Sepsis Awareness Month: Highlighting the Findings from BLINGIII
Continuous antibiotic infusions show positive results and may improve outcomes for patients with severe sepsis.
In a study that could reshape sepsis management practices worldwide, the B-Lactam Antibiotic Infusion Trial (BLINGIII) has yielded findings that challenge existing protocols. Led by Jeffrey Lipman, MD, DMed(Res), an intensive care specialist and principal investigator of the trial, the research involved 7,200 patients and compared continuous versus intermittent infusions of b-lactam antibiotics.
While the primary analysis indicated no significant reduction in 90-day mortality between the two infusion methods, Lipman highlighted a key takeaway: “The primary analysis showed a 1.9% reduction, which did cross the unity line. Therefore, the conclusion may have been a bit negative, but if you read the data, the trial showed a significant improvement in outcomes compared to previous studies.”
The trial's findings are underscored by a systemic review of 18 trials encompassing 9,000 patients, which demonstrated that continuous infusions could improve mortality rates, requiring the treatment of 26 patients to save one life. Lipman emphasized the necessity of continuous infusions for patients with severe sepsis, predicting a global shift in sepsis management, “There will be changes throughout the world over time, and it will save thousands of lives.”
This conversation coincides with Sepsis Awareness Month, prompting critical conversations in intensive care units. Lipman posed a crucial question: “Is it only severe sepsis that needs continuous infusion, or should all patients with sepsis and some organ dysfunction have a continuous infusion introduced?” This inquiry could pave the way for broader adoption of continuous infusion practices in treating sepsis.
Lipman noted the slow but inevitable evolution of medical practice, stating, “I think there will be a change. It takes time for medical practice to change, but in previous guidelines, there was weak evidence that continuous infusions were beneficial. Now there is strong evidence.” He believes this evidence will lead to improvements in the lives of countless patients globally.
Additionally, Lipman addressed the complexities surrounding antibiotic administration in sepsis management. He pointed out that the current practice is often risk-averse, leading to unnecessary antibiotic use in patients who may not have a confirmed infection. “There will be changes over time in the diagnosis of sepsis, more definitively in the ICU, so that the appropriate antibiotics can be given only to those patients with sepsis,” he said.
He also challenged traditional beliefs regarding the duration of antibiotic courses, noting, “The long courses of antibiotics... are being challenged, and there will be shorter courses of antibiotics used worldwide.” This shift aims to mitigate antibiotic misuse and the subsequent rise of resistant organisms.
As the medical community explores new markers for sepsis, many of which are currently under investigation, Lipman remains hopeful about the future of sepsis treatment. “A better marker for sepsis is being investigated in many places, with some promising responses, but still, there isn't a good marker for a lot of patients with sepsis in the ICU,” he remarked.
The findings from the BLINGIII trial not only contribute to the ongoing discourse around sepsis management but also signal a potential turning point in how healthcare professionals approach this critical condition. With a focus on continuous infusion and more precise antibiotic use, there is optimism for improved patient outcomes in the face of sepsis.
