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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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A Comparison Between Cefepime and Piperacillin-Tazobactam in the Management of Septic Shock

Robert C Ross1, Abbie N Rosen1, Kenneth K Tran2

  • 1Pharmacy, North Florida/South Georgia Veterans Health System, Gainesville, USA.

Cureus
|November 18, 2021
PubMed

Insights

Cefepime did not show improved outcomes for septic shock compared to piperacillin-tazobactam regarding acute kidney injury (AKI) or Clostridioides difficile infection (CDI). Higher mortality was observed with cefepime, warranting further investigation.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Septic shock involves a dysregulated host response and hemodynamic instability.
  • Concerns about acute kidney injury (AKI) with vancomycin and piperacillin-tazobactam may increase cefepime use.
  • Cefepime is an alternative broad-spectrum antipseudomonal beta-lactam antibiotic.

Purpose of the Study:

  • To assess if cefepime is associated with improved outcomes compared to piperacillin-tazobactam in septic shock patients.
  • To evaluate the association between cefepime and piperacillin-tazobactam and outcomes including AKI and mortality.
  • To compare the incidence of Clostridioides difficile infection (CDI) between the two antibiotic groups.

Main Methods:

  • Retrospective cohort study of veterans with septic shock (2008-2018).
  • Compared initial antibiotic management with cefepime versus piperacillin-tazobactam.
  • Outcomes assessed: AKI, CDI, hospital length of stay, ICU mortality, and 30-day mortality.

Main Results:

  • No significant difference in AKI proportions between piperacillin-tazobactam (60.0%) and cefepime (58.3%) cohorts (p = 0.90).
  • Mortality was significantly higher in the cefepime cohort compared to the piperacillin-tazobactam cohort.
  • No significant differences were found in CDI rates or hospital length of stay.

Conclusions:

  • Initial management of septic shock with cefepime or piperacillin-tazobactam showed no difference in AKI or CDI incidence.
  • Higher mortality observed with cefepime suggests a need for further investigation.
  • The choice of antipseudomonal beta-lactam antibiotic may not significantly impact AKI or CDI in septic shock.
Keywords:
acute kidney injuryanti-infectivescritical careinfectious diseasessepsis

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