Palavras-chave
Infusão intermitente
Sepse
Como Citar
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Resumo
Objetivo: Avaliar a eficácia da infusão contínua e intermitente de antibióticos beta-lactâmicos no manejo da sepse. Métodos: Trata-se de uma revisão integrativa cujo principal objetivo foi encontrar evidências sobre a infusão contínua e intermitente de antibióticos no manejo da sepse, considerando mortalidade, tempo de recuperação e prevenção da resistência bacteriana. Foram utilizadas as palavras-chave “sepsis” OR “sepsis shock” AND “prolonged infusion” OR “intermittent infusion” OR “short-term”. As buscas foram realizadas na base de dados PubMed Central, resultando em um total de 306 artigos que foram submetidos aos critérios de seleção. Após a aplicação desses critérios, 20 artigos foram selecionados para o desenvolvimento do presente estudo. Resultados: Dos 20 artigos analisados, encontramos estudos que demonstram que a infusão prolongada teve mais benefícios que a infusão intermitente, estudos que não conseguiram demonstrar diferenças significativas, estudos que analisaram doses-alvo de diferentes antibióticos, e um estudo que analisou os efeitos da administração prolongada de beta-lactâmicos. Considerações finais: Constatou-se que, a infusão prolongada de antibióticos beta-lactâmicos mostra benefícios em pacientes com sepse grave, como redução da mortalidade e resistência bacteriana, mas ainda há discordância sobre sua superioridade, exigindo mais pesquisas para comprovar sua eficácia.
Referências
ABDUL-AZIZ MH, et al. 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. Intensive care medicine, 2016; 42: 1535-1545.
ÁLVAREZ-MORENO CA, et al. Efficacy of Continuous vs. Intermittent Administration of Cefepime in Adult ICU Patients with Gram-Negative Bacilli Bacteremia: A Randomized Double-Blind Clinical Study. Antibiotics, 2024; 13(3): 229.
BARTON GJ. A survey of antibiotic administration practices involving patients with sepsis in UK critical care units. International Journal of Clinical Pharmacy, 2020; 42(1): 65-71.
CAO G, et al. Extended infusion of meropenem in neonatal sepsis: A historical cohort study. Antibiotics, 2022; 11(3): 341.
CHEN CHANGHUA CCH, et al. Continuous versus intermittent infusions of antibiotics for the treatment of infectious diseases: meta-analysis and systematic review. 2019; 14632.
CHEN P, et al. Clinical outcomes of continuous vs intermittent meropenem infusion for the treatment of sepsis: A systematic review and meta-analysis. Advances in Clinical & Experimental Medicine, 2020; 29(8).
DULHUNTY JM, et al. A multicenter randomized trial of continuous versus intermittent β-lactam infusion in severe sepsis. American journal of respiratory and critical care medicine, 2015; 192(11): 1298-1305.
DUSZYNSKA W, et al. Continuous vs. intermittent vancomycin therapy for Gram-positive infections not caused by methicillin-resistant Staphylococcus aureus. Minerva anestesiologica, 2015; 82(3): 284-293.
GARREAU R, et al. Population pharmacokinetics and dosing simulation of vancomycin administered by continuous injection in critically ill patient. Antibiotics, 2021; 10(10): 1228.
GWEE A, et al. Protocol for a randomised controlled trial of continuous infusions of vancomycin to improve the attainment of target vancomycin levels in young infants: The VANC trial. BMJ open, 2018; 8(11): 22603.
HANRAHAN T, et al. Vancomycin-associated nephrotoxicity: a meta-analysis of administration by continuous versus intermittent infusion. International journal of antimicrobial agents, 2015; 46(3): 249-253.
HUI LA, et al. Linezolid administration to critically ill patients: intermittent or continuous infusion? A systematic literature search and review. Antibiotics, 2022; 11(4): 436.
JAMAL JA, et al. Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: a randomised controlled trial of continuous infusion versus intermittent bolus administration. International journal of antimicrobial agents, 2015; 46(1): 39-44.
KARABA SM, et al. Extended-infusion β-lactam therapy, mortality, and subsequent antibiotic resistance among hospitalized adults with gram-negative bloodstream infections. JAMA Network Open, 2024; 7(7): 2418234-2418234.
KONDO Y, et al. Prolonged versus intermittent β-lactam antibiotics intravenous infusion strategy in sepsis or septic shock patients: a systematic review with meta-analysis and trial sequential analysis of randomized trials. Journal of Intensive Care, 2020; 8: 1-11.
LI X, et al. Prolonged vs intermittent intravenous infusion of β-lactam antibiotics for patients with sepsis: a systematic review of randomized clinical trials with meta-analysis and trial sequential analysis. Annals of Intensive Care, 2023; 13(1): 121.
OSTHOFF M, et al. Prolonged administration of β-lactam antibiotics–a comprehensive review and critical appraisal. Swiss medical weekly, 2016; 146(4142): 14368-14368.
RAFAILIDIS PI e FALAGAS ME. Benefits of prolonged infusion of beta-lactam antibiotics in patients with sepsis: personal perspectives. Expert Review of Anti-infective Therapy, 2020; 18(10): 957-966.
RICHTER DC, et al. Prolonged infusion of β-Lactams decreases mortality in patients with septic shock: a retrospective before-and-after study. Antibiotics, 2021; 10(6): 687.
ROBERTS JA, et al. Continuous versus intermittent β-lactam infusion in severe sepsis. A meta-analysis of individual patient data from randomized trials. American journal of respiratory and critical care medicine, 2016; 194(6): 681-691.
SJÖVALL F, et al. Maximally effective dosing regimens of meropenem in patients with septic shock. Journal of Antimicrobial Chemotherapy, 2018; 73(1): 191-198.
TILANUS A e DRUSANO G. Optimizing the use of beta-lactam antibiotics in clinical practice: a test of time. In: Open Forum Infectious Diseases. US: Oxford University Press, 2023; 10(7): 305.
VARDAKAS KZ, et al. Prolonged versus short-term intravenous infusion of antipseudomonal β-lactams for patients with sepsis: a systematic review and meta-analysis of randomised trials. The Lancet infectious diseases, 2018; 18(1): 108-120.
WINISZEWSKI H, et al. β-lactam dosing at the early phase of sepsis: performance of a pragmatic protocol for target concentration achievement in a prospective cohort study. Journal of Critical Care, 2022; 67: 141-146.
WU CC, et al. Loading dose and efficacy of continuous or extended infusion of beta‐lactams compared with intermittent administration in patients with critical illnesses: A subgroup meta‐analysis and meta‐regression analysis. Journal of Clinical Pharmacy and Therapeutics, 2021; 46(2): 424-432.
ZHAO HY, et al. Pharmacokinetic and pharmacodynamic efficacies of continuous versus intermittent administration of meropenem in patients with severe sepsis and septic shock: a prospective randomized pilot study. Chinese medical journal, 2017; 130(10): 1139-1145.