ArticlePharmacotherapy2023
Adequacy of cefepime concentrations in the early phase of critical illness: A case for precision pharmacotherapy.
Article in Pharmacotherapy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Cefepime and Mortality: A Systematic Review and Bayesian Meta-Analysis.JAMA network open · 2026Pooled it
- Piperacillin/tazobactam clearance predicted by non-creatinine based estimates of GFR in critically ill adults.International journal of antimicrobial agents · 2025Article
- Impact of Extending Beta-Lactam Infusions on IV Access Requirements.Critical care explorations · 2025Article
- Cystatin C-Guided Dosing Nomogram Improves Target Attainment for Cefepime in the Critically Ill.Critical care medicine · 2025Article
- Restoring cefepime activity against multidrug-resistant KPC-producingAntimicrobial agents and chemotherapy · 2025Article
- Use of the DMAIC Lean Six Sigma quality improvement framework to improve beta-lactam antibiotic adequacy in the critically ill.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2024Article
- A New Dosing Frontier: Retrospective Assessment of Effluent Flow Rates and Residual Renal Function Among Critically Ill Patients Receiving Continuous Renal Replacement Therapy.Critical care explorations · 2024Article
- Impact of Various Estimated Glomerular Filtration Rate Equations on the Pharmacokinetics of Meropenem in Critically Ill Adults.Critical care explorations · 2023Article
- Outcomes of Intravenous Push versus Intermittent Infusion Administration of Cefepime in Critically Ill Patients.Antibiotics (Basel, Switzerland) · 2023Article
- The Frequency of Extended-Spectrum β-Lactamase Genes Harbored by Enterobacterales Isolates at High Risk for Clinically Significant ChromosomalOpen forum infectious diseases · 2023Article
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 2 countries.
Funding
Abstract
STUDY
objectiveIn critically ill patients, adequacy of early antibiotic exposure has been incompletely evaluated. This study characterized factors associated with inadequate cefepime exposure in the first 24 h of critical illness.
designProspective cohort study.
settingAcademic Medical Center. PATIENTS: Critically ill adults treated with cefepime. Patients with acute kidney injury or treated with kidney replacement therapy or extracorporeal membrane oxygenation were excluded.
interventionNone. MEASUREMENTS: A nonlinear mixed-effects pharmacokinetic (PK) model was developed to estimate cefepime concentrations for each patient over time. The percentage of time the free drug concentration exceeded 8 mg/L during the first 24 h of therapy was calculated (%ƒT>8; appropriate for the susceptible breakpoint for Pseudomonas aeruginosa). Factors predictive of low %ƒT>8 were explored with multivariable regression. MAIN
resultsIn the 100 included patients, a one-compartment PK model was developed with first-order elimination with covariates for weight and estimated glomerular filtration rate based on creatinine and cystatin C (eGFRSCr-CysC). The median (interquartile range) %ƒT>8 for cefepime in the first 24 h of therapy based on this model was 85% (66%, 100%). Less than 100% ƒT>8 during first 24 h of therapy occurred in 70 (70%) individuals. Lower Sequential Organ Failure Assessment score (p = 0.032) and higher eGFRSCr-CysC (p < 0.001) predicted a lower %ƒT>8. Central nervous system infection source was protective (i.e., associated with a higher %ƒT>8; p = 0.008).
conclusionsDuring early critical illness, cefepime concentrations were inadequate in a significant proportion of patients. Antimicrobial optimization is needed to improve the precision of pharmacotherapy in the critically ill patients.
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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.