ReviewMicroorganisms2021
Beta-Lactams Toxicity in the Intensive Care Unit: An Underestimated Collateral Damage?
Review in Microorganisms, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 1 of them a synthesis that pooled it.
What it found
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
70 citing papers in PubMed, 1 synthesis or guideline pooled it, 114 citations in OpenAlex.
- Systematic review and meta-analysis to identify meropenem exposures and pharmacological targets predictive of clinical outcomes.The Journal of antimicrobial chemotherapy · 2026Pooled it
- Intrapulmonary penetration of ceftolozane/tazobactam and ceftazidime/avibactam administered by continuous infusion in critically ill patients with nosocomial pneumonia: a randomized pharmacokinetic trial.Critical care (London, England) · 2026Trial
- Characterizing Ertapenem Neurotoxicity: A Systematic Review and Experience at a Tertiary Medical Center.Open forum infectious diseases · 2024Trial
- Model-informed precision dosing of beta-lactam antibiotics and ciprofloxacin in critically ill patients: a multicentre randomised clinical trial.Intensive care medicine · 2022Trial
- Automated method for determining the zeta potential of red blood cells via motion tracking in microelectrophoresis.Biochemistry and biophysics reports · 2026Article
- Burden of and risk factors for neurological complications in critical illness.Intensive care medicine · 2026Review
- Time over minimum inhibitory concentration and variations in beta-lactam concentrations during prolonged and intermittent infusions in patients with septic shock: A post hoc observational study.The Journal of international medical research · 2026Observational
- A multicentre evaluation of pharmacokinetic/pharmacodynamic target attainment of piperacillin and tazobactam and the association with clinical outcomes in critically ill patients with sepsis and septic shock.The Journal of antimicrobial chemotherapy · 2026Article
- Inappropriate Antimicrobial Dosing in Regard to Renal Function in a Tertiary Hospital in Greece-A Single-Center Point Prevalence Study.Medicina (Kaunas, Lithuania) · 2026Article
- Elevated hippocampal and cortical cefepime concentrations correlate with seizures in an acute kidney injury rat model.Antimicrobial agents and chemotherapy · 2026Article
- Article
- Real-world use of eravacycline for the treatment of mono- and polymicrobial infections involving Enterobacterales.Microbiology spectrum · 2026Article
- Cefepime neurotoxicity in elderly patient with renal impairment: a case report.Annals of medicine and surgery (2012) · 2026Article
- Can Model-Informed Precision Dosing of Beta-Lactams in Critical Care Improve Clinical Outcomes?Chemotherapy · 2026Review
- Optimal Piperacillin/Tazobactam Dosing in Adults with Low Body Weight: A Population Pharmacokinetic and Simulation-Based Study.Drug design, development and therapy · 2026Observational
- Early piperacillin exposure during continuous infusion in critically ill patients: the impact of renal and liver dysfunctions.Annals of intensive care · 2026Article
- Neurotoxicity of Broad-Spectrum Antibiotics in Urinary Tract Infections: Mechanisms and Clinical Implications.Advances in urology · 2026Review
- Real-world pharmacovigilance assessment of meropenem-associated adverse events: age stratification and time-to-onset analysis using FAERS.Frontiers in medicine · 2026Article
- Association between early prophylactic heparin therapy and mortality in patients with septic shock secondary to respiratory infections: analysis based on MIMIC-IV database.BMC infectious diseases · 2025Article
- Dose individualisation of antibiotics in critically ill patients with inflammation: A narrative review.British journal of clinical pharmacology · 2025Review
10 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Beta-lactams are the most commonly prescribed antimicrobials in intensive care unit (ICU) settings and remain one of the safest antimicrobials prescribed. However, the misdiagnosis of beta-lactam-related adverse events may alter ICU patient management and impact clinical outcomes. To describe the clinical manifestations, risk factors and beta-lactam-induced neurological and renal adverse effects in the ICU setting, we performed a comprehensive literature review via an electronic search on PubMed up to April 2021 to provide updated clinical data. Beta-lactam neurotoxicity occurs in 10-15% of ICU patients and may be responsible for a large panel of clinical manifestations, ranging from confusion, encephalopathy and hallucinations to myoclonus, convulsions and non-convulsive status epilepticus. Renal impairment, underlying brain abnormalities and advanced age have been recognized as the main risk factors for neurotoxicity. In ICU patients, trough concentrations above 22 mg/L for cefepime, 64 mg/L for meropenem, 125 mg/L for flucloxacillin and 360 mg/L for piperacillin (used without tazobactam) are associated with neurotoxicity in 50% of patients. Even though renal complications (especially severe complications, such as acute interstitial nephritis, renal damage associated with drug induced hemolytic anemia and renal obstruction by crystallization) remain rare, there is compelling evidence of increased nephrotoxicity using well-known nephrotoxic drugs such as vancomycin combined with beta-lactams. Treatment mainly relies on the discontinuation of the offending drug but in the near future, antimicrobial optimal dosing regimens should be defined, not only based on pharmacokinetics/pharmacodynamic (PK/PD) targets associated with clinical and microbiological efficacy, but also on PK/toxicodynamic targets. The use of dosing software may help to achieve these goals.
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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.