Background Cefepime and piperacillin-tazobactam are commonly used broad-spectrum antibiotics used to treat patients with potential gram-negative bacterial sepsis. Piperacillin-tazobactam has been shown to be associated with acute kidney injury (AKI). However, it has not been compared to cefepime in patients with septic shock. We compared cefepime and piperacillin-tazobactam on the incidence of severe AKI in patients with septic shock. Methods This was a retrospective, multicenter, inverse probability-of-treatment weighted cohort study conducted in 220 geographically diverse community and teaching hospitals across the U.S. Adult patients were included if they had septic shock on hospital admission and received cefepime or piperacillin-tazobactam. Proportion of patients who developed stage 3 AKI during hospitalization were compared between groups. Results Of the 8427 patients included in the final cohort, 4569 received cefepime and 3858 received piperacillin-tazobactam. Patients had a mean (SD) age of 66.2 years (15.2), and 45.3% were female, mean (SD) eGFR was 48 (24) ml/min/1.73m2 on the day of admission. In the weighted cohort, stage 3 AKI occurred in 9.9% with cefepime and 9.8% with piperacillin-tazobactam (OR 0.98, 95% CI 0.84–1.15, p=0.823). In terms of secondary outcomes, there was no significant difference between cefepime and piperacillin-tazobactam with regard to renal replacement therapy, in-hospital death, major adverse kidney events, stage 1 AKI, stage 2 AKI, maximum recorded serum creatinine, or hospital length of stay Conclusions Among hospitalized patients with septic shock, there was no difference between cefepime and piperacillin-tazobactam on the occurrence of severe AKI.

中文翻译：

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一项比较头孢吡肟与哌拉西林-他唑巴坦对感染性休克患者严重急性肾损伤发展影响的全国回顾性队列研究


背景 头孢吡肟和哌拉西林-他唑巴坦是常用的广谱抗生素，用于治疗潜在的革兰氏阴性细菌性脓毒症患者。哌拉西林-他唑巴坦已被证明与急性肾损伤 （AKI） 有关。然而，尚未将其与头孢吡肟在脓毒性休克患者中进行比较。我们比较了头孢吡肟和哌拉西林-他唑巴坦对感染性休克患者严重 AKI 发生率的影响。方法 这是一项回顾性、多中心、逆治疗概率加权队列研究，在美国 220 家地理位置不同的社区和教学医院进行，如果成年患者在入院时患有感染性休克并接受头孢吡肟或哌拉西林-他唑巴坦治疗，则被纳入其中。比较两组间住院期间发生 3 期 AKI 的患者比例。结果 在最终队列纳入的 8427 例患者中，4569 例接受头孢吡肟治疗，3858 例接受哌拉西林-他唑巴坦治疗。患者的平均 （SD） 年龄为 66.2 岁 （15.2），45.3% 为女性，入院当天的平均 （SD） eGFR 为 48 （24） ml/min/1.73m2。在加权队列中，头孢吡肟组发生 3 期 AKI 的发生率为 9.9%，哌拉西林-他唑巴坦组发生率为 9.8% （OR 0.98,95% CI 0.84-1.15，p=0.823）。在次要结局方面，头孢吡肟和哌拉西林-他唑巴坦在肾脏替代治疗、院内死亡、主要不良肾脏事件、1 期 AKI、2 期 AKI、最大血清肌酐记录或住院时间方面无显著差异结论 在感染性休克住院患者中，头孢吡肟和哌拉西林-他唑巴坦在严重 AKI 发生方面没有差异。