{"id":26261,"date":"2024-06-20T04:20:00","date_gmt":"2024-06-19T20:20:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26261"},"modified":"2024-06-20T04:30:26","modified_gmt":"2024-06-19T20:30:26","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%bb%b6%e9%95%bf%e6%88%96%e9%97%b4%e6%96%ad%e8%be%93%e6%b3%a8%ce%b2-%e5%86%85%e9%85%b0%e8%83%ba%e7%b1%bb%e6%8a%97%e7%94%9f%e7%b4%a0%e6%b2%bb","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26261","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u5ef6\u957f\u6216\u95f4\u65ad\u8f93\u6ce8\u03b2-\u5185\u9170\u80fa\u7c7b\u6297\u751f\u7d20\u6cbb\u7597\u6210\u5e74\u8113\u6bd2\u75c7\u6216\u611f\u67d3\u6027\u4f11\u514b\u60a3\u8005"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

June 12, 2024<\/p>\n\n\n\n

Prolonged vs Intermittent Infusions of \u03b2-Lactam Antibiotics in Adults With Sepsis or Septic Shock: A Systematic Review and Meta-Analysis<\/h1>\n\n\n\n

Mohd H.\u00a0Abdul-Aziz,\u00a0Naomi E.\u00a0Hammond,\u00a0Stephen J.\u00a0Brett,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online June 12, 2024. doi:10.1001\/jama.2024.9803<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Does the administration of \u03b2-lactam antibiotics by prolonged infusion reduce 90-day mortality compared with intermittent infusion in adult patients with sepsis or septic shock?<\/p>\n\n\n\n

Findings<\/strong>  This systematic review and bayesian meta-analysis of 18 randomized trials that included 9108 critically ill adults with sepsis or septic shock reported a 99.1% posterior probability that prolonged infusions were associated with lower 90-day mortality compared with intermittent infusions (risk ratio, 0.86).<\/p>\n\n\n\n

Meaning<\/strong>  Prolonged infusions of \u03b2-lactam antibiotics are associated with a reduced risk of death in critically ill adult patients with sepsis or septic shock compared with intermittent infusions.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  There is uncertainty about whether prolonged infusions of \u03b2-lactam antibiotics improve clinically important outcomes in critically ill adults with sepsis or septic shock.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether prolonged \u03b2-lactam antibiotic infusions are associated with a reduced risk of death in critically ill adults with sepsis or septic shock compared with intermittent infusions.<\/p>\n\n\n\n

Data Sources<\/strong>  The primary search was conducted with MEDLINE (via PubMed), CINAHL, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from inception to May 2, 2024.<\/p>\n\n\n\n

Study Selection<\/strong>  Randomized clinical trials comparing prolonged (continuous or extended) and intermittent infusions of \u03b2-lactam antibiotics in critically ill adults with sepsis or septic shock.<\/p>\n\n\n\n

Data Extraction and Synthesis<\/strong>  Data extraction and risk of bias were assessed independently by 2 reviewers. Certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. A bayesian framework was used as the primary analysis approach and a frequentist framework as the secondary approach.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was all-cause 90-day mortality. Secondary outcomes included intensive care unit (ICU) mortality and clinical cure.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0From 18 eligible randomized clinical trials that included 9108 critically ill adults with sepsis or septic shock (median age, 54 years; IQR, 48-57; 5961 men [65%]), 17 trials (9014 participants) contributed data to the primary outcome. The pooled estimated risk ratio for all-cause 90-day mortality for prolonged infusions of \u03b2-lactam antibiotics compared with intermittent infusions was 0.86 (95% credible interval, 0.72-0.98;\u00a0I<\/em>2<\/sup>\u2009=\u200921.5%; high certainty), with a 99.1% posterior probability that prolonged infusions were associated with lower 90-day mortality. Prolonged infusion of \u03b2-lactam antibiotics was associated with a reduced risk of intensive care unit mortality (risk ratio, 0.84; 95% credible interval, 0.70-0.97; high certainty) and an increase in clinical cure (risk ratio, 1.16; 95% credible interval, 1.07-1.31; moderate certainty).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among adults in the intensive care unit who had sepsis or septic shock, the use of prolonged \u03b2-lactam antibiotic infusions was associated with a reduced risk of 90-day mortality compared with intermittent infusions. The current evidence presents a high degree of certainty for clinicians to consider prolonged infusions as a standard of care in the management of sepsis and septic shock.<\/p>\n\n\n\n

Trial Registration<\/strong>  PROSPERO Identifier: CRD42023399434<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26261"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26261"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26261\/revisions"}],"predecessor-version":[{"id":26262,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26261\/revisions\/26262"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26261"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26261"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26261"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}