{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T06:04:43Z","timestamp":1774677883623,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Septic shock necessitates timely antibiotic therapy, often with broad\u2010spectrum beta\u2010lactam antibiotics (\u00df\u2010LA). To our knowledge, no previous study has examined antibiotic concentrations repeatedly during the initial phase of treatment. This observational study aimed to assess early\u2010phase plasma concentrations of \u00df\u2010LA in patients with septic shock.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Prospective observational study of patients with septic shock, according to the SEPSIS\u20103 criteria, who received cefotaxime, piperacillin\/tazobactam, or meropenem in accordance with Swedish practice. Demographic and clinical data were recorded for each patient. Consecutive blood samples were obtained during the first 24\u2009h of treatment, and total antibiotic concentrations were measured using liquid chromatography mass spectrometry. Target concentrations were defined as 100% of the time that free (unbound) antibiotic concentrations remained above the minimal inhibitory concentration (<jats:italic>f<\/jats:italic>T\u2009&gt;\u2009MIC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010two patients were included, 15 (68%) were male and the median age was 65.5\u2009years (IQR 46.3\u201365.5). In\u2010hospital mortality was 7\/22 (32%). Antibiotic exposure exceeding 100% <jats:italic>f<\/jats:italic>T\u2009&gt;\u2009MIC was achieved in 16 (73%) of the patients. Four patients did not receive the recommended additional dose between the first and second doses of antibiotics; two of them still achieved 100% <jats:italic>f<\/jats:italic>T\u2009&gt;\u2009MIC, whereas the other two attained 66% and 33% <jats:italic>f<\/jats:italic>T\u2009&gt;\u2009MIC, respectively. Among the patients who received the additional dose, four did not achieve 100% <jats:italic>f<\/jats:italic>T\u2009&gt;\u2009MIC. No relationship between mortality and <jats:italic>f<\/jats:italic>T\u2009&gt;\u2009MIC was observed. Significant associations with achieving 100% <jats:italic>f<\/jats:italic>T\u2009&gt;\u2009MIC were observed for older age (<jats:italic>p<\/jats:italic>\u2009=\u20090.045) and illness severity (SAPS3, <jats:italic>p<\/jats:italic>\u2009=\u20090.025).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings demonstrate considerable variability in antibiotic exposure during the initial 24\u2009h of septic shock treatment, highlighting a critical gap in understanding the clinical relevance of sub\u2010optimal serum antibiotic concentrations and their potential impact on patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Editorial Comment<\/jats:title><jats:p>Therapeutic drug monitoring of antimicrobials is increasingly being used in research and clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.70050","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T18:36:38Z","timestamp":1746210998000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Plasma Trough Concentrations of Beta\u2010Lactam Antibiotics in the Early Phase of Septic Shock"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2201-9759","authenticated-orcid":false,"given":"Malin","family":"H\u00e4gglund","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Region V\u00e4stra G\u00f6taland, Sahlgrenska University Hospital  Gothenburg Sweden"},{"name":"Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy University of Gothenburg  Gothenburg 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G\u00f6taland, Sahlgrenska University Hospital  Gothenburg Sweden"},{"name":"Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy University of Gothenburg  Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8265-9313","authenticated-orcid":false,"given":"Carl Johan","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Region V\u00e4stra G\u00f6taland, Sahlgrenska University Hospital  Gothenburg Sweden"},{"name":"Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences at the Sahlgrenska Academy University of Gothenburg  Gothenburg 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