Evidence map›Paper›PMID 26200166›Full record

Trial reportAmerican journal of respiratory and critical care medicine2015

A Multicenter Randomized Trial of Continuous versus Intermittent β-Lactam Infusion in Severe Sepsis.

Joel M Dulhunty, Jason A Roberts, Joshua S Davis, Steven A R Webb, Rinaldo Bellomo, Charles Gomersall, Charudatt Shirwadkar, Glenn M Eastwood, John Myburgh, David L Paterson and 4 more

Abstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in American journal of respiratory and critical care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 128 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
128citing papers in PubMed, 10 pooled it
26.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

128 citing papers in PubMed, 10 syntheses or guidelines pooled it, 262 citations in OpenAlex.

  1. Pooled it
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  10. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016
    Guideline
  11. Trial
  12. Trial
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  14. Clinical outcomes of extended versus intermittent administration of piperacillin/tazobactam for the treatment of hospital-acquired pneumonia: a randomized controlled trial.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2017
    Trial
  15. Review
  16. Article
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68 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 8 institutions in 3 countries.

Joel M Dulhunty1 Department of Intensive Care Medicine.ORCID 0000-0002-4524-0548
Jason A Roberts1 Department of Intensive Care Medicine.ORCID 0000-0001-6218-435X
Joshua S Davis4 Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
Steven A R Webb6 Department of Intensive Care, Royal Perth Hospital, Perth, Australia.
Rinaldo Bellomo8 Department of Intensive Care, Austin Hospital, Melbourne, Australia.
Charles Gomersall10 Prince of Wales Hospital, Hong Kong.
Charudatt Shirwadkar12 Department of Intensive Care, Blacktown Hospital, Blacktown, Australia.
Glenn M Eastwood8 Department of Intensive Care, Austin Hospital, Melbourne, Australia.
John Myburgh13 Critical Care and Trauma Division, The George Institute for Global Health, Sydney, Australia.
David L Paterson15 Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Therese Starr1 Department of Intensive Care Medicine.
Sanjoy K Paul17 Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Australia.ORCID 0000-0003-0848-7194
Jeffrey Lipman1 Department of Intensive Care Medicine.
BLING II Investigators for the ANZICS Clinical Trials Group *
The University of Queensland · AUAustin Hospital · AUBlacktown & Mount Druitt Hospital · AUChinese University of Hong Kong · HKJohn Hunter Hospital · AUQIMR Berghofer Medical Research Institute · AUThe University of Western Australia · AUUNSW Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

rationaleContinuous infusion of β-lactam antibiotics may improve outcomes because of time-dependent antibacterial activity compared with intermittent dosing.

objectivesTo evaluate the efficacy of continuous versus intermittent infusion in patients with severe sepsis.

methodsWe conducted a randomized controlled trial in 25 intensive care units (ICUs). Participants commenced on piperacillin-tazobactam, ticarcillin-clavulanate, or meropenem were randomized to receive the prescribed antibiotic via continuous or 30-minute intermittent infusion for the remainder of the treatment course or until ICU discharge. The primary outcome was the number of alive ICU-free days at Day 28. Secondary outcomes were 90-day survival, clinical cure 14 days post antibiotic cessation, alive organ failure-free days at Day 14, and duration of bacteremia. MEASUREMENTS AND MAIN

resultsWe enrolled 432 eligible participants with a median age of 64 years and an Acute Physiology and Chronic Health Evaluation II score of 20. There was no difference in ICU-free days: 18 days (interquartile range, 2-24) and 20 days (interquartile range, 3-24) in the continuous and intermittent groups (P = 0.38). There was no difference in 90-day survival: 74.3% (156 of 210) and 72.5% (158 of 218); hazard ratio, 0.91 (95% confidence interval, 0.63-1.31; P = 0.61). Clinical cure was 52.4% (111 of 212) and 49.5% (109 of 220); odds ratio, 1.12 (95% confidence interval, 0.77-1.63; P = 0.56). There was no difference in organ failure-free days (6 d; P = 0.27) and duration of bacteremia (0 d; P = 0.24).

conclusionsIn critically ill patients with severe sepsis, there was no difference in outcomes between β-lactam antibiotic administration by continuous and intermittent infusion. Australian New Zealand Clinical Trials Registry number (ACT RN12612000138886).

Indexed as

AgedAnti-Bacterial Agentsbeta-LactamsDouble-Blind MethodDrug Administration ScheduleFemaleHumansInfusions, IntravenousLength of StayMaleMiddle AgedProspective StudiesSepsisSurvival AnalysisTreatment OutcomeAnti-Bacterial Agentsbeta-Lactamsantibioticclinical outcomeintensive carepharmacodynamicspharmacokinetics

Identifiers

PMID26200166
OpenAlexW1933142041

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.