News: Antibiotic for treating sepsis linked to increased mortality, study shows

Piperacillin-tazobactam, one of the antibiotics most frequently prescribed in an empirical regiment for sepsis, was associated with a higher mortality rate and increased duration in organ dysfunction compared with cefepime for adults hospitalized with suspected sepsis, according to a recent study published in JAMA Internal Medicine.

The retrospective study found that empirical treatment with vancomycin and piperacillin-tazobactam resulted in a 5% absolute increase in 90-day mortality compared with empirical treatment with vancomycin and cefepime (22.5% vs 17.5%), MedPage Today reported.

Researchers analyzed a final sample of 7,569 adult patients who came to the emergency department at the University of Michigan from 2014 to 2018 and received empirical treatment with sepsis. Of these, 4,523 were treated with vancomycin and piperacillin-tazobactam and 3,046 were treated with vancomycin and cefepime. Besides the mortality increase, piperacillin-tazobactam was also associated with 2.1 fewer organ failure-free days, 1.1 fewer ventilator-free days, and 1.5 fewer vasopressor-free days when compared with cefepime.

The combination of vancomycin and piperacillin-tazobactam is the most frequently prescribed empirical regimen for sepsis, the authors pointed out, but given the results of their study, the combination may contribute to one additional death per every 20 patients with sepsis.

The researchers looked at the association between receipt of any anti-anaerobic antibiotic and patient outcomes in comparison with no receipt of anti-anaerobic antibiotics in a secondary analysis. They found anti-anaerobic antibiotic treatment was associated with a 12% increase in 90-day mortality using a two-stage regression model and a 14% increase in mortality using a non-linear two-stage residual inclusion model. Treatment with anti-anaerobic antibiotics was associated with fewer ventilator-free days, vasopressor free-days, and organ failure-free days.

“Most patients with sepsis do not have a specific indication for anti-anaerobic antibiotics, and our study suggests they could cause real harm,” Rishi Chanderraj, MD, MSc, of the Ann Arbor Veterans Affairs Hospital in Michigan, told MedPage Today. “Making the right antibiotic choice is not just a matter of preventing future antibiotic resistance—these choices directly impact clinical outcomes for the patients in front of us.”

Editor’s note: To read MedPage Today’s coverage of this story, click here. To access the JAMA study, click here.