Factors associated with the decision to administer β-lactams via prolonged infusion in patients with sepsis: a prospective observational cohort study.

Objective: β-lactams are the most widely used antibiotics in sepsis. We aimed to explore the factors that drive physicians to choose prolonged infusion (PI) of β-lactams in septic patients.

Methods: This prospective observational national cohort study was conducted in 40 ICUs at the teaching hospitals of 31 provinces in China between August 20, 2021 and September 20, 2021.

Results: Of the 441 enrolled patients, 265 (60.09%) received PI therapy. Multivariate analysis showed that multidrug-resistant bacterial infection and septic shock were independent factors associated with PI. However, our data showed that the survival benefit of PI use was evident in subgroups with less severe sepsis, including those with lower Charlson comorbidity index values (<2), those without septic shock, and those with lower acute physiology and chronic health evaluation II scores (<15). Univariate and multivariate Cox regression indicated that PI was an independent protective factor of 28d mortality, even after adjusting the variables associated with disease severity.

Conclusions: PI for administering β-lactams was not a commonly applied strategy in sepsis and was more likely to be used in severely ill patients. However, PI had a survival benefit independent of disease severity.