Efficacy and Nephrotoxicity of Extended versus Intermittent Infusion of Beta-Lactams for the Treatment of Ventilator Associated Pneumonia
Authors: Ali Rihan Bassel Fathalla , Nashed Sherif Wadie , Elagamy Ashraf El Sayed , Hassan Ramy Mohammed 
Published: November 2024

Abstract

Background
Patients in the intensive care unit (ICU) are at risk for dying not only from their critical illness but also from secondary processes such as nosocomial infection. Pneumonia is the second most common nosocomial infection in critically ill patients. Eighty-six percent of nosocomial pneumonias are associated with mechanical ventilation and are termed ventilator- associated pneumonia (VAP). Ventilator-associated pneumonia is defined as pneumonia occurring more than 48 h after patients have been intubated and received mechanical ventilation. Diagnosing VAP requires a high clinical suspicion combined with bedside examination, radiographic examination, and microbiologic analysis of respiratory secretions.

Aim of the Work
to compare the Efficacy and nephrotoxicity of extended versus intermittent infusion of beta-lactams for the treatment of ventilator associated pneumonia.

Patients and Methods
This Retrospective cohort study has been held in Intensive Care Units in Ain Shams University Hospitals on critically ill patients with ventilator associated pneumonia after applying exclusion criteria, in the period from April 2023 till December 2023. After approval of Ethical & Research committee of Ain Shams University.

Results
The current study results compared between the extended infusion group and the intermittent infusion group based on bacterial eradication, statistically significant differences were observed. In the extended infusion group, 70.0% of patients achieved bacterial eradication, whereas in the intermittent infusion group, only 45.0% achieved bacterial eradication. The p-value for this comparison was 0.024, indicating statistical significance. These findings suggest that patients in the extended infusion group had a higher rate of bacterial eradication compared to those in the intermittent infusion group. This implies that extended infusion of beta-lactam antibiotics may be more effective in eliminating bacteria associated with ventilator-associated pneumonia. The current study results compared between the extended infusion group and the intermittent infusion group based on the incidence of acute kidney injury (AKI), no statistically significant differences were observed. In the extended infusion group, 35.0% of patients experienced AKI, while in the intermittent infusion group, 40.0% experienced AKI. The p-value for this comparison was 0.644, indicating no significant difference. These findings suggest that there were similar incidences of AKI between the two infusion groups.

Conclusion
Our study comparing extended infusion versus intermittent infusion of beta-lactam antibiotics for the treatment of ventilator-associated pneumonia (VAP) has provided valuable insights. Extended infusion demonstrated superiority over intermittent infusion in terms of shorter time to normalization of white cell count and C-reactive protein, fewer ventilator days, increased ventilator-free days, higher rates of ICU survival, and improved bacterial eradication. However, there were no significant differences between the two groups2 regarding demographic data, comorbidities, microbiologic characteristics, minimum creatinine clearance reached, and incidence of acute kidney injury. These findings suggest that extended infusion of beta-lactam antibiotics may offer clinical benefits in the management of VAP, particularly in terms of efficacy and patient outcomes, without substantially increasing the risk of nephrotoxicity.