title: Prolonged versus Intermittent Infusion of β-Lactams for the Treatment of Nosocomial Pneumonia: A Meta-Analysis.
abstract: BACKGROUND
  The primary objective of this meta-analysis is aimed at determining whether β-lactams prolonged infusion in patients with nosocomial pneumonia (NP) results in higher cure rate and improved mortality compared to intermittent infusion.
  
  
  METHODS
  Relevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL from inception to September 1st, 2015. All published articles which evaluated the outcome of extended/continuous infusion of antimicrobial therapy versus intermittent infusion therapy in the treatment of NP were reviewed.
  
  
  RESULTS
  A total of ten studies were included in the analysis involving 1,051 cases of NP. Prolonged infusion of β-lactams was associated with higher clinical cure rate (OR 2.45, 95% CI, 1.12, 5.37) compared to intermittent infusion. However, there was no significant difference in mortality (OR 0.85, 95% CI 0.63-1.15) between the two groups. Subgroup analysis for β-lactam subclasses and for severity of illness showed comparable outcomes.
  
  
  CONCLUSIONS
  The limited data available suggest that reduced clinical failure rates when using prolonged infusions of β-lactam antibiotics in critically ill patients with NP. More detailed studies are needed to determine the impact of such strategy on mortality in this patient population.
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.; Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and Department of Social and Preventive Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
authors.forename: Ashima
authors.initials: A
authors.lastname: Lal
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.; Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and Department of Social and Preventive Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Jaoude
authors.affiliation: The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.; Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and Department of Social and Preventive Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.; School of Public Health and Health Professions, Buffalo, NY, USA.
authors.forename: Ali A
authors.identifier: 0000-0003-4237-8776
authors.initials: AA
authors.lastname: El-Solh
keywords: Clinical cure; Mortality; Prolonged infusion; β-lactams