Is there a role for continuous infusion of β-lactam antibiotics in severe sepsis?

Sepsis is a leading cause of mortality and morbidity in critical care (1,2). There is an expanding literature examining optimal administration of β-lactam antibiotics in critically ill patients (3,4). The bactericidal and broad spectrum nature of β-lactams make them attractive in patients with sepsis. The time-over-MIC dependent killing with β-lactams would suggest benefit with administration as continuous infusion instead of intermittent dosing, particularly given the fluid shifts that occur in critically ill patients (5-7). Meta-analysis of studies comparing continuous infusions of β-lactams to standard intermittent dosing in acute infections have failed to find a consistent clinical benefit in mortality, infection recurrence, clinical cure, super-infection post-therapy, and safety outcomes in both critically- and non-critically ill patients (3,4,8-10). The question remains whether patients with severe sepsis will benefit (11).