Implementation of beta-lactam Therapeutic Drug Monitoring in clinical practice: A prospective, comparative, interventional study in intensive care unit patients
Authors' conclusion
In this study, the implementation of TDM did not significantly impact PK/PD target attainment, which underscores the importance of integrating a protocolised dose adaptation algorithm. Neurological adverse events were associated with drug overexposure and kidney function impairment.
Study context
- Population
- ICU patients aged 18 years or older treated with cefepime, ceftazidime, cefotaxime, piperacillin/tazobactam, or meropenem administered in continuous infusionnon-TDM group 60 · TDM group 112
- Participants
- 112 vs 60
- Comparison
- TDM vs. non-TDM group
- TDM groupn = 112
- non-TDM groupn = 60
- Primary endpoint
- PK/PD target attainment
- Follow-up
- D4 and D7
Methodological detailsTDM of beta-lactams sequentially implemented, conducted in two ICUs
- TDM of beta-lactams sequentially implemented
- Conducted in two ICUs
Primary result
As reported in the abstract
D4
D7
- TDM group vs non-TDM group: P = 0.89 — Target achievement at D4 or D7 was not correlated with TDM implementation
Further findings
PK/PD target attainment · D1
Factors correlated with target achievement at D4 or D7
- Reaching the target concentrations at D1
- P < 0.001
- A documented infection
- P = 0.008
Safety
Electroencephalogram (EEG) neurotoxicity · D4 · no significant difference
P = 0.34
Concentration at D1 and/or D4 above the toxicity threshold
| Estimate | P value | ||
|---|---|---|---|
| Acute kidney dysfunction | OR for concentration above the toxicity threshold 8.5 (CI 2.1–35.4) | P = 0.002 | |
| Concentration above the toxicity threshold | OR for neurotoxicity 6.0 (CI 1.7–21.7) | P = 0.005 | |
| 0.050.21520Ratio (log scale) |
Original publication
Implementation of beta-lactam Therapeutic Drug Monitoring in clinical practice: A prospective, comparative, interventional study in intensive care unit patients. Anaesth Crit Care Pain Med. Published 5 October 2026. doi:10.
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