ArticleCritical care (London, England)2010
Insufficient β-lactam concentrations in the early phase of severe sepsis and septic shock.
Article in Critical care (London, England), 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 179 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pharmacokinetics and Pharmacodynamic (PK/PD) of Extended-infusion Meropenem, Piperacillin-tazobactam and Cefepime in the Early Phase of Septic Shock
Prospective Observational Study of Serum Ceftazidime Concentrations in Hemodialysis Patients at the University Hospital of Charleroi, Belgium
A Pilot Study for Optimizing Meropenem Administration in the Intensive Care Unit - Short Six Times vs Prolonged Three Times Courses Daily
Who cites it
179 citing papers in PubMed, 4 syntheses or guidelines pooled it, 369 citations in OpenAlex.
- Continuous or extended vs intermittent infusions of beta-lactam antibiotics in ICU patients with pneumonia: a systematic review and meta-analysis of randomized controlled trials.Antimicrobial agents and chemotherapy · 2025Pooled it
- Continuous versus intermittent infusion of β-lactams in patients with sepsis and septic shock: a systematic review and meta-analysis.BMC infectious diseases · 2025Pooled it
- Optimization of the treatment with beta-lactam antibiotics in critically ill patients-guidelines from the French Society of Pharmacology and Therapeutics (Société Française de Pharmacologie et Thérapeutique-SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation-SFAR).Critical care (London, England) · 2019Guideline
- Antibiotics in critically ill patients: a systematic review of the pharmacokinetics of β-lactams.Critical care (London, England) · 2011Pooled it
- Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial.Intensive care medicine · 2022Trial
- Evaluation of pharmacokinetic and pharmacodynamic parameters of meropenem in critically ill patients with acute kidney disease.European journal of clinical pharmacology · 2021Trial
- Population Pharmacokinetic Model to Optimize Cefotaxime Dosing Regimen in Critically Ill Children.Clinical pharmacokinetics · 2018Trial
- Pharmacokinetic and Pharmacodynamic Efficacies of Continuous versus Intermittent Administration of Meropenem in Patients with Severe Sepsis and Septic Shock: A Prospective Randomized Pilot Study.Chinese medical journal · 2017Trial
- Clinical outcomes of extended versus intermittent administration of piperacillin/tazobactam for the treatment of hospital-acquired pneumonia: a randomized controlled trial.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2017Trial
- Doripenem Treatment during Continuous Renal Replacement Therapy.Antimicrobial agents and chemotherapy · 2015Trial
- A multicenter study on the effect of continuous hemodiafiltration intensity on antibiotic pharmacokinetics.Critical care (London, England) · 2015Trial
- Assessment of pharmacokinetic changes of meropenem during therapy in septic critically ill patients.BMC pharmacology & toxicology · 2014Trial
- Therapeutic drug monitoring-based dose optimisation of piperacillin and meropenem: a randomised controlled trial.Intensive care medicine · 2014Trial
- DALI: Defining Antibiotic Levels in Intensive care unit patients: a multi-centre point of prevalence study to determine whether contemporary antibiotic dosing for critically ill patients is therapeutic.BMC infectious diseases · 2012Trial
- Ceftazidime dosage regimen in intensive care unit patients: from a population pharmacokinetic approach to clinical practice via Monte Carlo simulations.British journal of clinical pharmacology · 2012Trial
- Optimization of Cefotaxime Treatment in Intensive Care Patients: Impact of Inter- and Intra-patient Variability on Pharmacokinetics and Target Attainment.Clinical pharmacokinetics · 2026Article
- Achieving target plasma concentrations of beta-lactam antibiotics in critically ill patients: a retrospective study of full-dose administration in the first 24 hours.Pharmacological reports : PR · 2026Observational
- ASP-COMPLEX: redefining antimicrobial stewardship to improve outcomes in high-risk patients with severe infections.Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia · 2026Review
- The time has come for optimizing beta-lactam therapy in critically ill patients with renal dysfunction.Intensive care medicine · 2026Article
- Article
119 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAltered pharmacokinetics (PK) in critically ill patients can result in insufficient serum β-lactam concentrations when standard dosages are administered. Previous studies on β-lactam PK have generally excluded the most severely ill patients, or were conducted during the steady-state period of treatment. The aim of our study was to determine whether the first dose of piperacillin-tazobactam, ceftazidime, cefepime, and meropenem would result in adequate serum drug concentrations in patients with severe sepsis and septic shock.
methodsOpen, prospective, multicenter study in four Belgian intensive care units. All consecutive patients with a diagnosis of severe sepsis or septic shock, in whom treatment with the study drugs was indicated, were included. Serum concentrations of the antibiotics were determined by high-pressure liquid chromatography (HPLC) before and 1, 1.5, 4.5 and 6 or 8 hours after administration.
results80 patients were treated with piperacillin-tazobactam (n = 27), ceftazidime (n = 18), cefepime (n = 19) or meropenem (n = 16). Serum concentrations remained above 4 times the minimal inhibitory concentration (T > 4 × MIC), corresponding to the clinical breakpoint for Pseudomonas aeruginosa defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST), for 57% of the dosage interval for meropenem (target MIC = 8 μg/mL), 45% for ceftazidime (MIC = 32 μg/mL), 34% for cefepime (MIC = 32 μg/mL), and 33% for piperacillin-tazobactam (MIC = 64 μg/mL). The number of patients who attained the target PK profile was 12/16 for meropenem (75%), 5/18 for ceftazidime (28%), 3/19 (16%) for cefepime, and 12/27 (44%) for piperacillin-tazobactam.
conclusionsSerum concentrations of the antibiotic after the first dose were acceptable only for meropenem. Standard dosage regimens for piperacillin-tazobactam, ceftazidime and cefepime may, therefore, be insufficient to empirically cover less susceptible pathogens in the early phase of severe sepsis and septic shock.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.