Evidence map›Paper›PMID 41331481›Full record

ArticleCritical care (London, England)2025

Beta-lactam dose reductions in critically ill patients with acute kidney injury: a scoping review.

M M B Horstink, W J R Rietdijk, D R Geel, P E Deetman, H Endeman, B C P Koch, C A den Uil

Abstract readScoping Review
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

7 authors.

M M B HorstinkDepartment of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands. m.horstink@erasmusmc.nl.
W J R RietdijkDepartment of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands.
D R GeelRotterdam Clinical Pharmacometrics Group, Erasmus MC, Rotterdam, The Netherlands.
P E DeetmanDepartment of Intensive Care, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
H EndemanDepartment of Intensive Care, Erasmus MC, Rotterdam, The Netherlands.
B C P KochRotterdam Clinical Pharmacometrics Group, Erasmus MC, Rotterdam, The Netherlands.
C A den UilDepartment of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAcute kidney injury is a common complication in critically ill patients, often coinciding with the need for antibiotic therapy. The dose of beta-lactam antibiotics is frequently adjusted and often reduced based on estimated Glomerular Filtration Rate. However, early dose reductions may lead to underdosing, especially during the critical first 48 h of infection treatment, when acute kidney injury may be transient and adequate antibiotic treatment is critical. While some reviews suggest delaying dose reductions improves clinical outcomes, evidence remains limited. This scoping review evaluates the current literature on beta-lactam dosing strategies in critically ill patients with acute kidney injury, focusing on pharmacological and clinical outcomes.

methodsWe conducted a systematic scoping review following PRISMA-ScR guidelines. We searched Medline, Embase, Web of Science, Cochrane CENTRAL, and Google Scholar from database inception through March 24, 2025. Two reviewers independently screened all articles and assessed study quality using ROB-2 and ROBINS-E tools. Eligible studies included critically ill adult patients with acute kidney injury, receiving beta-lactams, and reporting clinical or pharmacological outcomes. Data were extracted using a standardized template and categorized by pharmacological or clinical outcomes. Further stratification by antibiotic type or patient characteristics was not feasible.

resultsOut of the 1,436 screened articles, 11 studies involving 1,407 patients were included. The risk of bias was high in most studies. Most studies were observational; one was a randomized controlled trial. Seven studies reported beta-lactam plasma concentrations. Higher concentrations were generally observed in patients with acute kidney injury, even though dosages were oftentimes already reduced. One study associated early dose reductions with lower rates of neurotoxicity. One study reported higher rates of treatment failure with early dose reductions and three studies linked delayed dose reductions to reduced mortality.

conclusionsCurrent evidence on beta-lactam dose reduction in critically ill patients with acute kidney injury is limited and of low quality. Delaying reductions may improve clinical outcomes, but further prospective studies are urgently needed.

trial registrationThe protocol for this scoping review was not prospectively registered.

Indexed as

Acute Kidney InjuryAnti-Bacterial Agentsbeta-LactamsCritical IllnessDose-Response Relationship, DrugHumansAnti-Bacterial Agentsbeta-LactamsAcute renal failureBeta-lactam antibioticsIntensive careMortalityTarget attainment

Identifiers

PMID41331481
PMCPMC12777441

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Registered trials

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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.