What is the connection between Cefepime treatment for infection and neurological dysfunction?

In a recent clinical trial published in JAMA, researchers have shed light on the comparative safety of two commonly prescribed antibiotics for hospitalized adults. The trial, known as the Antibiotic Choice on Renal Outcomes (ACORN), found that piperacillin-tazobactam did not increase the risk of acute kidney injury or death, while cefepime was associated with more neurological dysfunction.

Cefepime and piperacillin-tazobactam are frequently administered to hospitalized adults for the empirical treatment of infections. However, concerns have lingered regarding the potential side effects of these antibiotics, with piperacillin-tazobactam linked to acute kidney injury and cefepime associated with neurological dysfunction.

The ACORN trial, conducted in a medical center in the United States, recruited patients who required antipseudomonal antibiotics within 12 hours of their hospital admission. Over the course of the study, which ran from November 2021 to October 2022, researchers aimed to provide clarity on the safety profiles of these antibiotics.

The study included 2511 patients, who were randomized into two groups, with one receiving cefepime and the other piperacillin-tazobactam. The results of the trial revealed that there was no significant difference in the highest stage of acute kidney injury or mortality between the two groups. The incidence of major adverse kidney events at day 14 also did not differ significantly between the cefepime and piperacillin-tazobactam groups. However, a notable finding was that patients in the cefepime group experienced more neurological dysfunction compared to those in the piperacillin-tazobactam group.

Reference: Qian ET, Casey JD, Wright A, et al. Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. Published online October 14, 2023. DOI: 10.1001/jama.2023.20583