Extended or Continuous versus Short-term Intravenous Infusion of Meropenem/Imipenem for Severe Infection: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YAOLi ¹ , MAHong-xia ² , FANFang-fang ¹ , HULan ¹ ,  GAOZhen ³

1. Department of Clinical Pharmacy, Traditional Chinese Medical Hospital of XinJiang Uygur Autonomous Region, Urumqi 830000, China;
2. Department of Respiration, Traditional Chinese Medical Hospital of XinJiang Uygur Autonomous Region, Urumqi 830000, China;
3. National Clinical Research Base of TCM, Traditional Chinese Medical Hospital of XinJiang Uygur Autonomous Region, Urumqi 830000, China;

Corresponding author：

GAOZhen, Email: 709785841@qq.com

Keywords：

Meropenem; Imipenem; Prolonged infusion time; Severe infection; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20160015

Video：

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Objective To systematically review the efficacy and safety of extended or continuous intravenous infusion (EI/CI) versus short-term intravenous infusion (STI) of imipenem/meropenem in adult patients with severe lung infection. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015) and CBM from inception to June, 2015, to collect random controlled trials (RCTs) about EI/CI versus STI of imipenem/meropenem for severe infection. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 6 RCTs involving 442 patients were included. The results of meta-analysis showed that, compared with the STI group, the EI/CI could significantly improve the microbiological success rate (RR=1.16, 95%CI 1.02 to 1.32, P=0.02) without increasing adverse drug reaction (RR=0.99, 95%CI 0.65 to 1.52, P=0.97). There were no significant differences in clinical effective rate (RR=1.12, 95%CI 0.97 to 1.28, P=0.13), survival rate (RR=1.03, 95%CI 0.92 to 1.16, P=0.62) and hospital stays (MD=-0.43, 95%CI-1.29 to 0.42, P=0.32) between the two groups. Conclusion s There is no significant difference in clinical effect between EI/CI and STI for severe lung infection. While, the infections caused by gram-negative bacteria with high MIC could benefit more from EI/CI. Due to the limited quantity and quality of the included studies, the above conclusion still need to be further verified by more high quality studies.

Citation： YAOLi, MAHong-xia, FANFang-fang, HULan, GAOZhen. Extended or Continuous versus Short-term Intravenous Infusion of Meropenem/Imipenem for Severe Infection: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(1): 73-78. doi: 10.7507/1672-2531.20160015 Copy

1.	刘涛, 臧远胜, 修清玉. 碳青霉烯类抗生素研究进展. 中国新药与临床杂志, 2013, 32(12): 927-931.
2.	American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
3.	Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis, 2007, 44(Suppl2): S27-S72.
4.	曾宪涛, 包翠萍, 曹世义, 等. Meta分析系列之三: 随机对照试验的质量评价工具. 中国循证心血管医学杂志, 2012, 4(3): 183-185.
5.	王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
6.	Wang D. Experience with extended-infusion meropenem in the management of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii. Int J Antimicrob Agents, 2009, 33(3): 290-291.
7.	Chytra I, Stepan M, Benes J, et al. Clinical and microbiological efficacy of continuous versus intermittent application of meropenem in critically ill patients: a randomized open-label controlled trial. Crit Care, 2012, 16(3): R113.
8.	王振红, 单悌超, 刘宇, 等. 美罗培南3h和30min输注给药治疗重症监护病房患者医院获得性肺炎的随机对照临床研究. 中华危重病急救医学, 2014, 26(9): 644-649.
9.	Sakka SG, Glauner AK, Bulitta JB, et al. Population pharmacokinetics and pharmacodynamics of continuous versus short-term infusion of imipenem-cilastatin in critically ill patients in a randomized, controlled trial. Antimicrob Agents Chemother, 2007, 51(9): 3304-3310.
10.	李双玲, 王东信. 延长美罗培南输注时间治疗外科重症监护病房严重感染的临床研究. 中华医院感染学杂志, 2008, 18(9): 1306-1309.
11.	Okimoto N, Ishiga M, Nanba F, et al. Clinical effects of continuous infusion and intermittent infusion of meropenem on bacterial pneumonia in the elderly. Nihon Kokyuki Gakkai Zasshi, 2009, 47(7): 553-557.
12.	Jaruratanasirikul S, Sudsai T. Comparison of the pharmacodynamics of imipenem in patients with ventilator-associated pneumonia following administration by 2 or 0. 5 h infusion. J Antimicrob Chemother, 2009, 63(3): 560-563.
13.	Jaruratanasirikul S, Sriwiriyajan S, Punyo J. Comparison of the pharmacodynamics of meropenem in patients with ventilator-associated pneumonia following administration by 3-hour infusion or bolus injection. Antimicrob Agents Chemother, 2005, 49(4): 1337-1339.
14.	Falagas ME, Tansarli GS, Ikawa K, et al. Clinical outcomes with extended or continuous versus short-term intravenous infusion of carbapenems and piperacillin/tazobactam: a systematic review and meta-analysis. Clin Infect Dis, 2013, 56(2): 272-282.
15.	Lorente L, Lorenzo L, Martin M M, et al. Meropenem by continuous versus intermittent infusion in ventilator-associated pneumonia due to gram-negative bacilli. Ann Pharmacother, 2006, 40(2): 219-223.

1. 刘涛, 臧远胜, 修清玉. 碳青霉烯类抗生素研究进展. 中国新药与临床杂志, 2013, 32(12): 927-931.
2. American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
3. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis, 2007, 44(Suppl2): S27-S72.
4. 曾宪涛, 包翠萍, 曹世义, 等. Meta分析系列之三: 随机对照试验的质量评价工具. 中国循证心血管医学杂志, 2012, 4(3): 183-185.
5. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
6. Wang D. Experience with extended-infusion meropenem in the management of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii. Int J Antimicrob Agents, 2009, 33(3): 290-291.
7. Chytra I, Stepan M, Benes J, et al. Clinical and microbiological efficacy of continuous versus intermittent application of meropenem in critically ill patients: a randomized open-label controlled trial. Crit Care, 2012, 16(3): R113.
8. 王振红, 单悌超, 刘宇, 等. 美罗培南3h和30min输注给药治疗重症监护病房患者医院获得性肺炎的随机对照临床研究. 中华危重病急救医学, 2014, 26(9): 644-649.
9. Sakka SG, Glauner AK, Bulitta JB, et al. Population pharmacokinetics and pharmacodynamics of continuous versus short-term infusion of imipenem-cilastatin in critically ill patients in a randomized, controlled trial. Antimicrob Agents Chemother, 2007, 51(9): 3304-3310.
10. 李双玲, 王东信. 延长美罗培南输注时间治疗外科重症监护病房严重感染的临床研究. 中华医院感染学杂志, 2008, 18(9): 1306-1309.
11. Okimoto N, Ishiga M, Nanba F, et al. Clinical effects of continuous infusion and intermittent infusion of meropenem on bacterial pneumonia in the elderly. Nihon Kokyuki Gakkai Zasshi, 2009, 47(7): 553-557.
12. Jaruratanasirikul S, Sudsai T. Comparison of the pharmacodynamics of imipenem in patients with ventilator-associated pneumonia following administration by 2 or 0. 5 h infusion. J Antimicrob Chemother, 2009, 63(3): 560-563.
13. Jaruratanasirikul S, Sriwiriyajan S, Punyo J. Comparison of the pharmacodynamics of meropenem in patients with ventilator-associated pneumonia following administration by 3-hour infusion or bolus injection. Antimicrob Agents Chemother, 2005, 49(4): 1337-1339.
14. Falagas ME, Tansarli GS, Ikawa K, et al. Clinical outcomes with extended or continuous versus short-term intravenous infusion of carbapenems and piperacillin/tazobactam: a systematic review and meta-analysis. Clin Infect Dis, 2013, 56(2): 272-282.
15. Lorente L, Lorenzo L, Martin M M, et al. Meropenem by continuous versus intermittent infusion in ventilator-associated pneumonia due to gram-negative bacilli. Ann Pharmacother, 2006, 40(2): 219-223.

Chinese Journal of Evidence-Based Medicine

Extended or Continuous versus Short-term Intravenous Infusion of Meropenem/Imipenem for Severe Infection: A Meta-analysis

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