JAMA

ID Week highlight: Cefepime vs pip/tazo in adults hospitalized with acute infection

October 20, 2023

After years of preference toward cefepime, infectious disease experts note this randomized trial provides the first real-world, high-quality data showing that piperacillin-tazobactam doesn't increase the risk of acute kidney injury (AKI) or death; however, treatment with cefepime resulted in more neurological dysfunction.

• The Antibiotic Choice on Renal Outcomes (ACORN) trial compared cefepime vs piperacillin-tazobactam in adults for whom an order for antipseudomonal antibiotics was initiated within 12 hours of presentation to the ED or medical ICU. Primary outcome was the highest stage of AKI or death by day 14.
• A total of 2,511 patients were included in the primary analysis (median age, 58 years; 42.7% female; 16.3% Non-Hispanic Black; 5.4% Hispanic; 94.7% enrolled in the ED; and 77.2% were receiving vancomycin at enrollment).
• The highest stage of AKI or death wasn't significantly different between the cefepime and piperacillin-tazobactam group; there were 85 patients (n = 1,214; 7.0%) in the cefepime group with stage 3 acute kidney injury and 92 (7.6%) who died vs. 97 patients (n = 1,297; 7.5%) in the piperacillin-tazobactam group with stage 3 acute kidney injury and 78 (6.0%) who died (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.80 to 1.13, P = .56). 
• Incidence of major adverse kidney events at day 14 didn't differ between groups (124 patients [10.2%] in the cefepime group vs. 114 patients [8.8%] in the piperacillin-tazobactam group; absolute difference, 1.4%; 95% CI, -1.0% to 3.8%). 
• Cefepime recipients experienced fewer days alive and free of delirium and coma within 14 days (mean, 11.9 days vs. 12.2 days in the piperacillin-tazobactam group; OR, 0.79; 95% CI, 0.65 to 0.95).

Source:

Qian ET, et al. (2023, October 14). JAMA. Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/37837651/