Piperacillin-tazobactam appears safe for kidney health in hospitalized adults
Treatment with piperacillin-tazobactam did not increase the incidence of acute kidney injury or death among hospitalized adults, according to a study. However, treatment with cefepime was associated with a higher risk of neurological dysfunction. This information is crucial for clinicians when deciding between these two commonly administered antibiotics for the empirical treatment of infections in hospitalized adults.
In the Antibiotic Choice on Renal Outcomes (ACORN) randomized clinical trial, 2511 adults, for whom a clinician initiated an order for antipseudomonal antibiotics within 12 hours of hospital presentation, were randomly assigned in a 1:1 ratio to receive either cefepime or piperacillin-tazobactam.
The primary outcome of the study was the highest stage of acute kidney injury or death by day 14, assessed on a 5-level ordinal scale ranging from no acute kidney injury to death. No significant difference in this outcome was found between the groups. In the cefepime group, 7.0% of patients experienced stage 3 acute kidney injury, with 7.6% mortality, while in the piperacillin-tazobactam group, 7.5% experienced stage 3 acute kidney injury, with 6.0% mortality.
Secondary outcomes included the incidence of major adverse kidney events at day 14 and the number of days alive and free of delirium and coma within 14 days. The trial found no significant difference in the incidence of major adverse kidney events at day 14 between the groups (10.2% in the cefepime group vs 8.8% in the piperacillin-tazobactam group). However, patients in the cefepime group experienced slightly fewer days alive and free of delirium and coma within the 14-day period.
Qian ET, Casey JD, Wright A, et al; Vanderbilt Center for Learning Healthcare and the Pragmatic Critical Care Research Group. Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023;e2320583. doi: 10.1001/jama.2023.20583. Epub ahead of print. PMID: 37837651; PMCID: PMC10576861.