298. A Preliminary Report of a Study of Efficacy and Safety of Beta-lactam Antibiotics Administration by Extended Infusion versus Intermittent Infusion in Acutely Ill Patients with Sepsis
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • betalactamIDSA-poster-final.pdf (631.1 kB)
  • Background: 

    Sepsis is a high mortality related situation. Prescribing early appropriate antibiotics with optimal dosage can improve the survival. The β-lactam antibiotics are commonly empirical therapy in sepsis. The best pharmacodynamic index of β-lactams is T/MIC. Several study agreed that extended/continuous infusion of β-lactam antibiotics was more cost effective than intermittent infusion. We aimed to determine the efficacy and safety of β-lactam antibiotics administered by 4-hour extended infusion versus conventional intermittent infusion for 30 minutes in acutely ill patients with sepsis.

    Methods: 

    We conducted an open-label, randomized controlled study in the hospitalized patients at Siriraj Hospital, Thailand, since January 2010 to January 2011. The patients which clinically diagnosed of sepsis (infection with systemic inflammatory response syndrome) were randomized using block of four to receive 4-hour extended infusions (EI) or 30-minute intermittent infusion (II) of β-lactam antibiotics (ceftazidime, cefepime, piperacillin-tazobactam, imipenem, meropenem, and doripenem). The primary outcome was a favorable clinical response (improvement or cure). The secondary outcomes were a microbiological response and a 28-day overall mortality.

    Results: 

    Seventy-nine patients were enrolled. The EI group (n=38) and II group (n=41) were similar in terms of demographics data including the severity of illness. The favorable clinical response was 70.7% (29/41) in II group and 68.4% (26/38) in EI group (p=1.00). The good microbiological response was 41.5% (17/41) and 55.3% (21 of 38) in II and EI group, respectively (p=0.32). The 28-day overall mortality was 19.5% (8/41) in II group while 26.3% (10/38) in EI group (p=0.65). Neither serious antibiotics-related nor infusion-related adverse events were observed in both groups.

    Conclusion: 

    This preliminary report demonstrated no clinical and microbiological advantages of EI over II group in sepsis patients with a trend toward extended infusion in microbiological response. However, the present study is on going to enroll more patients for the further conclusion.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Palakorn Srinithiwat, MD, Medicine Department, Sriraj Hospital, Bangkok, Thailand and Pornpan Koomanachai, MD, Medicine Department, Siriraj Hospital, Bangkok, Thailand

    Disclosures:

    P. Srinithiwat, None

    P. Koomanachai, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.