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Meta-Analysis
. 2025 Sep 26;25(1):1138.
doi: 10.1186/s12879-025-11504-2.

Continuous versus intermittent infusion of β-lactams in patients with sepsis and septic shock: a systematic review and meta-analysis

David A Tejada  1 , Hazel C García  1 , Eduardo Tomás-Alvarado  2 , Judith Yangali-Vicente  3 , Oriana Rivera-Lozada  4 , Joshuan J Barboza  5
Affiliations
Meta-Analysis

Continuous versus intermittent infusion of β-lactams in patients with sepsis and septic shock: a systematic review and meta-analysis

David A Tejada et al. BMC Infect Dis. .

Abstract

Objective: To assess whether continuous infusion of β-lactam antibiotics improves clinical outcomes compared to intermittent infusion in adult patients with sepsis or septic shock.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing continuous versus intermittent β-lactam infusion. Databases searched included PubMed, Scopus, Web of Science, and Embase. Risk of bias was assessed using the RoB 2.0 tool, and the certainty of evidence was evaluated using GRADE.

Results: Eleven studies involving 9,166 patients were analyzed, comparing continuous versus intermittent infusion of β-lactams in sepsis or septic shock. There was no significant difference in overall mortality (RR 0.94; 95% CI: 0.88-1.01) or ICU mortality (RR 0.94; 95% CI: 0.88-1.01). Continuous infusion was associated with lower hospital mortality (RR 0.92; 95% CI: 0.85-0.99), higher survival at the end of the study (RR 1.04; 95% CI: 1.02-1.07), and higher clinical cure rate (RR 1.42; 95% CI: 1.12-1.80). No significant differences were observed in the length of stay in the ICU (MD 0.75 days; 95% CI: -1.17 to 2.68) or hospital stay (MD -2.51 days; 95% CI: -10.13 to 5.12), or in the adverse events (RR 0.82; 95% CI: 0.60-1.12).

Conclusion: Continuous infusion of β-lactams could reduce hospital mortality and increase the clinical cure rate in critically ill patients, although its effect on overall mortality, hospital stay, and adverse events remains uncertain. PROSPERO number: CRD42024613938.

Keywords: Beta lactam antibiotics; Continuous infusion; Intermittent infusion; Sepsis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: All authors consent to the publication of the manuscript. Competing interests: The authors declare that they have no competing interests. Clinical trial: Not applicable.

Figures

Fig. 1
Fig. 1
PRISMA 2020 Flow chart. Flow chart of selection of studies
Fig. 2
Fig. 2
Risk of bias assessment
Fig. 3
Fig. 3
Effect of continuous infusion on primary outcomes: (a) APACHE II, (b) All-cause mortality.
Fig. 4
Fig. 4
Effect of continuous infusion on secondary outcomes: (a) length of ICU stay; (b) Length of hospital stay; (c) ICU survivors; (d) Hospital survivors
Fig. 5
Fig. 5
Effect of continuous infusion on secondary outcomes: (a) Clinical cure, (b) Adverse events
Fig. 6
Fig. 6
Effect of continuous infusion on secondary outcomes: a) survival at study completion
See this image and copyright information in PMC

References

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