Commonly used antibiotic brings more complications, organ failure and death in patients with sepsis: JAMA

Researchers have found in a recent study that in patients with sepsis,  treatment with piperacillin-tazobactam was associated with a 5 percent increase in 90-day mortality, more days on a ventilator, and more time with organ failure compared to Cefepime.

The study conducted at the University of Michigan analyzed in depth regarding the antibiotic treatment for bacterial sepsis and revealed the potentially negative consequences associated with the empirical use of certain antibiotics. The key findings of this study were published in the recent issue of the Journal of American Medical Association - Internal Medicine.

The study scrutinized the outcomes of patients treated empirically for sepsis with two commonly used antibiotics, the piperacillin-tazobactam and cefepime. Previous studies had hinted at adverse outcomes associated with the use of antianaerobic antibiotics like piperacillin-tazobactam, when compared to the anaerobe-sparing antibiotics like cefepime. However, the most recent investigation by Rishi Chanderraj and colleagues was undertaken to provide clear insights into this matter.

This study analyzed data that spanned from July 2014 to December 2018 and examined over 7,500 hospital admissions, including a 15-month period characterized by a shortage of piperacillin-tazobactam. The patients treated with either piperacillin-tazobactam or cefepime for sepsis were included in the study. 

Despite the previous observations that suggest no significant difference in short-term outcomes, this study uncovered a strong reality. When administered empirically, piperacillin-tazobactam was associated with higher mortality rates and prolonged organ dysfunction than cefepime. These results imply that the widespread empirical use of antianaerobic antibiotics in sepsis treatment might harbor unintended harm.

This study utilized an instrumental variable analysis by leveraging the piperacillin-tazobactam shortage period as a tool to reduce the potential confounding factors. This meticulous approach provided robust evidence for the adverse effects associated with piperacillin-tazobactam use in sepsis treatment.

Given the critical nature of sepsis management, these findings suggest that clinicians must cautiously consider the choice of antibiotics. While the broad-spectrum coverage may seem appealing, this study illuminates the importance of weighing the risks and benefits associated with the selection of empirical antibiotics.

Further research and comprehensive analysis are imperative to highlight the optimal antibiotic strategies for sepsis management. Refining the treatment protocols based on the comprehensive evidence would help in improving the patient outcomes and reducing the potential harm. It is obvious that a precise approach to antibiotic selection in sepsis treatment is essential. The outcomes of this study can help in prioritizing patient safety and efficacy which can in turn aid better navigation of this complex terrain with great precision.

Source:

Chanderraj, R., Admon, A. J., He, Y., Nuppnau, M., Albin, O. R., Prescott, H. C., Dickson, R. P., & Sjoding, M. W. (2024). Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. In JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2024.0581