Searched major databases (PubMed, Web of Science, Scopus, ClinicalTrials.gov) for eligible RCTs.
- Included 24 RCTs with 9558 adult critically ill patients comparing prolonged vs. intermittent beta-lactam infusion.
Main Results:
- Prolonged infusion was associated with significantly lower short-term mortality (OR = 0.87; high certainty).
- No statistically significant difference in 90-day mortality was observed (OR = 0.91; moderate certainty), supported by TSA.
- Prolonged infusion significantly improved clinical cure rates (OR = 1.31; low certainty) and microbiological eradication (OR = 2.29; moderate certainty).
Conclusions:
- Prolonged infusion of beta-lactam antibiotics offers significant benefits in short-term mortality, clinical cure, and microbiological eradication.
- While 90-day mortality did not show statistical benefit, TSA supports the short-term survival advantage.
- This evidence supports the use of prolonged beta-lactam infusion in critically ill patients.
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