New hope for critically ill patients

An international clinical trial led by Metro North Health researchers is delivering new hope for patients critically ill with sepsis.

Sepsis is a serious condition where the body’s response to an infection damages its own tissues and organs, with severe cases potentially leading to organ failure and death.

Early diagnosis and treatment with appropriate antibiotics are crucial to fight the infection. Patients are usually in an intensive care unit (ICU).

A research team from Metro North’s Herston Infectious Diseases Institute (HeIDI) — lead by Royal Brisbane and Women’s Hospital Research Director Dr Joel Dulhunty and Interim Director Dr Jason Roberts, with former ICU Director Prof Jeffrey Lipman — set out to determine the clinical impact of better dosing beta-lactam antibiotics in patients with sepsis.

The BLING III study set out to determine whether continuous infusion of beta-lactam antibiotics could decrease all-cause mortality at 90 days in critically ill patients with sepsis, compared to the standard intermittent infusion.

This prospective double-blind multicentre study was built on previous BLING investigations. BLING III was conducted with more than 7000 patients in 104 adult ICUs in Australia, Belgium, France, Malaysia, New Zealand, Sweden and the UK between 2018 and 2023.

Two Metro North sites — Royal Brisbane and Women’s Hospital and Redcliffe Hospital — were included, alongside 23 other ICUs across Australia.

The most common sites of sepsis infection in patients were pulmonary (59.5 per cent), followed by intra-abdominal (13 per cent).

Randomised drug administration by continuous infusion (over 24 hours) or intermittent infusion (over 30 minutes given 3–4 times per day) was used for the duration of the treatment course or until ICU discharge, whichever occurred first.

The phase III trial found a statistically significant difference in clinical cure among the cohort who received continuous infusion, reducing mortality by 1.9 per cent after 90 days.

Considering the findings, adult ICU patients with sepsis now receive continuous infusions where intravenous access is available, given this potential for benefit alongside no evidence for harm. It is also recommended by the world-leading clinical practice guidelines because of the results of the BLING program.

HeIDI Director Dr Jason Roberts said BLING III and previous BLING investigations were developed by Metro North researchers first as single centre studies, before growing into multi-continental studies.

“When the BLING program started in 2010, it was led by Metro North Health and involved our intensive care, infectious diseases, pharmacy, and nursing teams,” Dr Roberts said.

“When HeIDI came into being in 2020, it supported the people who were leading BLING III.

“We also enjoyed a very close and successful collaboration with the University of Queensland (UQ), specifically the UQ Centre for Clinical Research (UQCCR).”