Evidence map›Paper›PMID 26754759›Full record

Trial reportIntensive care medicine2016

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.

Mohd H Abdul-Aziz, Helmi Sulaiman, Mohd-Basri Mat-Nor, Vineya Rai, Kang K Wong, Mohd S Hasan, Azrin N Abd Rahman, Janattul A Jamal, Steven C Wallis, Jeffrey Lipman and 2 more

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 150 papers, 14 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
150citing papers in PubMed, 14 pooled it
40.4field-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

150 citing papers in PubMed, 14 syntheses or guidelines pooled it, 312 citations in OpenAlex.

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  15. 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
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90 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 2 countries.

Mohd H Abdul-AzizBurns, 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.
Helmi SulaimanInfectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Mohd-Basri Mat-NorDepartment of Anaesthesiology and Intensive Care, School of Medicine, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia.
Vineya RaiDepartment of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Kang K WongDepartment of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Mohd S HasanDepartment of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Azrin N Abd RahmanSchool of Pharmacy, International Islamic University of Malaysia, Kuantan, Pahang, Malaysia.
Janattul A JamalDepartment of Pharmacy, Hospital Tengku Ampuan Afzan, Kuantan, Malaysia.
Steven C WallisBurns, 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.
Jeffrey LipmanBurns, 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.
Christine E StaatzSchool of Pharmacy, The University of Queensland, Brisbane, Australia.
Jason A RobertsBurns, 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.
University of Malaya · MYRoyal Brisbane and Women's Hospital · AUInternational Islamic University Malaysia · MYUniversity of Queensland · AUHospital Tengku Ampuan Afzan · MY

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis 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.

methodsThis 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.

resultsA 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 < 0.043) than IB participants. PK/PD target attainment rates were higher in the CI arm at 100 % fT >MIC than the IB arm on day 1 (97 versus 70 %, p < 0.001) and day 3 (97 versus 68 %, p < 0.001) post-randomisation. There was no difference in 14-day or 30-day survival between the treatment arms.

conclusionsIn critically ill patients with severe sepsis not receiving RRT, CI demonstrated higher clinical cure rates and had better PK/PD target attainment compared to IB dosing of beta-lactam antibiotics. Continuous beta-lactam infusion may be mostly advantageous for critically ill patients with high levels of illness severity and not receiving RRT. Malaysian National Medical Research Register ID: NMRR-12-1013-14017.

Indexed as

AdultAnti-Bacterial Agentsbeta-LactamsChi-Square DistributionCritical CareCritical IllnessFemaleHumansInfusions, IntravenousKaplan-Meier EstimateMaleMiddle AgedProspective StudiesSepsisStatistics, NonparametricAnti-Bacterial Agentsbeta-LactamsAntibioticsCritically illIntermittent bolusPharmacodynamicsPharmacokineticsProlonged infusion

Identifiers

PMID26754759
OpenAlexW2239960209

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.