{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:11:54Z","timestamp":1793502714931,"version":"4.5.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Optimal \u03b2-lactam dosing for the treatment of Gram-negative bacteria bloodstream infections (GNB-BSIs) remains a debated issue. Herein, the efficacy and safety of a loading dose (LD) followed by extended\/continuous infusion (EI\/CI) versus intermittent bolus (IB) of these drugs for the treatment of GNB-BSIs was evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a retrospective observational study enrolling patients with GNB-BSIs treated with \u03b2-lactams from 1 October 2020 to 31 March 2022. The 30 day infection-related mortality rate was assessed with Cox regression, while mortality risk reduction was evaluated by an inverse probability of treatment weighting regression adjustment (IPTW-RA) model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 224 patients were enrolled: 140 and 84 in the IB and EI\/CI groups, respectively. \u03b2-Lactam regimens were chosen according to pathogen antibiogram, clinical judgement and current guidelines. Interestingly, the LD\u200a+\u200aEI\/CI regimen was associated with a significant lower mortality rate (17% versus 32%, P\u200a=\u200a0.011). Similarly, \u03b2-lactam LD\u200a+\u200aEI\/CI was significantly associated with a reduced risk of mortality at multivariable Cox regression [adjusted HR (aHR)\u200a=\u200a0.46; 95%CI\u200a=\u200a0.22\u20130.98; P\u200a=\u200a0.046]. Finally, the IPTW-RA (adjusted for multiple covariates) was performed, showing a significant risk reduction in the overall population [\u221214% (95% CI\u200a=\u200a\u221223% to \u22125%)]; at the subgroup restricted analysis, a significant risk reduction (&amp;gt;15%) was observed in the case of GNB-BSI in severely immunocompromised patients (P\u200a=\u200a0.003), for SOFA score\u200a&amp;gt;\u200a6 (P\u200a=\u200a0.014) and in septic shock (P\u200a=\u200a0.011).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of LD\u200a+\u200aEI\/CI of \u03b2-lactams in patients with a GNB-BSI may be associated with reduced mortality; also in patients with severe presentation of infection or with additional risk factors, such as immunodepression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkad215","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T21:45:45Z","timestamp":1688075145000},"page":"2175-2184","source":"Crossref","is-referenced-by-count":15,"title":["Loading dose plus continuous\/extended infusion versus intermittent bolus of \u03b2-lactams for the treatment of Gram-negative bacteria bloodstream infections: a propensity score-adjusted retrospective cohort study"],"prefix":"10.1093","volume":"78","author":[{"given":"Davide Fiore","family":"Bavaro","sequence":"first","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari , Policlinic of Bari, Piazza Giulio Cesare n. 11, 70124 Bari , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Belati","sequence":"additional","affiliation":[{"name":"Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine 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