The DALI study: defining antibiotic levels in intensive care unit patients: prolonged infusion of beta-lactam antibiotics in critically ill patients
Background – The aim of this study was to determine whether there is any pharmacokinetic and/or clinical advantage associated with the administration of beta-lactam antibiotics by prolonged infusion (PI; continuous or extended-infusion) compared to intermittent bolus (IB) dosing in critically ill p...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Conference or Workshop Item |
| Language: | English English |
| Published: |
2013
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/36784/ http://irep.iium.edu.my/36784/ http://irep.iium.edu.my/36784/4/the_DALI.pdf http://irep.iium.edu.my/36784/7/ICAAC_2013_DALI_Poster_PI_v_IB_Finalv2.pdf |
| Summary: | Background – The aim of this study was to determine whether there is any pharmacokinetic and/or clinical advantage associated with the administration of beta-lactam antibiotics by prolonged infusion (PI; continuous or extended-infusion) compared to intermittent bolus (IB) dosing in critically ill patients.
Methods - This report is part of the multi-national DALI study which included 68 intensive care units (ICU) throughout Europe. This study was a pharmacokinetic point-prevalence study, that was performed to describe concentrations of 3 beta-lactam antibiotics at two specified time-points. Differences in plasma antibiotic concentrations and clinical outcomes between PI and IB were assessed by using univariate and multivariate analyses.
Results – This study included 224 critically ill patients whereby 63% and 37% of them received beta-lactam antibiotics via IB and PI dosing, respectively. IB dosing was preferred for piperacillin (IB 61% vs. PI 39%) and meropenem (IB 70% vs. PI 30%). The frequency of use of PI differed significantly between countries. PI demonstrated consistently higher drug concentrations compared to IB dosing. Clinical cure (IB 66% vs. PI 62%, p = 0.63), mortality (IB 28% vs. PI 30%, p = 0.87) and infection-related mortality rates (IB 22% vs. PI 17%, p = 0.288) were similar between PI and IB. Multiple regression analyses suggested that mortality was significantly predicted by SOFA score (OR = 1.10, 95% CI 1.00-1.21) and clinical cure (OR = 0.12, 95% CI 0.06-0.28). Only SOFA score predicted clinical cure (OR = 0.89, 95% CI 0.82-0.96).
Conclusions – PI of beta-lactams is as effective as the traditional IB dosing in critically ill patients.
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