Correspondence discusses BLING III's findings on continuous vs. intermittent infusion in sepsis patients, suggesting implications for antimicrobial resistance.
<ns3:p>This correspondence discusses the BLING III study by Dulhunty and colleagues, which reported no difference in 90-day mortality between continuous and intermittent infusions of β-lactam antibiotics in critically ill patients with sepsis. Both this study and subsequent meta-analysis are in favor of continuous infusions for the potential benefits of secondary endpoints though the primary endpoints is not significant. We elaborate that continuous infusion of time-dependent antimicrobials might result in treatment failure as well as the emergence of antimicrobial resistance if the steady state concentration is below the desired target. That might be a potential explanation of the negative results observed in BLING III and other studies. In our opinion, extended or prolonged infusion of β-lactams (over 3 hours) might provide a better target attainment, even without therapeutic drug monitoring.</ns3:p>
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Li et al. (2025) studied this question.
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