Cefepime vs Piperacillin-Tazobactam en adultos hospitalizados con infección aguda: el ensayo clínico aleatorizado de
Edward T Qian1, Jonathan D Casey1, Adam Wright2,3
1Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA
|October 14, 2023
Resumen
En un ensayo aleatorizado, se mostraron riesgos similares para la lesión renal aguda o la muerte en adultos hospitalizados. Sin embargo, la cefepina se asoció con un aumento de la disfunción neurológica.
Área de la Ciencia:
- Enfermedades infecciosas
- Nefrología
- Neurología
Sus antecedentes:
- Cefepime y piperacilina-tazobactam son tratamientos empíricos comunes para adultos hospitalizados.
- Las hipótesis anteriores sugirieron que la piperacilina-tazobactam puede causar lesión renal aguda y que la cefepina puede causar disfunción neurológica.
- Faltaban datos comparativos de seguridad de ensayos clínicos aleatorizados.
Objetivo del estudio:
- Comparar los riesgos de lesión renal aguda y disfunción neurológica entre cefepima y piperacilina- tazobactam en adultos hospitalizados.
- Evaluar el impacto de la elección de antibióticos en los resultados renales y neurológicos.
Principales métodos:
- El ensayo Antibiotic Choice on Renal Outcomes (ACORN) fue un ensayo clínico aleatorizado en el que participaron adultos hospitalizados.
- Los pacientes recibieron cefepima o piperacilina- tazobactam.
- Resultado primario: etapa más alta de lesión renal aguda o muerte al día 14. Resultados secundarios: acontecimientos renales adversos importantes y días vivos y libres de delirio/coma dentro de los 14 días.
Principales resultados:
- No hubo diferencias significativas en la lesión renal aguda o la muerte al día 14 entre los grupos de cefepina y piperacilina- tazobactam (7,0% frente a 7,5% en la etapa 3 de la IAC/ muerte).
- Los eventos renales adversos mayores en el día 14 fueron similares entre los grupos (10,2% frente a 8,8%).
- Los pacientes que recibieron cefepima tuvieron menos días de vida y libres de delirio y coma en 14 días (media de 11,9 versus 12,2 días).
Conclusiones:
- La piperacilina- tazobactam no aumentó la incidencia de lesión renal aguda o muerte en comparación con cefepima en adultos hospitalizados.
- El tratamiento con cefepima se asoció con un aumento de la disfunción neurológica (delirio y coma).
- La elección entre estos antibióticos puede influir en los resultados neurológicos sin afectar significativamente el riesgo de lesión renal aguda.
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