Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis

Abdul-Aziz MH 1 , Sulaiman H 2 , Mat-Nor MB 3 , Rai V 4 , Wong KK 4 , Hasan MS 4 Show all authors , Abd Rahman AN 5 , Jamal JA 6 , Wallis SC 7 , Lipman J 7 , Staatz CE 8 , Roberts JA 9

Affiliations 

  • 1 Burns, Trauma and Critical Care Research Centre, Level 3, Ned Hanlon Building, Royal Brisbane and Women's Hospital, The University of Queensland, Herston, QLD, 4029, Australia. mohd.abdulaziz1@uqconnect.edu.au
  • 2 Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Department of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
  • 4 Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 5 School of Pharmacy, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia
  • 6 Department of Pharmacy, Hospital Tengku Ampuan Afzan, Kuantan, Malaysia
  • 7 Burns, Trauma and Critical Care Research Centre, Level 3, Ned Hanlon Building, Royal Brisbane and Women's Hospital, The University of Queensland, Herston, QLD, 4029, Australia
  • 8 School of Pharmacy, The University of Queensland, Brisbane, Australia
  • 9 Burns, Trauma and Critical Care Research Centre, Level 3, Ned Hanlon Building, Royal Brisbane and Women's Hospital, The University of Queensland, Herston, QLD, 4029, Australia. j.roberts2@uq.edu.au
Intensive Care Med, 2016 Oct;42(10):1535-1545.
PMID: 26754759 DOI: 10.1007/s00134-015-4188-0

Abstract

PURPOSE: This study aims to determine if continuous infusion (CI) is associated with better clinical and pharmacokinetic/pharmacodynamic (PK/PD) outcomes compared to intermittent bolus (IB) dosing in critically ill patients with severe sepsis.

METHODS: This was a two-centre randomised controlled trial of CI versus IB dosing of beta-lactam antibiotics, which enrolled critically ill participants with severe sepsis who were not on renal replacement therapy (RRT). The primary outcome was clinical cure at 14 days after antibiotic cessation. Secondary outcomes were PK/PD target attainment, ICU-free days and ventilator-free days at day 28 post-randomisation, 14- and 30-day survival, and time to white cell count normalisation.

RESULTS: A total of 140 participants were enrolled with 70 participants each allocated to CI and IB dosing. CI participants had higher clinical cure rates (56 versus 34 %, p = 0.011) and higher median ventilator-free days (22 versus 14 days, p MIC than the IB arm on day 1 (97 versus 70 %, p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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