Extended Infusion β-Lactams for the Treatment of Gram-Negative Bacteremia in Children

J Pediatr Pharmacol Ther. 2022;27(7):677-681. doi: 10.5863/1551-6776-27.7.677. Epub 2022 Sep 26.


Objective: The pharmacokinetics of β-lactam antibiotics favor administration via an extended infusion. Although literature to support extended infusion β-lactams exists for adults, few data are available in pediatrics, especially among patients with bacteremia. The purpose of this study was to compare clinical outcomes between extended and standard infusions in children with Gram-negative bacteremia.

Methods: This retrospective chart analysis included hospitalized patients ages 0 to 18 years who received at least 72 hours of cefepime, meropenem, or piperacillin-tazobactam between January 1, 2013 and July 30, 2021. Clinical outcomes included duration of antibiotic therapy, hospital length of stay, readmission within 30 days, all-cause mortality, time to blood culture clearance, and time to normalization of inflammatory markers.

Results: A total of 124 patients (51 extended infusion, 73 standard infusion) met criteria for evaluation. Duration of antibiotic therapy was shorter in the extended infusion group (6.6 days versus 10.2 days; p = 0.01). There were no differences in hospital length of stay, readmission rates, all-cause mortality, time to normalization of inflammatory markers, or time to blood culture clearance.

Conclusions: Use of extended infusion β-lactam antibiotics in children with Gram-negative bacteremia was associated with shorter durations of therapy and should be the preferred method of administration when feasible.

Keywords: bacteremia; extended infusion; outcomes; pediatrics; β-lactam.

Grants and funding

Disclosures. The authors declare no financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. All authors had full access to the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.