Comparison of Cefepime and Piperacillin-Tazobactam For Risk of Acute Kidney Injury

Piperacillin-tazobactam, a commonly administered empirical treatment for infection, does not increase the incidence of acute kidney injury or death in hospitalized adults, according to a randomized clinical trial.

Researchers compared piperacillin-tazobactam to another commonly administered empirical treatment—cefepime—to determine whether health risks were associated with each medication. Prior to the study, it was hypothesized that piperacillin-tazobactam may cause acute kidney injury, while cefepime causes neurological dysfunction.

In total, 2511 patients were included in the Antibiotic Choice on Renal Outcomes (ACORN) trial. Patients randomly received either cefepime or piperacillin-tazobactam within 12 hours of presenting to an emergency department or intensive care unit in the United States between November 10, 2021, and October 7, 2022. The primary outcome for the trial was the highest stage of acute kidney injury or death by day 14.

Of the total patients who received cefepime (n = 1214), 85 patients (7.0%) were diagnosed with stage 3 acute kidney injury and 92 (7.6%) who died. Comparatively, the results were not significantly different from the piperacillin-tazobactam group (n = 1297): 97 patients (7.5%) had stage 3 acute kidney and 78 (6.0%) died.

Further, the incidence of major adverse kidney events at day 14 was not different between groups (124 patients [10.2%] in the cefepime group vs 114 patients [8.8%] in the piperacillin-tazobactam group).

“Among hospitalized adults in this randomized clinical trial, treatment with piperacillin-tazobactam did not increase the incidence of acute kidney injury or death. Treatment with cefepime resulted in more neurological dysfunction,” the researchers concluded.

Reference:

Qian ET, Casey JD, Wright A, et al. Cefepime vs piperacillin-tazobactam in adults hospitalized with acute infection. JAMA. 2023;330(16):1557-1567. doi:10.1001/jama.2023.20583