19 September 2025
When Professor Jeffrey Lipman AM approached a Belgian colleague to gauge his interest in an international trial involving 7,000 intensive care patients, his colleague laughed. Undeterred, Professor Lipman pushed ahead, completing BLING III, one of the largest randomised clinical trials in the field of intensive care medicine, which challenged the conventional dosing of a commonly used group of antibiotics.
Without a doubt, Professor Lipman was the right person for the job. Determination, persistence and innovation were hallmarks of his long and distinguished career in intensive care medicine, which began in the 1970s in South Africa. While treating patients, Professor Lipman always had 2 questions at the back of his mind.
“I always thought, ‘How can I treat this patient in the best way possible?’. At the same time, asking, ‘How can I treat the next patient coming into that bed better in the future?’” Professor Lipman said.
“BLING III was the culmination of three decades of work studying β-lactam antibiotics, mainstay drugs in intensive care used to treat serious infections, including sepsis. Because they are so effective and commonly prescribed, even small changes in how we use these antibiotics can have a big impact on patient outcomes worldwide. But we have been using them the same way for over 50 years, so challenging this practice requires level one scientific evidence, randomised controlled trials.”
BLING was a series of international clinical trials led by Professor Lipman, currently Chair of trauma-related clinical research at the Jamieson Trauma Institute (JTI) at the Royal Brisbane Women’s Hospital (part of Metro North Health) and Emeritus Professor at The University of Queensland. The trials investigated whether giving β-lactam antibiotics by continuous infusion, rather than the standard intermittent doses over a day improved health outcomes for people with sepsis and septic shock.
Professor Lipman explained that in 2015, BLING II, a double-blind, controlled trial involving 420 patients, showed a slight improvement in outcomes using continuous infusion; however, the finding was not statistically significant.
“I asked the statisticians how many patients we would need to show significance,” Professor Lipman said. “Their response was 7,000, so that became my target for BLING III.”
“In the end, we recruited 7,202 patients from 104 ICUs in 7 countries. That also meant 290 contracts, 872 site personnel, approximately 36,000 health professionals, 72,000 hours of education, 132,598 doses of the study drug (with 95% compliance) and 4,179,743 data points. COVID-19 set us back a few months, but we got there.”
“We published the results in JAMA in 2024, having shown a meaningful (2%) difference in the 90-day mortality rate using continuous infusion rather than the conventional intermittent bolus,” Professor Lipman said. “That means that of the patients that would’ve died, 2% extra lived – or put another way, with every 50 patients we treat with continuous infusion, we could save an extra life, with no increase in side effects or costs.”[i]
The team did not stop there. They conducted a systematic review and meta-data analysis. The analysis, also published in JAMA in 2024, combined data from 18 randomised clinical trials covering over 9,100 adults in ICUs with sepsis or septic shock. The study provided certainty that prolonged infusion of β-lactam antibiotics can be a more effective way to treat sepsis, showing that with every 26 patients treated in this manner, an additional life was saved. [ii]
BLING III has been applauded as a well-conducted study. In their editorial accompanying the above-mentioned JAMA manuscripts, Wiersinga and van Agtmael described it as “a beautiful and impressive example of true team science that accelerates progress in the field.” [iii]
Professor Lipman said that the evidence from BLING III, the meta-analysis, and the systematic review, supports making the change to using prolonged infusions for adult patients with sepsis or septic shock in intensive care.
“Sepsis is the leading cause of death in ICUs worldwide, so this change in approach has the potential to impact millions of patients,” Professor Lipman said. “In ICUs, it’s not difficult to give a continuous infusion because so many patients have central lines already inserted – so there’s no barrier to changing this practice.
“The BLING trials have built a strong case that how antibiotics are given in sepsis, not just which antibiotics are given, can save lives. As to which subgroups of patients would benefit most, well, that would have made the BLING III study even larger!”
While Professor Lipman retired from clinical practice in 2021 and the BLING trials are now complete, he continues to research infection management in intensive care. He is currently working with the JTI team conducting pilot studies of D-lactate as a promising biomarker for the diagnosis of sepsis.
“One of the major challenges is defining and diagnosing sepsis in the ICU. If doctors can define it quickly and accurately, they can treat it more effectively,” Professor Lipman said. “We have done some initial studies in joint infections using D-lactate. Now, we are extending this work to other ICU patients. If it can help diagnose infection immediately, it will be a game-changer to prevent the overuse of antibiotics where sepsis is suspected.”
Professor Jeff Lipman’s determination to challenge long-standing practices has reshaped the way doctors around the world treat one of the deadliest conditions in intensive care. His work is a testament to the power of persistence, innovation, and collaboration in health and medical research.
Metro North Health is a partner of Health Translation Queensland (HTQ). This article is part of the series “HTQ Partner Showcase”.
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[i] Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial
[ii] Prolonged vs Intermittent Infusions of β-Lactam Antibiotics in Adults With Sepsis or Septic Shock: A Systematic Review and Meta-Analysis
[iii] Resolving the Dilemma on Continuous vs Intermittent β-Lactam Antibiotics in Sepsis
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