Trial reportIntensive care medicine2022
Effect of therapeutic drug monitoring-based dose optimization of piperacillin/tazobactam on sepsis-related organ dysfunction in patients with sepsis: a randomized controlled trial.
Trial report in Intensive care medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 103 papers, 6 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
103 citing papers in PubMed, 6 syntheses or guidelines pooled it, 163 citations in OpenAlex.
- β-lactam infusion strategies in critical illness: is continuous superior to extended infusion? A systematic review and network meta-analysis.Frontiers in epidemiology · 2026Pooled it
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- [S3 guideline on renal replacement therapy in intensive care medicine : Evidence-based implementation of renal replacement therapy in critically ill patients].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- 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
- Pooled it
- Beta-Lactam Antibiotic Therapeutic Drug Monitoring in Critically Ill Patients: A Systematic Review and Meta-Analysis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Pooled it
- Unraveling the impact of therapeutic drug monitoring via machine learning for patients with sepsis.Cell reports. Medicine · 2024Trial
- Achievement of therapeutic antibiotic exposures using Bayesian dosing software in critically unwell children and adults with sepsis.Intensive care medicine · 2024Trial
- Model-informed precision dosing of beta-lactam antibiotics and ciprofloxacin in critically ill patients: a multicentre randomised clinical trial.Intensive care medicine · 2022Trial
- From early recognition to precision medicine: advances in the diagnosis and management of adult sepsis and septic shock-a narrative review.Infection · 2026Review
- Development and evaluation of machine learning-based prediction-modelling for initial vancomycin serum concentrations in septic ICU patients using clinical health record data.Intensive care medicine experimental · 2026Article
- Implementing a Model-Informed Precision Dosing Service for Cefepime in a Quaternary Children's Hospital: A First-Year Experience.Therapeutic drug monitoring · 2026Article
- Therapeutic drug monitoring of high-dosage intravenous flucloxacillin and mortality in patients with Staphylococcus aureus bacteremia: a retrospective cohort study using inverse probability weighting.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Rising Carbapenem MICs and Clinical Dose Optimization: Bridging Resistance Surveillance and Pharmacokinetic/Pharmacodynamic Strategies.Antibiotics (Basel, Switzerland) · 2026Review
- A Retrospective Cohort Study to Optimize Piperacillin/Tazobactam Dosing in Routine Intensive-Care Patients via a Newly Designed Clinical Pharmacy Service Including TDM- and Algorithm-Based Recommendations.Pharmacy (Basel, Switzerland) · 2026Article
- Comparison of nutritional inflammatory indicators for predicting outcomes in patients with sepsis: a retrospective study based on clinical and MIMIC data.BMC infectious diseases · 2026Article
- Article
- Systematic Review of Antimicrobial Therapies and Clinical Outcomes inLife (Basel, Switzerland) · 2026Review
- The evolution of sepsis care: from protocol-driven management to personalized intensive care.Infection · 2026Review
- The time has come for optimizing beta-lactam therapy in critically ill patients with renal dysfunction.Intensive care medicine · 2026Article
43 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
24 authors at 11 institutions in 3 countries.
Funding
Abstract
purposeInsufficient antimicrobial exposure is associated with worse outcomes in sepsis. We evaluated whether therapeutic drug monitoring (TDM)-guided antibiotic therapy improves outcomes.
methodsRandomized, multicenter, controlled trial from January 2017 to December 2019. Adult patients (n = 254) with sepsis or septic shock were randomly assigned 1:1 to receive continuous infusion of piperacillin/tazobactam with dosing guided by daily TDM of piperacillin or continuous infusion with a fixed dose (13.5 g/24 h if eGFR ≥ 20 mL/min). Target plasma concentration was four times the minimal inhibitory concentration (range ± 20%) of the underlying pathogen, respectively, of Pseudomonas aeruginosa in empiric situation. Primary outcome was the mean of daily total Sequential Organ Failure Assessment (SOFA) score up to day 10.
resultsAmong 249 evaluable patients (66.3 ± 13.7 years; female, 30.9%), there was no significant difference in mean SOFA score between patients with TDM (7.9 points; 95% CI 7.1-8.7) and without TDM (8.2 points; 95% CI 7.5-9.0) (p = 0.39). Patients with TDM-guided therapy showed a lower 28-day mortality (21.6% vs. 25.8%, RR 0.8, 95% CI 0.5-1.3, p = 0.44) and a higher rate of clinical (OR 1.9; 95% CI 0.5-6.2, p = 0.30) and microbiological cure (OR 2.4; 95% CI 0.7-7.4, p = 0.12), but these differences did not reach statistical significance. Attainment of target concentration was more common in patients with TDM (37.3% vs. 14.6%, OR 4.5, CI 95%, 2.9-6.9, p < 0.001).
conclusionTDM-guided therapy showed no beneficial effect in patients with sepsis and continuous infusion of piperacillin/tazobactam with regard to the mean SOFA score. Larger studies with strategies to ensure optimization of antimicrobial exposure are needed to definitively answer the question.
Indexed as
Identifiers
What OpenQuestion holds
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.