Sepsis Antibiotics: Can Longer Infusions Improve

Why does antibiotic delivery matter after COVID-19?

The CDC's account of COVID-19 and antimicrobial resistance documents how pandemic pressures disrupted infection prevention and antibiotic prescribing. Resistant hospital-onset infections and associated deaths increased by at least 15% between 2019 and 2020 across seven tracked pathogens. These are historical findings, rather than a new October surveillance release, but they explain the continuing importance of improving treatment for severe infections. [CDC: COVID-19 and Antimicrobial Resistance](https://www.cdc.gov/antimicrobial-resistance/data-research/threats/covid-19.html)

One approach changes how hospitals administer beta-lactam antibiotics. These medicines work best when their available concentration remains above the level needed to inhibit the infecting bacteria for sufficient time. An extended infusion delivers a dose over several hours; a continuous infusion spreads administration across the day. This can improve drug exposure in critically ill patients whose illness alters antibiotic distribution and clearance. An initial loading dose helps establish effective concentrations promptly. [Surviving Sepsis Campaign guidelines, 2021](https://www.sccm.org/clinical-resources/guidelines/guidelines/surviving-sepsis-guidelines-2021)

What did clinical trials find about survival?

The BLING III trial, published in JAMA in 2024, included 7,031 adults in its primary analysis. It compared equivalent daily doses of piperacillin-tazobactam or meropenem delivered continuously or intermittently. Death within 90 days occurred in 24.9% of patients receiving continuous infusion and 26.8% receiving intermittent infusion. That difference did not meet statistical significance in the primary analysis. Clinical cure, a secondary outcome, occurred in 55.7% versus 50.0%, respectively. The survival result leaves room for a meaningful benefit but does not establish one on its own. [BLING III randomized trial](https://jamanetwork.com/journals/jama/fullarticle/2819971)

A separate JAMA systematic review published in 2024 combined 18 randomized trials involving 9,108 critically ill adults. Seventeen trials contributed mortality data. The pooled analysis favored prolonged infusion, with an estimated mortality risk ratio of 0.86 and a 95% credible interval of 0.72 to 0.98. That represents an estimated 14% relative reduction, not a 14-percentage-point reduction in absolute risk. BLING III contributed to this analysis, so the two publications should not be treated as independent confirmations. Most included trials studied continuous infusion, leaving less direct evidence for other extended schedules. [JAMA systematic review and meta-analysis](https://jamanetwork.com/journals/jama/fullarticle/2819970)

How should hospitals use prolonged antibiotic infusions?

The 2026 Surviving Sepsis Campaign gives this approach a strong recommendation supported by moderate-certainty evidence. Its recommendations also allow antibiotic concentration monitoring in selected patients, depending on clinical circumstances and availability. Implementing prolonged infusion therefore involves choosing an appropriate medicine and maintaining effective exposure throughout treatment. [Surviving Sepsis Campaign adult guidelines](https://www.sccm.org/survivingsepsiscampaign/guidelines-and-resources/surviving-sepsis-campaign-adult-guidelines)

Longer infusion time should not be interpreted as a proven way to reverse antimicrobial resistance. BLING III did not find a statistically significant difference in its combined outcome of newly acquired resistant organisms or C. difficile infection. The practical implication is narrower: administration technique may improve treatment outcomes, while preventing resistant infections still requires separate measures. The trial also does not justify giving antibiotics for the coronavirus itself. [BLING III trial findings](https://jamanetwork.com/journals/jama/fullarticle/2819971)