Efficacy and safety of prolonged versus intermittent infusion of beta-lactam antibiotics as empirical therapy in patients with sepsis

Abstract

© Journal of the medical association of Thailand. Objective: To determine the efficacy and safety of beta-lactam antibiotics (ceftazidime, cefepime, piperacillin/tazobactam, imipenem, meropenem, and doripenem) administered by intermittent infusion (II) compared with three to four-hour prolonged infusion (PI) in acutely ill-hospitalized patients with sepsis. Materials and Methods: The authors conducted a prospective cohort study between January 2010 and December 2013. Results: Of 219 subjects, 213 were recruited in the present study, 109 patients were in the II group and 104 patients were in the PI group. No significant difference of baseline characteristics between both groups. About 70% of infections from both groups were associated with hospital-associated infection. Sepsis was significantly higher in PI group (p=0.02). Pneumonia, bacteremia, and urinary tract infection (UTI) were the major foci of sepsis in the present study. Escherichia coli that mainly came from UTI was the major etiologic pathogen, whereas the causative pathogen was unknown in 49.3%. The 28-day survival was 87.2% in the II group and 79.8% in the PI group (p=0.27). Favorable clinical outcomes resulted in 74.3% of the II group and 76.9% of the PI group (p=0.11). A complete microbiological response was documented in 62.3% of the II group and 63.2% of the PI group (p=0.91). No serious adverse events were observed in either group. Conclusion: There were no significant differences in clinical, microbiological, and safety outcomes between the two groups.