The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting
Background: This study aims to determine if continuous infusion (CI) of beta-lactam antibiotics achieves the pharmacokinetic/pharmacodynamic (PK/PD) targets for time-dependent bacterial killing and/or are associated with improved clinical outcomes compared to intermittent bolus (IB) dosing in critic...
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| Format: | Proceeding Paper |
| Language: | English English |
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2015
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| Online Access: | http://irep.iium.edu.my/44991/ http://irep.iium.edu.my/44991/1/BLISS_ICAACv4.pdf http://irep.iium.edu.my/44991/6/44991.pdf |
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| author | Abdul Aziz, Mohd. Hafiz Sulaiman, Helmi Mat Nor, Mohd Basri Rai, Vineya Wong, K. Hasan, Mohd Shahnaz Wallis, Steven C Lipman, Jeffrey Staatz, Christine E. Roberts, Jason A. |
| author_facet | Abdul Aziz, Mohd. Hafiz Sulaiman, Helmi Mat Nor, Mohd Basri Rai, Vineya Wong, K. Hasan, Mohd Shahnaz Wallis, Steven C Lipman, Jeffrey Staatz, Christine E. Roberts, Jason A. |
| author_sort | Abdul Aziz, Mohd. Hafiz |
| building | IIUM Repository |
| collection | Online Access |
| description | Background: This study aims to determine if continuous infusion (CI) of beta-lactam antibiotics achieves the pharmacokinetic/pharmacodynamic (PK/PD) targets for time-dependent bacterial killing and/or are associated with improved clinical outcomes compared to intermittent bolus (IB) dosing in critically ill patients with severe sepsis. Methods: This is a report from the BLISS Study which was a prospective, multicentre, open-labelled, randomised, controlled trial of CI vs IB dosing of beta-lactam antibiotics, recruiting critically ill patients with severe sepsis from two Malaysian ICUs. The primary end-point, PK/PD target attainment, was evaluated at the halfway point and end of the dosing interval on days 1 and 3 of treatment, by comparing beta-lactam concentrations against causative pathogens based on EUCAST MIC. Secondary end-points were number of days before patient’s white blood cell (WBC) count normalised and that patient’s required infection-related mechanical ventilation (MV), as well as 14-day mortality. Results: 140 critically ill patients with severe sepsis were enrolled with 70 patients each randomly allocated to the CI and IB treatment arms. APACHE II (CI 22 vs IB 20, p = 0.336) and SOFA (CI 9 vs IB 8, p = 0.217) scores were similar between CI and IB patients. CI patients demonstrated numerically higher PK/PD target attainment rates compared to IB patients at the halfway point (CI 96.6% vs IB 83.9%, p = 0.022) and end (CI 96.6% vs IB 62.5%, p < 0.001) of the dosing interval on Day 1, and at the halfway point (CI 100.0% vs IB 85.7%, p = 0.003) and end (CI 98.2% vs IB 58.9%, p < 0.001) of the dosing interval on Day 3, respectively. WBC count normalisation (CI 4 vs IB 6 days, p = 0.014) and infection-related MV (CI 6 vs IB 9 days, p = 0.038) were shorter for CI patients. Mortality rates (CI 17.7% vs IB 16.0%, p = 0.807) were similar between CI and IB patients. Conclusion: Preliminary results of the BLISS study provide additional PK/PD and clinical outcome data to support the practice of CI administration of beta-lactam antibiotics in critically ill patients with severe sepsis. |
| first_indexed | 2025-11-14T16:09:40Z |
| format | Proceeding Paper |
| id | iium-44991 |
| institution | International Islamic University Malaysia |
| institution_category | Local University |
| language | English English |
| last_indexed | 2025-11-14T16:09:40Z |
| publishDate | 2015 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | iium-449912020-07-15T02:57:22Z http://irep.iium.edu.my/44991/ The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting Abdul Aziz, Mohd. Hafiz Sulaiman, Helmi Mat Nor, Mohd Basri Rai, Vineya Wong, K. Hasan, Mohd Shahnaz Wallis, Steven C Lipman, Jeffrey Staatz, Christine E. Roberts, Jason A. RM300 Drugs and their action RS Pharmacy and materia medica Background: This study aims to determine if continuous infusion (CI) of beta-lactam antibiotics achieves the pharmacokinetic/pharmacodynamic (PK/PD) targets for time-dependent bacterial killing and/or are associated with improved clinical outcomes compared to intermittent bolus (IB) dosing in critically ill patients with severe sepsis. Methods: This is a report from the BLISS Study which was a prospective, multicentre, open-labelled, randomised, controlled trial of CI vs IB dosing of beta-lactam antibiotics, recruiting critically ill patients with severe sepsis from two Malaysian ICUs. The primary end-point, PK/PD target attainment, was evaluated at the halfway point and end of the dosing interval on days 1 and 3 of treatment, by comparing beta-lactam concentrations against causative pathogens based on EUCAST MIC. Secondary end-points were number of days before patient’s white blood cell (WBC) count normalised and that patient’s required infection-related mechanical ventilation (MV), as well as 14-day mortality. Results: 140 critically ill patients with severe sepsis were enrolled with 70 patients each randomly allocated to the CI and IB treatment arms. APACHE II (CI 22 vs IB 20, p = 0.336) and SOFA (CI 9 vs IB 8, p = 0.217) scores were similar between CI and IB patients. CI patients demonstrated numerically higher PK/PD target attainment rates compared to IB patients at the halfway point (CI 96.6% vs IB 83.9%, p = 0.022) and end (CI 96.6% vs IB 62.5%, p < 0.001) of the dosing interval on Day 1, and at the halfway point (CI 100.0% vs IB 85.7%, p = 0.003) and end (CI 98.2% vs IB 58.9%, p < 0.001) of the dosing interval on Day 3, respectively. WBC count normalisation (CI 4 vs IB 6 days, p = 0.014) and infection-related MV (CI 6 vs IB 9 days, p = 0.038) were shorter for CI patients. Mortality rates (CI 17.7% vs IB 16.0%, p = 0.807) were similar between CI and IB patients. Conclusion: Preliminary results of the BLISS study provide additional PK/PD and clinical outcome data to support the practice of CI administration of beta-lactam antibiotics in critically ill patients with severe sepsis. 2015 Proceeding Paper PeerReviewed application/pdf en http://irep.iium.edu.my/44991/1/BLISS_ICAACv4.pdf application/pdf en http://irep.iium.edu.my/44991/6/44991.pdf Abdul Aziz, Mohd. Hafiz and Sulaiman, Helmi and Mat Nor, Mohd Basri and Rai, Vineya and Wong, K. and Hasan, Mohd Shahnaz and Wallis, Steven C and Lipman, Jeffrey and Staatz, Christine E. and Roberts, Jason A. (2015) The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting. In: Joint 55th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) and 28th International Congress of Chemotherapy (ICC) Meeting (ICAAC/ICC 2015), 17-21 September 2015, San Diego, CA. (Unpublished) http://www.abstractsonline.com/Plan/ViewSession.aspx?sKey=eeeaba1b-2666-42d0-be09-8f7f806718f9 |
| spellingShingle | RM300 Drugs and their action RS Pharmacy and materia medica Abdul Aziz, Mohd. Hafiz Sulaiman, Helmi Mat Nor, Mohd Basri Rai, Vineya Wong, K. Hasan, Mohd Shahnaz Wallis, Steven C Lipman, Jeffrey Staatz, Christine E. Roberts, Jason A. The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting |
| title | The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting |
| title_full | The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting |
| title_fullStr | The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting |
| title_full_unstemmed | The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting |
| title_short | The BLISS study: Beta-Lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a Malaysian ICU setting |
| title_sort | bliss study: beta-lactam infusion in severe sepsis-randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis in a malaysian icu setting |
| topic | RM300 Drugs and their action RS Pharmacy and materia medica |
| url | http://irep.iium.edu.my/44991/ http://irep.iium.edu.my/44991/ http://irep.iium.edu.my/44991/1/BLISS_ICAACv4.pdf http://irep.iium.edu.my/44991/6/44991.pdf |