Prolonged Versus Intermittent Beta-Lactam Antibiotic Infusions in Paediatric Critical Care: A Systematic Review and Meta-Analysis.

OBJECTIVE

In paediatric intensive care units (PICUs), beta-lactam antibiotic administration is often suboptimal, placing critically ill children at risk. We aimed to investigate the mortality, PICU length of stay, and pharmacokinetic/pharmacodynamic (PK/PD) benefits of prolonged beta-lactam infusions in PICU compared to intermittent infusions.

METHODS

A systematic review was conducted to identify studies investigating prolonged infusions compared to intermittent infusions. Studies were sourced from a previously published review and a systematic search of MEDLINE, Cochrane, Embase and Web of Science databases. Case reports, case series, systematic reviews and non-English language reports were excluded (PROSPERO CRD 42022375397). A meta-analysis with odds ratios (OR) and 95% confidence intervals (CIs) was conducted. When insufficient data were available, a descriptive analysis was undertaken. Risk of bias was assessed using the Robins-I tool.

RESULTS

In total, 566 studies were screened, of which 10 studies were included in the systematic review. All studies were observational, with sample sizes from 21 to 174 PICU patients (median 76; IQR 33-156). There was no reduction in mortality (N = 6 studies; OR 0.60; 95% CI 0.24, 1.51; I 2 = 40%) in the prolonged infusion group compared to the intermittent group. There was insufficient data to perform further meta-analyses. The risk of bias was high and the overall quality of evidence was low.

CONCLUSIONS

Available studies on prolonged infusions of beta lactams in PICU patients are limited and of low quality. Further research is needed to assess for clinical benefits associated with prolonged beta-lactam infusions for treatment of severe infection.