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. 2024 Mar 8:15:1337570.
doi: 10.3389/fmicb.2024.1337570. eCollection 2024.

Mortality of continuous infusion versus intermittent bolus of meropenem: a systematic review and meta-analysis of randomized controlled trials

Ming-Ying Ai  1 , Wei-Lun Chang  1 , Chia-Ying Liu  2
Affiliations

Mortality of continuous infusion versus intermittent bolus of meropenem: a systematic review and meta-analysis of randomized controlled trials

Ming-Ying Ai et al. Front Microbiol. .

Abstract

Background: Meropenem belongs to the carbapenem class, which is categorized as beta-lactam antibiotics. These antibiotics are administered in intermittent bolus doses at specific time intervals. However, the continuous infusion approach ensures sustained drug exposure, maintaining the drug concentration above the minimum inhibitory concentration (MIC) throughout the entire treatment period. This study aimed to find out the association between continuous infusions of meropenem and mortality rates.

Materials and methods: We conducted a search of the PubMed/Medline, EMBASE, Cochrane Central, and ClinicalTrials.gov databases up to 14 August 2023. The six randomized controlled trials (RCTs) were identified and included in our analysis. The random-effects model was implemented using Comprehensive Meta-Analysis software to examine the outcomes.

Results: Our study included a total of 1,529 adult patients from six randomized controlled trials. The primary outcome indicated that continuous infusion of meropenem did not lead to reduction in the mortality rate (odds ratio = 0.844, 95% CI: 0.671-1.061, P =0.147). Secondary outcomes revealed no significant differences in ICU length of stay (LOS), ICU mortality, clinical cure, or adverse events between continuous infusion and traditional intermittent bolus strategies of meropenem. Notably, we observed significant improvements in bacterial eradication (odds ratio 19 = 2.207, 95% CI: 1.467-3.320, P < 0.001) with continuous infusion of meropenem. Our study also suggested that performing continuous infusion may lead to better bacterial eradication effects in resistant pathogens (coefficient: 2.5175, P = 0.0138*).

Conclusion: Continuous infusion of meropenem did not result in the reduction of mortality rates but showed potential in improving bacterial eradication. Furthermore, this strategy may be particularly beneficial for achieving better bacterial eradication, especially in cases involving resistant pathogens.

Keywords: bacterial eradication; continuous infusion; meropenem; mortality; resistant pathogens.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
A summary of quality assessment of studies included in the meta-analysis using the Cochrane risk-of-bias 2 tool.
Figure 3
Figure 3
The forest plot of continuous infusion and intermittent bolus with mortality.
Figure 4
Figure 4
Sensitivity analysis of continuous infusion and intermittent bolus with mortality utilizing the one-study removal method.
Figure 5
Figure 5
The funnel plot of continuous infusion and intermittent bolus with mortality.
Figure 6
Figure 6
The forest plot of continuous infusion and intermittent bolus with mortality in the subgroup.
Figure 7
Figure 7
Regression between continuous infusion dosage and mortality.
Figure 8
Figure 8
The forest plot of continuous infusion and intermittent bolus with clinical success.
Figure 9
Figure 9
The forest plot of continuous infusion and intermittent bolus with bacteria eradication.
Figure 10
Figure 10
The forest plot of continuous infusion and intermittent bolus with serious adverse effects.
Figure 11
Figure 11
Regression between resistant pathogen (%) and mortality.
Figure 12
Figure 12
Regression between resistant pathogen (%) and bacterial eradication.
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