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Published on: August 30, 2018
Comparing the mortality of patients with sepsis using empirical piperacillin/tazobactam and cefepime: analysis of the
Yongseop Lee1, Jaeeun Seong1, Jung Ah Lee1
1Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Objectives:
We compared the effectiveness of piperacillin/tazobactam and cefepime as empirical antibiotics for sepsis.
Patients And Methods:
This retrospective cohort study included adult patients diagnosed with sepsis, receiving either piperacillin/tazobactam or cefepime as empirical treatment. Relevant data were extracted from the Medical Information Mart for Intensive Care IV database. Stabilized inverse probability of treatment weighting was used to adjust for the imbalance in covariates between both groups. The primary outcome was 90-day mortality, and Clostridium difficile infection and vancomycin-resistant enterococci colonization rates were the secondary outcomes.
Results:
Among 2485 eligible patients, 1161 received piperacillin/tazobactam and 1324 received cefepime as empirical treatment for sepsis. After stabilized inverse probability of treatment weighting, 90-day mortality did not significantly differ between the groups. The Kaplan-Meier curve showed no difference in 90-day mortality between the two groups (log-rank test, P = 0.947). Similarly, the rate of C. difficile infection and vancomycin-resistant enterococci colonization did not significantly differ.
Conclusions:
No significant difference was observed in the risk of mortality in the empirical use of either antibiotic, suggesting comparable efficacy in sepsis. Therefore, individual patient characteristics should be considered when treating sepsis rather than systematically recommending antibiotics.
Insights
Piperacillin/tazobactam and cefepime show comparable effectiveness for empirical sepsis treatment. Neither antibiotic significantly impacted 90-day mortality or secondary outcomes like C. difficile infection.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Sepsis management requires prompt empirical antibiotic therapy.
- Piperacillin/tazobactam and cefepime are commonly used broad-spectrum antibiotics for sepsis.
Purpose of the Study:
- To compare the effectiveness of piperacillin/tazobactam versus cefepime as empirical antibiotics for sepsis.
Main Methods:
- Retrospective cohort study of 2485 adult sepsis patients.
- Utilized stabilized inverse probability of treatment weighting for covariate adjustment.
- Primary outcome: 90-day mortality; Secondary outcomes: C. difficile infection and VRE colonization.
Main Results:
- No significant difference in 90-day mortality between piperacillin/tazobactam and cefepime groups (P=0.947).
- Kaplan-Meier analysis confirmed no difference in 90-day survival.
- Similar rates of C. difficile infection and vancomycin-resistant enterococci colonization observed.
Conclusions:
- Piperacillin/tazobactam and cefepime demonstrate comparable efficacy for empirical sepsis treatment.
- Antibiotic choice should be individualized based on patient characteristics, not solely on broad recommendations.
- Further research may explore specific patient subgroups benefiting from one agent over the other.
