Should β-lactam antibiotics be administered by continuous infusion in critically ill patients? A survey of Australia and New Zealand intensive care unit doctors and pharmacists
Should β-lactam antibiotics be administered by continuous infusion in critically ill patients? A survey of Australia and New Zealand intensive care unit doctors and pharmacists
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DOI：
10.1016/j.ijantimicag.2016.02.017
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发表时间：
2016-06-01
影响因子：
10.8
通讯作者：
Lipman, Jeffrey
中科院分区：
文献类型：
--
作者：
Cotta, Menino O.;Dulhunty, Joel M.;Lipman, Jeffrey
虽然有连续或延长输注β-内酰胺类抗生素的生物学先例，但与间歇给药相比，没有明确的生存获益证据。本研究的目的是探讨临床医生对连续输注β-内酰胺类抗生素给药的不确定性。对澳大利亚和新西兰重症监护室（ICU）的医生和药剂师进行了调查，以调查当前β-内酰胺类抗生素给药实践以及两种常用广谱β-内酰胺类药物（美罗培南和哌拉西林/他唑巴坦（TZP））持续输注获益的不确定程度。共有111人参加了调查。间歇输注被报告为美罗培南（73.9%）和TZP（82.0%）的标准实践。药师认为持续输注比间断给药更有效的比例高于医生（分别为85.4%和34.3%; P < 0.001）。两组均报告不确定连续输注给药是否会导致更好的患者结局（分别为65.9%和74.6%; P = 0.85）。总体而言，91.0%的受访者准备招募合格患者参加一项关于β-内酰胺类抗生素给药的确定性随机对照试验。总之，在澳大利亚和新西兰ICU工作的临床医生中，对于连续输注给药是否能为重症患者提供生存获益，存在平衡。(C)2016 Elsevier B. V.和国际化疗学会。All rights reserved.
Although there is a biological precedent for administration of beta-lactam antibiotics by continuous or extended infusion, there is no definitive evidence of a survival benefit compared with intermittent administration. The aim of this study was to explore clinician uncertainty with regard to the administration of beta-lactam antibiotics by continuous infusion. Doctors and pharmacists in Australian and New Zealand intensive care units (ICUs) were surveyed to investigate current beta-lactam antibiotic administration practices as well as the degree of uncertainty regarding the benefit of continuous infusion of two commonly used broad-spectrum beta-lactams, namely meropenem and piperacillin/tazobactam (TZP). There were 111 respondents to the survey. Intermittent infusion was reported as standard practice for meropenem (73.9%) and TZP (82.0%). A greater proportion of pharmacists compared with doctors believed continuous infusion to be more effective than intermittent administration (85.4% vs. 34.3%, respectively; P < 0.001). Both groups reported uncertainty as to whether administration by continuous infusion resulted in better patient outcomes (65.9% and 74.6%, respectively; P = 0.85). Overall, 91.0% of respondents were prepared to enrol eligible patients into a definitive randomised controlled trial on beta-lactam antibiotic administration. In conclusion, there is equipoise among clinicians working in Australian and New Zealand ICUs as to whether administration by continuous infusion offers a survival benefit in critically ill patients. (C) 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.