Infect Chemother.  2016 Jun;48(2):81-90. 10.3947/ic.2016.48.2.81.

Prolonged versus Intermittent Infusion of β-Lactams for the Treatment of Nosocomial Pneumonia: A Meta-Analysis

• Lal A
• Jaoude P
• El-Solh AA

• KMID: 2327975
• DOI: http://doi.org/10.3947/ic.2016.48.2.81

Abstract

BACKGROUND
The primary objective of this meta-analysis is aimed at determining whether β-lactams prolonged infusion in patients with nosocomial pneumonia (NP) results in higher cure rate and improved mortality compared to intermittent infusion.
MATERIALS AND METHODS
Relevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL from inception to September 1st, 2015. All published articles which evaluated the outcome of extended/continuous infusion of antimicrobial therapy versus intermittent infusion therapy in the treatment of NP were reviewed.
RESULTS
A total of ten studies were included in the analysis involving 1,051 cases of NP. Prolonged infusion of β-lactams was associated with higher clinical cure rate (OR 2.45, 95% CI, 1.12, 5.37) compared to intermittent infusion. However, there was no significant difference in mortality (OR 0.85, 95% CI 0.63-1.15) between the two groups. Subgroup analysis for β-lactam subclasses and for severity of illness showed comparable outcomes.
CONCLUSION
The limited data available suggest that reduced clinical failure rates when using prolonged infusions of β-lactam antibiotics in critically ill patients with NP. More detailed studies are needed to determine the impact of such strategy on mortality in this patient population.

Keyword

Prolonged infusion; β-lactams; Clinical cure; Mortality

MeSH Terms

Anti-Bacterial Agents
Critical Illness
Humans
Mortality
Pneumonia*
Anti-Bacterial Agents

Figure

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  Figure 1 Flow diagram of the selection process of the identified studies. CAP, community acquired pneumonia; HCAP, Health care associated pneumonia.

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  Figure 2 Forest plot comparing mortality rates in patients with nosocomial pneumonia receiving prolonged infusion and intermittent boluses. CI, continuous infusion.

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  Figure 3 Funnel plot illustrating meta-analysis of mortality rate. SE, standard error; RR, relative risk.

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  Figure 4 Forest plot comparing clinical cure rates in patients with nosocomial pneumonia receiving prolonged infusion and intermittent boluses. CI, continuous infusion.

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