Continuous versus intermittent beta-lactam antibiotic infusions in critically ill patients: the UK cohort of the BLING III trial
Author(s)
Type
Journal Article
Abstract
Background:
There are theoretical reasons why beta-lactam antibiotics may be more effective in treating severe infections if administered by continuous infusion, rather than short
intermittent infusions. The Beta-Lactam Infusion Group (BLING) III trial was a multinational randomised clinical trial (RCT) which tested this hypothesis in participants with sepsis who were cared for in an intensive care unit (ICU). The United Kingdom (UK) findings are reported here.
Methods:
The global trial was an open-label RCT conducted in the UK, Australia, New Zealand, Belgium, France, Sweden and Malaysia. Participants were critically ill adults being treated with meropenem or piperacillin/tazobactam due to a confirmed or presumed infection. Participants were randomised to receive the antibiotic by either continuous
infusion or short intermittent infusion at equivalent daily doses as selected by the treating team. The primary outcome was 90-day all-cause mortality; secondary
outcomes included clinical cure up to 14 days after randomisation, new infection and acquisition of resistant organisms, ICU and in hospital mortality.
Results:
Overall, 7,202 participants were randomised, with 2,900 from the UK. The UK cohort had very similar baseline characteristics and outcomes to the global trial. For continuous versus intermittent infusion, the global trial showed 24.9% versus 26.8% participants had died by 90 days (odds ratio 0.91, 95%CI 0.81-1.01, p=0.08); and in
the UK 26.7% versus 29.3% participants had died (odds ratio 0.88, 95%CI 0.75-1.04, p=0.13). Although not statistically significant, all outcomes showed point estimates in favour of continuous infusion.
Conclusions:
The findings in the UK cohort are consistent with the conclusions drawn from the global BLING III trial. It seems reasonable to conclude the finding are applicable to the UK.
There are theoretical reasons why beta-lactam antibiotics may be more effective in treating severe infections if administered by continuous infusion, rather than short
intermittent infusions. The Beta-Lactam Infusion Group (BLING) III trial was a multinational randomised clinical trial (RCT) which tested this hypothesis in participants with sepsis who were cared for in an intensive care unit (ICU). The United Kingdom (UK) findings are reported here.
Methods:
The global trial was an open-label RCT conducted in the UK, Australia, New Zealand, Belgium, France, Sweden and Malaysia. Participants were critically ill adults being treated with meropenem or piperacillin/tazobactam due to a confirmed or presumed infection. Participants were randomised to receive the antibiotic by either continuous
infusion or short intermittent infusion at equivalent daily doses as selected by the treating team. The primary outcome was 90-day all-cause mortality; secondary
outcomes included clinical cure up to 14 days after randomisation, new infection and acquisition of resistant organisms, ICU and in hospital mortality.
Results:
Overall, 7,202 participants were randomised, with 2,900 from the UK. The UK cohort had very similar baseline characteristics and outcomes to the global trial. For continuous versus intermittent infusion, the global trial showed 24.9% versus 26.8% participants had died by 90 days (odds ratio 0.91, 95%CI 0.81-1.01, p=0.08); and in
the UK 26.7% versus 29.3% participants had died (odds ratio 0.88, 95%CI 0.75-1.04, p=0.13). Although not statistically significant, all outcomes showed point estimates in favour of continuous infusion.
Conclusions:
The findings in the UK cohort are consistent with the conclusions drawn from the global BLING III trial. It seems reasonable to conclude the finding are applicable to the UK.
Date Issued
2026-02-01
Date Acceptance
2025-10-27
Citation
Journal of the Intensive Care Society, 2026, 27 (1), pp.30-40
ISSN
1751-1437
Publisher
SAGE Publications
Start Page
30
End Page
40
Journal / Book Title
Journal of the Intensive Care Society
Volume
27
Issue
1
Copyright Statement
© The Intensive Care Society 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
License URL
Identifier
10.1177/17511437251396871
Subjects
antibiotic
clinical outcomes
infection
intensive care
microbiology
pharmacokinetics
process of care
Publication Status
Published
Date Publish Online
2025-11-27