JAMA Intern Med

Natural experiment uncovers mortality risk of anti-anaerobic antibiotic used in sepsis

May 15, 2024

Among patients with suspected sepsis and no definitive indication for anti-anaerobic coverage, a combination of vancomycin (vanco) and piperacillin-tazobactam (pip-tazo) was associated with higher mortality and increased duration of organ dysfunction vs. vanco and cefepime.

• For this retrospective cohort study, investigators used instrumental variable analysis of a 15-month pip-tazo shortage to compare 90-day mortality in patients treated empirically for sepsis. Hospital admissions at the University of Michigan from July 2014 to December 2018, including a pip-tazo shortage period from June 2015 to September 2016, were examined. Adults with suspected sepsis treated with vanco and either pip-tazo or cefepime were included in the study.
• Among 7.569 patients (55% male; median age, 63 years) with sepsis meeting study eligibility, 4,523 were treated with vanco and pip-tazo and 3,046 were treated with vanco and cefepime. In an instrumental variable analysis, pip-tazo was associated with an absolute mortality increase of 5.0% at 90 days and 2.1 fewer organ failure–free days, 1.1 fewer ventilator-free days, and 1.5 fewer vasopressor-free days.
• The findings suggest that the widespread use of empirical antianaerobic antibiotics in sepsis may be harmful.

Source:

Chanderraj R, et al. (2024, May 13). JAMA Intern Med. Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. https://pubmed.ncbi.nlm.nih.gov/38739397/