1 Department of Intensive Care Medicine.
2 The Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
Am J Respir Crit Care Med. 2015 Dec 1;192(11):1298-305. doi: 10.1164/rccm.201505-0857OC.
Continuous infusion of β-lactam antibiotics may improve outcomes because of time-dependent antibacterial activity compared with intermittent dosing.
To evaluate the efficacy of continuous versus intermittent infusion in patients with severe sepsis.
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.
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).
In critically ill patients with severe sepsis, there was no difference in outcomes between β-lactam antibiotic administration by continuous and intermittent infusion. Australian New Zealand Clinical Trials Registry number (ACT RN12612000138886).
与间歇性给药相比，β-内酰胺类抗生素的连续输注可能因其具有时间依赖性抗菌活性而改善结局。
评估连续输注与间歇性输注在严重脓毒症患者中的疗效。
我们在 25 个重症监护病房（ICU）进行了一项随机对照试验。接受哌拉西林他唑巴坦、替卡西林克拉维酸或美罗培南治疗的患者被随机分配接受连续输注或 30 分钟间歇性输注，以完成剩余的治疗疗程或直至 ICU 出院。主要结局是第 28 天的 ICU 无死亡天数。次要结局为 90 天生存率、抗生素停药后 14 天的临床治愈率、第 14 天的存活无器官衰竭天数和菌血症持续时间。
我们纳入了 432 名符合条件的患者，中位年龄为 64 岁，急性生理学和慢性健康评估 II 评分 20 分。连续组和间歇组的 ICU 无死亡天数无差异：18 天（四分位距，2-24）和 20 天（四分位距，3-24）（P=0.38）。90 天生存率也无差异：74.3%（156/210）和 72.5%（158/218）；危险比为 0.91（95%置信区间，0.63-1.31；P=0.61）。临床治愈率分别为 52.4%（111/212）和 49.5%（109/220）；比值比为 1.12（95%置信区间，0.77-1.63；P=0.56）。无器官衰竭天数（6 天；P=0.27）和菌血症持续时间（0 天；P=0.24）也无差异。
在严重脓毒症的危重症患者中，β-内酰胺类抗生素连续输注与间歇性输注的结局无差异。澳大利亚新西兰临床试验注册编号（ACT RN12612000138886）。
