Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials
<p>Abstract</p> <p>Background</p> <p>The emergence of multi-drug resistant Gram-negatives (MDRGNs) coupled with an alarming scarcity of new antibiotics has forced the optimization of the therapeutic potential of available antibiotics. To exploit the time above the minim...
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| Format: | Article |
| Language: | English |
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BMC
2011-06-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | http://www.biomedcentral.com/1471-2334/11/181 |
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| author | Van Arendonk Kyle J Suh Yong D Putcha Nirupama Tamma Pranita D Rinke Michael L |
| author_facet | Van Arendonk Kyle J Suh Yong D Putcha Nirupama Tamma Pranita D Rinke Michael L |
| author_sort | Van Arendonk Kyle J |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>The emergence of multi-drug resistant Gram-negatives (MDRGNs) coupled with an alarming scarcity of new antibiotics has forced the optimization of the therapeutic potential of available antibiotics. To exploit the time above the minimum inhibitory concentration mechanism of β-lactams, prolonging their infusion may improve outcomes. The primary objective of this meta-analysis was to determine if prolonged β-lactam infusion resulted in decreased mortality and improved clinical cure compared to intermittent β-lactam infusion.</p> <p>Methods</p> <p>Relevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL. Heterogeneity was assessed qualitatively, in addition to I<sup>2 </sup>and Chi-square statistics. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated using Mantel-Haenszel random-effects models.</p> <p>Results</p> <p>Fourteen randomized controlled trials (RCTs) were included. Prolonged infusion β-lactams were not associated with decreased mortality (n= 982; RR 0.92; 95% CI:0.61-1.37) or clinical cure (n = 1380; RR 1.00 95% CI:0.94-1.06) compared to intermittent infusions. Subgroup analysis for β-lactam subclasses and equivalent total daily β-lactam doses yielded similar results. Most studies had notable methodological flaws.</p> <p>Conclusions</p> <p>No clinical advantage was observed for prolonged infusion β-lactams. The limited number of studies with MDRGNs precluded evaluation of prolonged infusion of β-lactams for this subgroup. A large, multicenter RCT with critically ill patients infected with MDRGNs is needed.</p> |
| first_indexed | 2024-12-10T13:07:05Z |
| format | Article |
| id | doaj.art-4c9eac8ecc9a4520a56ea532d970607e |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-10T13:07:05Z |
| publishDate | 2011-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-4c9eac8ecc9a4520a56ea532d970607e2022-12-22T01:47:48ZengBMCBMC Infectious Diseases1471-23342011-06-0111118110.1186/1471-2334-11-181Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trialsVan Arendonk Kyle JSuh Yong DPutcha NirupamaTamma Pranita DRinke Michael L<p>Abstract</p> <p>Background</p> <p>The emergence of multi-drug resistant Gram-negatives (MDRGNs) coupled with an alarming scarcity of new antibiotics has forced the optimization of the therapeutic potential of available antibiotics. To exploit the time above the minimum inhibitory concentration mechanism of β-lactams, prolonging their infusion may improve outcomes. The primary objective of this meta-analysis was to determine if prolonged β-lactam infusion resulted in decreased mortality and improved clinical cure compared to intermittent β-lactam infusion.</p> <p>Methods</p> <p>Relevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL. Heterogeneity was assessed qualitatively, in addition to I<sup>2 </sup>and Chi-square statistics. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated using Mantel-Haenszel random-effects models.</p> <p>Results</p> <p>Fourteen randomized controlled trials (RCTs) were included. Prolonged infusion β-lactams were not associated with decreased mortality (n= 982; RR 0.92; 95% CI:0.61-1.37) or clinical cure (n = 1380; RR 1.00 95% CI:0.94-1.06) compared to intermittent infusions. Subgroup analysis for β-lactam subclasses and equivalent total daily β-lactam doses yielded similar results. Most studies had notable methodological flaws.</p> <p>Conclusions</p> <p>No clinical advantage was observed for prolonged infusion β-lactams. The limited number of studies with MDRGNs precluded evaluation of prolonged infusion of β-lactams for this subgroup. A large, multicenter RCT with critically ill patients infected with MDRGNs is needed.</p>http://www.biomedcentral.com/1471-2334/11/181β-lactamsinfusionmulti-drug resistant Gram-negativesantibiotics |
| spellingShingle | Van Arendonk Kyle J Suh Yong D Putcha Nirupama Tamma Pranita D Rinke Michael L Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials BMC Infectious Diseases β-lactams infusion multi-drug resistant Gram-negatives antibiotics |
| title | Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials |
| title_full | Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials |
| title_fullStr | Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials |
| title_full_unstemmed | Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials |
| title_short | Does prolonged β-lactam infusions improve clinical outcomes compared to intermittent infusions? A meta-analysis and systematic review of randomized, controlled trials |
| title_sort | does prolonged β lactam infusions improve clinical outcomes compared to intermittent infusions a meta analysis and systematic review of randomized controlled trials |
| topic | β-lactams infusion multi-drug resistant Gram-negatives antibiotics |
| url | http://www.biomedcentral.com/1471-2334/11/181 |
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