Continuous beta-lactam infusion in critically ill patients: the clinical evidence

被引:80
作者
Abdul-Aziz, Mohd H. [1 ]
Dulhunty, Joel M. [1 ,2 ]
Bellomo, Rinaldo [3 ]
Lipman, Jeffrey [1 ,2 ]
Roberts, Jason A. [1 ,2 ,4 ]
机构
[1] Univ Queensland, Burns Trauma & Crit Care Res Ctr, Brisbane, Qld, Australia
[2] Royal Brisbane & Womans Hosp, Dept Intens Care Med, Brisbane, Qld, Australia
[3] Austin Hosp, Dept Intens Care, Melbourne, Vic 3084, Australia
[4] Royal Brisbane & Womans Hosp, Dept Pharm, Brisbane, Qld, Australia
基金
英国医学研究理事会;
关键词
Beta-lactam antibiotic; Continuous infusion; Critically ill; Pharmacokinetic; Pharmacodynamic; Treatment outcome; VENTILATOR-ASSOCIATED PNEUMONIA; INTENSIVE-CARE-UNIT; ACUTE KIDNEY INJURY; INTERMITTENT INFUSION; PSEUDOMONAS-AERUGINOSA; PIPERACILLIN-TAZOBACTAM; POPULATION PHARMACOKINETICS; TRACT-INFECTIONS; SEPTIC PATIENTS; RIFLE CRITERIA;
D O I
10.1186/2110-5820-2-37
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
There is controversy over whether traditional intermittent bolus dosing or continuous infusion of beta-lactam antibiotics is preferable in critically ill patients. No significant difference between these two dosing strategies in terms of patient outcomes has been shown yet. This is despite compelling in vitro and in vivo pharmacokinetic/pharmacodynamic (PK/PD) data. A lack of significance in clinical outcome studies may be due to several methodological flaws potentially masking the benefits of continuous infusion observed in preclinical studies. In this review, we explore the methodological shortcomings of the published clinical studies and describe the criteria that should be considered for performing a definitive clinical trial. We found that most trials utilized inconsistent antibiotic doses and recruited only small numbers of heterogeneous patient groups. The results of these trials suggest that continuous infusion of beta-lactam antibiotics may have variable efficacy in different patient groups. Patients who may benefit from continuous infusion are critically ill patients with a high level of illness severity. Thus, future trials should test the potential clinical advantages of continuous infusion in this patient population. To further ascertain whether benefits of continuous infusion in critically ill patients do exist, a large-scale, prospective, multinational trial with a robust design is required.
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收藏
页数:16
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