Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
Int J Antimicrob Agents. 2014 May;43(5):403-11. doi: 10.1016/j.ijantimicag.2014.01.027. Epub 2014 Mar 1.
The clinical advantages of prolonged (extended/continuous) infusion remain controversial. Previous studies and reviews have failed to show consistent clinical benefits of extending the infusion time. This meta-analysis sought to determine whether prolonged β-lactam infusions were associated with a reduction in mortality and improvement in clinical success. A search of PubMed, EMBASE and The Cochrane Library for randomised controlled trials (RCTs) and observational studies comparing prolonged infusion with intermittent bolus administration of the same antibiotic in hospitalised adult patients was conducted. Primary outcomes evaluated were mortality and clinical success. A total of 29 studies with 2206 patients (18 RCTs and 11 observational studies) were included in the meta-analysis. Compared with intermittent boluses, use of prolonged infusion appeared to be associated with a significant reduction in mortality [pooled relative risk (RR) = 0.66, 95% confidence interval (CI) 0.53-0.83] and improvement in clinical success (RR = 1.12, 95% CI 1.03-1.21). Statistically significant benefit was supported by non-randomised studies (mortality, RR = 0.57, 95% CI 0.43-0.76; clinical success, RR = 1.34, 95% CI 1.02-1.76) but not by RCTs (mortality, RR = 0.83, 95% CI 0.57-1.21; clinical success, RR = 1.05, 95% CI 0.99-1.12). The positive results from observational studies, especially in the face of increasing antibiotic resistance, serve to justify the imperative need to conduct a large-scale, well-designed, multicentre RCT involving critically ill patients infected with high minimum inhibitory concentration pathogens to clearly substantiate this benefit.
延长（持续/连续）输注的临床优势仍存在争议。先前的研究和综述未能显示出延长输注时间的一致临床益处。本荟萃分析旨在确定β-内酰胺类抗生素延长输注是否与降低死亡率和提高临床成功率相关。对 PubMed、EMBASE 和 The Cochrane Library 进行了检索，以查找比较住院成年患者中相同抗生素延长输注与间歇性推注给药的随机对照试验（RCT）和观察性研究。评估的主要结局是死亡率和临床成功率。共纳入 29 项研究，共 2206 例患者（18 项 RCT 和 11 项观察性研究）进行荟萃分析。与间歇性推注相比，使用延长输注似乎与死亡率显著降低相关（合并相对风险 [RR] = 0.66，95%置信区间 [CI] 0.53-0.83），临床成功率提高（RR = 1.12，95% CI 1.03-1.21）。非随机研究支持统计学显著获益（死亡率，RR = 0.57，95% CI 0.43-0.76；临床成功率，RR = 1.34，95% CI 1.02-1.76），但 RCT 则不然（死亡率，RR = 0.83，95% CI 0.57-1.21；临床成功率，RR = 1.05，95% CI 0.99-1.12）。观察性研究的阳性结果，特别是在抗生素耐药性不断增加的情况下，证明迫切需要开展一项涉及感染高最低抑菌浓度病原体的危重病患者的大规模、精心设计、多中心 RCT，以明确证实这一益处。
