Continuous or extended vs intermittent infusions of beta-lactam antibiotics in ICU patients with pneumonia: a systematic review and meta-analysis of randomized controlled trials.

Abstract

This systematic review and meta-analysis of randomized controlled trials (RCTs) of intensive care unit (ICU) patients with pneumonia was conducted to compare the clinical outcomes of beta-lactam antibiotics when administered by prolonged infusion vs intermittent infusion. The systematic search was conducted in Medline (via PubMed), CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov. The outcomes were mortality, clinical cure rate, microbiological cure rate, adverse events, and ICU length of stay. The pooled risk ratios or mean differences were estimated by the fixed or random effect methods according to heterogeneity statistics. Twelve eligible RCTs were included in the meta-analysis. ICU length of stay was lower in the prolonged infusion patients compared with intermittent infusion. However, compared to intermittent infusion, the prolonged infusion, both continuous and extended infusion, of beta-lactam antibiotics was not associated with statistically significant improvements in mortality, clinical cure rate, microbiological cure rate, and rate of adverse events. For the treatment of ICU patients with pneumonia, prolonged infusion was associated with a shorter ICU length of stay. Multicenter RCTs with large sample sizes of ICU patients with pneumonia are needed to better assess other important endpoints.