Two ‘powerful’ antibiotics previously suspected of causing kidney problems in ICU patients with severe bacterial infections, particularly when used together, might be less harmful to the kidneys than previously believed.
This discovery comes from a randomized trial conducted by Vanderbilt University Medical Center (VUMC) and the Pragmatic Critical Care Research Group, with funding from several sources including grants from the National Heart Lung and Blood Institute.
Nairametrics learns that as most hospitals across the world receive one or both of these antibiotics daily, it was important to emphasize the significance of comprehending their effects comparatively, as it plays a crucial role in determining the most effective treatment for patients based on their condition and infection.
The results of the study which compared cefepime and piperacillin/tazobactam, were published in JAMA and presented by Eddie Qian, MD, who is an assistant professor of Medicine in the Division of Pulmonary and Critical Care Medicine at VUMC, during ID Week 2023 in Boston.
What he said
Qian said,
- “I think the big take-home point here is, when you’re looking at piperacillin/tazobactam and renal dysfunction, our study didn’t find a big difference there, and so you should feel comfortable in using that for your patients when they come to the hospital for infection”.
What the study indicates
The Antibiotic Choice on Renal Outcomes (ACORN) randomized clinical trial, in the last year, compared cefepime with piperacillin/tazobactam in adults who were prescribed one of these antibiotics within 12 hours of arriving at the emergency department or medical intensive care unit in a U.S. academic medical centre.
The final analysis included 2,511 patients with a median age of 58 years. The primary outcome, which assessed the highest stage of acute kidney injury or death by day 14, showed no significant difference between the cefepime and piperacillin-tazobactam groups.
Dr. Todd Rice, a co-senior author of the study, explained,
- “Some observational studies have suggested that piperacillin/tazobactam could lead to renal failure, especially when used with another antibiotic called vancomycin. However, our randomized trial didn’t find this connection.”
- “Additionally, the research identified a secondary outcome: patients in the cefepime group experienced fewer days without delirium and coma within the first 14 days compared to those in the piperacillin/tazobactam group, indicating a potential association between cefepime treatment and neurological dysfunction”.
According to Rice,
- “We need to dig in deep with cefepime and find out what that means for our patients and what the risk factors might be.
- “We had some data that cefepime may cause some neurotoxicity – we found a signal for some neurotoxicity, although we are not entirely sure what it means clinically so that needs more study.”
The findings from this study may provide valuable insights that could contribute to current warnings regarding the risk of renal failure in critically ill patients using piperacillin/tazobactam and the potential neurotoxicity associated with cefepime, as suggested by the authors.
