The analysis showed a clear mortality benefit for extended or continuous infusion of β-lactams among critically ill patients.
Compared with short-term infusion, prolonged infusion was associated with lower all-cause mortality (risk ratio, 0.70; 95% confidence interval, 0.56 to 0.87).
“It is possible that these findings will change clinical practice,” said Dr. Vardakas. “For the first time, we have high-quality data supporting what we have been suspecting for years.”
Indeed, in an accompanying editorial
, Mical Paul, MD, from Israel Institute of Technology, Haifa, and Ursula Theuretzbacher, PhD, from the Center for Anti-Infective Agents, Vienna, Austria, call for immediate implementation of β-lactam prolonged infusion in patients with sepsis.
Nevertheless, Dr. Vardakas stressed that more research is still needed to evaluate prolonged infusion of β-lactams in critically ill patients. “We found that a benefit could be seen in all patients, but we suspect that some patients may benefit more,” he said—including those infected by problematic multi-drug resistant pathogens such as Pseudomonas aeruginosa
and Acinetobacter baumannii
He suggested that further studies would be useful to examine how prolonged infusion of β-lactams affects different patient subgroups according to the degree of renal dysfunction, type of infection (such as bacteremia or pneumonia), sepsis severity score, age, or immunocompetence.
“We should also examine whether additional modalities like therapeutic drug monitoring, combination therapies with additional antibiotics, and adjuvant therapies (such as vitamins or hydrocortisone) could have an additional impact,” Dr. Vardakas concluded.
Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.
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