Abstract
Introduction
In order to compare the clinical efficacy and safety of prolonged versus intermittent
antipseudomonal beta-lactam antibiotic infusion for the treatment of severe acute
infections in adult patients, a meta-analysis of randomized controlled trials (RCTs)
was performed.
Methods
We systematically searched MEDLINE and Cochrane Library databases until December 2022.
The outcomes were all-cause mortality, clinical success, microbiological eradication
and adverse events. The pooled risk ratios (RR) were estimated by the fixed or random
effect methods according to heterogeneity statistics. The Grading of Recommendations
Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the
certainty of evidence for each outcome.
Results
Twenty eligible RCTs with 2081 participants were included in the meta-analysis. The
risk of all-cause mortality was significantly lower in the prolonged infusion group
than in the intermittent infusion group (RR 0.77, 95% confidence interval [CI] 0.63–0.95,
p = 0.01, I2 = 0%; moderate certainty). Treatment with prolonged infusion showed significant benefit
in clinical success (RR 1.09, 95% CI 1.02–1.17, p = 0.008, I2 = 19%; moderate certainty). There were no significant differences in microbiological
eradication (RR 1.12, 95% CI 0.99–1.28, p = 0.07, I2 = 49%; low certainty), any adverse events (RR 0.96, 95% CI 0.86–1.08, p = 0.50, I2 = 27%; moderate certainty) and serious adverse events (RR 0.99, 95%CI 0.70–1.39 p = 0.95,
I2 = 0%; low certainty).
Conclusions
Prolonged antipseudomonal beta-lactam infusion probably decreases all-cause mortality.
Additionally, it probably increases clinical success in adults with severe acute infections.
This infusion strategy may result in little to no difference in microbiological eradication
and is probably not associated with a rise in any adverse events.The evidence suggests
that prolonged infusion may not increase serious adverse events.
Keywords
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Article info
Publication history
Published online: May 11, 2023
Accepted:
May 6,
2023
Received in revised form:
April 20,
2023
Received:
March 22,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
