Utility of Prolonged Beta-lactam Infusions in Children with Bacterial Infections

A new study aimed to evaluate whether extended or continuous beta-lactam infusions (EI/CI) enhance clinical outcomes in children with bacterial infections. 

In this systematic review and meta-analysis, both observational and interventional studies comparing EI/CI with standard infusions in children under 18 years were included. Emphasis was granted to outcomes such as mortality, length of hospital or intensive care unit stay, microbiological cure, and clinical cure. Data were sourced from PubMed, Medline, EBM Reviews, EMBASE, and CINAHL, covering January 1980 to November 2023. Thirteen studies involving 2,945 patients were analyzed – five randomized controlled trials (RCTs) and eight observational studies. These studies varied in indications and severity, including conditions like cystic fibrosis exacerbation and severe bacteremia.

It was found that EI/CI did not significantly reduce mortality in RCTs (n=1464), but observational studies (n=833) indicated a reduction. There was no difference in the length of hospital stay between the groups. The findings on clinical and microbiological cure rates were mixed and reported narratively. 

From the results, it was concluded that while observational studies suggest that prolonged beta-lactam infusions might reduce mortality, RCTs do not confirm this benefit. The evidence quality is inadequate for definitive recommendations. Further high-quality RCTs are needed, particularly for high-risk pediatric populations, to assess the efficacy of EI/CI more accurately.

Source: Briand A, Bernier L, Pincivy A, et al. The Journal of Pediatrics. 2024 Aug 2:114220.