A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis. Dulhunty, J. M, Roberts, J. A, Davis, J. S, Webb, S. A R, Bellomo, R., Gomersall, C., Shirwadkar, C., Eastwood, G. M, Myburgh, J., Paterson, D. L, Starr, T., Paul, S. K, & Lipman, J. American Journal of Respiratory and Critical Care Medicine, 192(11):1298–1305, July, 2015. Number: 11 Publisher: American Thoracic Society - AJRCCM![A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex Rationale: Continuous infusion of ?-lactam antibiotics may improve outcomes because of time-dependent antibacterial activity compared with intermittent dosing.Objectives: To evaluate the efficacy of continuous versus intermittent infusion in patients with severe sepsis.Methods: We conducted a randomized controlled trial in 25 intensive care units (ICUs). Participants commenced on piperacillin?tazobactam, ticarcillin?clavulanate, or meropenem were randomized to receive the prescribed antibiotic via continuous or 30-minute intermittent infusion for the remainder of the treatment course or until ICU discharge. The primary outcome was the number of alive ICU-free days at Day 28. Secondary outcomes were 90-day survival, clinical cure 14 days post antibiotic cessation, alive organ failure?free days at Day 14, and duration of bacteremia.Measurements and Main Results: We enrolled 432 eligible participants with a median age of 64 years and an Acute Physiology and Chronic Health Evaluation II score of 20. There was no difference in ICU-free days: 18 days (interquartile range, 2?24) and 20 days (interquartile range, 3?24) in the continuous and intermittent groups (P?=?0.38). There was no difference in 90-day survival: 74.3% (156 of 210) and 72.5% (158 of 218); hazard ratio, 0.91 (95% confidence interval, 0.63?1.31; P?=?0.61). Clinical cure was 52.4% (111 of 212) and 49.5% (109 of 220); odds ratio, 1.12 (95% confidence interval, 0.77?1.63; P?=?0.56). There was no difference in organ failure?free days (6 d; P?=?0.27) and duration of bacteremia (0 d; P?=?0.24).Conclusions: In critically ill patients with severe sepsis, there was no difference in outcomes between ?-lactam antibiotic administration by continuous and intermittent infusion.Australian New Zealand Clinical Trials Registry number (ACT RN12612000138886).
@article{dulhunty_multicenter_2015,
title = {A {Multicenter} {Randomized} {Trial} of {Continuous} versus {Intermittent} β-{Lactam} {Infusion} in {Severe} {Sepsis}},
volume = {192},
issn = {1073-449X},
url = {https://doi.org/10.1164/rccm.201505-0857OC},
doi = {10.1164/rccm.201505-0857OC},
abstract = {Rationale: Continuous infusion of ?-lactam antibiotics may improve outcomes because of time-dependent antibacterial activity compared with intermittent dosing.Objectives: To evaluate the efficacy of continuous versus intermittent infusion in patients with severe sepsis.Methods: We conducted a randomized controlled trial in 25 intensive care units (ICUs). Participants commenced on piperacillin?tazobactam, ticarcillin?clavulanate, or meropenem were randomized to receive the prescribed antibiotic via continuous or 30-minute intermittent infusion for the remainder of the treatment course or until ICU discharge. The primary outcome was the number of alive ICU-free days at Day 28. Secondary outcomes were 90-day survival, clinical cure 14 days post antibiotic cessation, alive organ failure?free days at Day 14, and duration of bacteremia.Measurements and Main Results: We enrolled 432 eligible participants with a median age of 64 years and an Acute Physiology and Chronic Health Evaluation II score of 20. There was no difference in ICU-free days: 18 days (interquartile range, 2?24) and 20 days (interquartile range, 3?24) in the continuous and intermittent groups (P?=?0.38). There was no difference in 90-day survival: 74.3\% (156 of 210) and 72.5\% (158 of 218); hazard ratio, 0.91 (95\% confidence interval, 0.63?1.31; P?=?0.61). Clinical cure was 52.4\% (111 of 212) and 49.5\% (109 of 220); odds ratio, 1.12 (95\% confidence interval, 0.77?1.63; P?=?0.56). There was no difference in organ failure?free days (6 d; P?=?0.27) and duration of bacteremia (0 d; P?=?0.24).Conclusions: In critically ill patients with severe sepsis, there was no difference in outcomes between ?-lactam antibiotic administration by continuous and intermittent infusion.Australian New Zealand Clinical Trials Registry number (ACT RN12612000138886).},
number = {11},
journal = {American Journal of Respiratory and Critical Care Medicine},
author = {Dulhunty, Joel M and Roberts, Jason A and Davis, Joshua S and Webb, Steven A R and Bellomo, Rinaldo and Gomersall, Charles and Shirwadkar, Charudatt and Eastwood, Glenn M and Myburgh, John and Paterson, David L and Starr, Therese and Paul, Sanjoy K and Lipman, Jeffrey},
month = jul,
year = {2015},
note = {Number: 11
Publisher: American Thoracic Society - AJRCCM},
pages = {1298--1305},
}
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K","Lipman, J."],"bibdata":{"bibtype":"article","type":"article","title":"A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis","volume":"192","issn":"1073-449X","url":"https://doi.org/10.1164/rccm.201505-0857OC","doi":"10.1164/rccm.201505-0857OC","abstract":"Rationale: Continuous infusion of ?-lactam antibiotics may improve outcomes because of time-dependent antibacterial activity compared with intermittent dosing.Objectives: To evaluate the efficacy of continuous versus intermittent infusion in patients with severe sepsis.Methods: We conducted a randomized controlled trial in 25 intensive care units (ICUs). Participants commenced on piperacillin?tazobactam, ticarcillin?clavulanate, or meropenem were randomized to receive the prescribed antibiotic via continuous or 30-minute intermittent infusion for the remainder of the treatment course or until ICU discharge. The primary outcome was the number of alive ICU-free days at Day 28. Secondary outcomes were 90-day survival, clinical cure 14 days post antibiotic cessation, alive organ failure?free days at Day 14, and duration of bacteremia.Measurements and Main Results: We enrolled 432 eligible participants with a median age of 64 years and an Acute Physiology and Chronic Health Evaluation II score of 20. There was no difference in ICU-free days: 18 days (interquartile range, 2?24) and 20 days (interquartile range, 3?24) in the continuous and intermittent groups (P?=?0.38). There was no difference in 90-day survival: 74.3% (156 of 210) and 72.5% (158 of 218); hazard ratio, 0.91 (95% confidence interval, 0.63?1.31; P?=?0.61). Clinical cure was 52.4% (111 of 212) and 49.5% (109 of 220); odds ratio, 1.12 (95% confidence interval, 0.77?1.63; P?=?0.56). There was no difference in organ failure?free days (6 d; P?=?0.27) and duration of bacteremia (0 d; P?=?0.24).Conclusions: In critically ill patients with severe sepsis, there was no difference in outcomes between ?-lactam antibiotic administration by continuous and intermittent infusion.Australian New Zealand Clinical Trials Registry number (ACT RN12612000138886).","number":"11","journal":"American Journal of Respiratory and Critical Care Medicine","author":[{"propositions":[],"lastnames":["Dulhunty"],"firstnames":["Joel","M"],"suffixes":[]},{"propositions":[],"lastnames":["Roberts"],"firstnames":["Jason","A"],"suffixes":[]},{"propositions":[],"lastnames":["Davis"],"firstnames":["Joshua","S"],"suffixes":[]},{"propositions":[],"lastnames":["Webb"],"firstnames":["Steven","A","R"],"suffixes":[]},{"propositions":[],"lastnames":["Bellomo"],"firstnames":["Rinaldo"],"suffixes":[]},{"propositions":[],"lastnames":["Gomersall"],"firstnames":["Charles"],"suffixes":[]},{"propositions":[],"lastnames":["Shirwadkar"],"firstnames":["Charudatt"],"suffixes":[]},{"propositions":[],"lastnames":["Eastwood"],"firstnames":["Glenn","M"],"suffixes":[]},{"propositions":[],"lastnames":["Myburgh"],"firstnames":["John"],"suffixes":[]},{"propositions":[],"lastnames":["Paterson"],"firstnames":["David","L"],"suffixes":[]},{"propositions":[],"lastnames":["Starr"],"firstnames":["Therese"],"suffixes":[]},{"propositions":[],"lastnames":["Paul"],"firstnames":["Sanjoy","K"],"suffixes":[]},{"propositions":[],"lastnames":["Lipman"],"firstnames":["Jeffrey"],"suffixes":[]}],"month":"July","year":"2015","note":"Number: 11 Publisher: American Thoracic Society - AJRCCM","pages":"1298–1305","bibtex":"@article{dulhunty_multicenter_2015,\n\ttitle = {A {Multicenter} {Randomized} {Trial} of {Continuous} versus {Intermittent} β-{Lactam} {Infusion} in {Severe} {Sepsis}},\n\tvolume = {192},\n\tissn = {1073-449X},\n\turl = {https://doi.org/10.1164/rccm.201505-0857OC},\n\tdoi = {10.1164/rccm.201505-0857OC},\n\tabstract = {Rationale: Continuous infusion of ?-lactam antibiotics may improve outcomes because of time-dependent antibacterial activity compared with intermittent dosing.Objectives: To evaluate the efficacy of continuous versus intermittent infusion in patients with severe sepsis.Methods: We conducted a randomized controlled trial in 25 intensive care units (ICUs). Participants commenced on piperacillin?tazobactam, ticarcillin?clavulanate, or meropenem were randomized to receive the prescribed antibiotic via continuous or 30-minute intermittent infusion for the remainder of the treatment course or until ICU discharge. The primary outcome was the number of alive ICU-free days at Day 28. Secondary outcomes were 90-day survival, clinical cure 14 days post antibiotic cessation, alive organ failure?free days at Day 14, and duration of bacteremia.Measurements and Main Results: We enrolled 432 eligible participants with a median age of 64 years and an Acute Physiology and Chronic Health Evaluation II score of 20. There was no difference in ICU-free days: 18 days (interquartile range, 2?24) and 20 days (interquartile range, 3?24) in the continuous and intermittent groups (P?=?0.38). There was no difference in 90-day survival: 74.3\\% (156 of 210) and 72.5\\% (158 of 218); hazard ratio, 0.91 (95\\% confidence interval, 0.63?1.31; P?=?0.61). 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