Evaluation of the B-lactam antibiotic concentration in the early phase of treatment of patients with suspected sepsis at the emergency department

Ilja Areskog Lejbman; Gustav Torisson; Fredrik Resman; Fredrik Sjövall

doi:10.1007/s15010-026-02785-z

Evaluation of the B-lactam antibiotic concentration in the early phase of treatment of patients with suspected sepsis at the emergency department

Infection. 2026 Mar 27. doi: 10.1007/s15010-026-02785-z. Online ahead of print.

Authors

Ilja Areskog Lejbman^{1

2}, Gustav Torisson^{3

4}, Fredrik Resman^{3

4}, Fredrik Sjövall^{5

6}

Affiliations

¹ Department of Intensive and Perioperative Care, Skåne University Hospital, Carl-Bertil Laurells gata 9, 205 02, Malmö, Sweden. ilja.areskog_lejbman@med.lu.se.
² Department of Clinical Sciences, Lund University, Malmö, Sweden. ilja.areskog_lejbman@med.lu.se.
³ Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden.
⁴ Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden.
⁵ Department of Intensive and Perioperative Care, Skåne University Hospital, Carl-Bertil Laurells gata 9, 205 02, Malmö, Sweden.
⁶ Department of Clinical Sciences, Lund University, Malmö, Sweden.

PMID: 41893986
DOI: 10.1007/s15010-026-02785-z

Abstract

Purpose: Early administration of beta-lactam antibiotics is a crucial part in the treatment of sepsis and septic shock. Beta-lactams demonstrate time-dependent killing and therefore it is important to optimize the time above the minimal inhibitory concentration (MIC). An extra dose is recommended in threatening/suspected/confirmed septic shock. This study aimed to examine whether patients with suspected sepsis achieved adequate concentrations after the initial dose.

Methods: A prospective observational study was conducted in patients with suspected sepsis at the emergency department, started on cefotaxime, piperacillin-tazobactam or meropenem. The primary endpoint was defined as trough serum concentration above EUCAST clinical breakpoints for Enterobacterales spp., during the whole dosing interval, 100% ƒT > MIC. Primary objective was the percentage of patients reaching 100% ƒT > MIC. Secondary objectives were how an eventual extra dose and patients related factors affected target attainment.

Results: The study included 60 patients with a median age of 78 years. Of all patients, 73% (44/60) attained 100% ƒT > MIC. Nine patients received an extra dose of whom all attained target. Patients not attaining target were younger with median age (years) 68 vs 79 and had better renal function in terms of median creatinine (µmol/l) 74 vs 121 and median eGFR (mL/min) 84 vs 49.

Conclusion: In this study, 27% (16/60) of patients admitted to the emergency department with suspected sepsis did not meet the target of 100% ƒT > MIC. This suggests that the treatment regimens for patients admitted to the emergency department with suspected sepsis can be further improved.

Keywords: Beta-lactam antibiotics; Early phase pharmacokinetics; Emergency department; Plasma drug concentration; Sepsis.