Prolonged Versus Intermittent Beta-Lactam Antibiotic Infusions in Paediatric Critical Care: A Systematic Review and...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• Suboptimal beta-lactam antibiotic dosing in pediatric intensive care units (PICUs) poses risks to critically ill children.
• Optimizing antibiotic administration is crucial for improving patient outcomes in PICUs.

Purpose of the Study:

• To evaluate the impact of prolonged beta-lactam infusions versus intermittent infusions on mortality, PICU length of stay, and pharmacokinetic/pharmacodynamic (PK/PD) parameters in PICU patients.
• To synthesize existing evidence on the efficacy and safety of different beta-lactam infusion strategies in critically ill children.

Main Methods:

• A systematic review and meta-analysis were conducted, searching multiple databases (MEDLINE, Cochrane, Embase, Web of Science).
• Included studies compared prolonged beta-lactam infusions to intermittent infusions in PICU settings.
• Risk of bias was assessed using the Robins-I tool; descriptive analysis was used when meta-analysis data were insufficient.

Main Results:

• Ten observational studies involving 21-174 PICU patients were included.
• No significant reduction in mortality was observed with prolonged infusions compared to intermittent infusions (OR 0.60; 95% CI 0.24, 1.51).
• The overall quality of evidence was low, with a high risk of bias, and insufficient data for further meta-analyses.

Conclusions:

• The current body of research on prolonged beta-lactam infusions in PICU patients is limited and of low quality.
• Further high-quality research is necessary to determine the clinical benefits of prolonged beta-lactam infusions for severe infections in critically ill children.