Study in JAMA Internal Medicine Links Commonly Prescribed Antibiotic to Increased Mortality in Suspected Sepsis Patients

A new study published in JAMA Internal Medicine suggests that a commonly prescribed broad-spectrum antibiotic used in patients with suspected sepsis is associated with increased mortality. CIDRAP has the news.

Specifically, the study found that “in patients with suspected sepsis and no clear indication for anti-anaerobic antibiotics, the combination of piperacillin-tazobactam and vancomycin was associated with a 5% absolute mortality increase at 90 days compared with cefepime and vancomycin.”

Zosyn is a medication that “combines a penicillin antibiotic with a beta-lactamase inhibitor and is…known to have potent activity against anaerobic gut bacteria.” Its use in potential sepsis patients is that it “covers as many potential pathogens as possible.” However, a nationwide shortage pushed clinicians toward prescribing other medicines, which allowed the study authors to test “the hypothesis that empiric use of piperacillin-tazobactam is linked to increased mortality compared with cefepime.”

The study authors analyzed 7,569 patients with suspected sepsis. 4,523 of them were treated with vancomycin and piperacillin-tazobactam and 3,046 received vancomycin and cefepime. Patients treated with piperacillin-tazobactam had a 22.5% 90-day mortality rate compared with 17.5% in those treated with cefepime, showing an absolute increase of 5% in 90-day mortality. 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.”

However, these results contradict a recent clinical trial that found “adults hospitalized with acute infections, acute kidney [failure] or death was not significantly different between those treated with piperacillin-tazobactam or cefepime.”