The following is a summary of “Piperacillin-Tazobactam Versus Anti-Pseudomonal Cephalosporins and Renal and Neurologic Outcomes in Critically Ill Adults: A Secondary Analysis of the SMART Trial.,” published in the June 2023 issue of Nephrology by Qian et al.

Previous research indicates potential links between the use of piperacillin-tazobactam and acute kidney injury and the use of anti-pseudomonal cephalosporins and neurotoxicity. 

For a study, researchers aimed to compare clinically significant renal and neurological outcomes in critically ill patients who were administered piperacillin-tazobactam or anti-pseudomonal cephalosporins. 

They conducted a secondary analysis of data from isotonic solutions and major adverse renal events trials, specifically examined patients who received either piperacillin-tazobactam or an anti-pseudomonal cephalosporin within 24 hours of being admitted to the intensive care unit. They used a proportional odds model in multivariable analysis, and they investigated the relationship between the initial antibiotic received and two outcomes: Major Adverse Kidney Events within 30 days (MAKE30) and the number of days alive and free of delirium and coma up to day 28.

They included 3,199 individuals, with 2,375 (74%) receiving piperacillin-tazobactam and 824 (26%) receiving anti-pseudomonal cephalosporin. After accounting for prespecified confounders, initial administration of piperacillin-tazobactam, compared to, did not show a significant association with a higher incidence of MAKE30 (adjusted odds ratio: 1.03; 95% CI: 0.83-1.27; P= 0.80). It was linked to a longer duration of being alive and free from delirium and coma (adjusted odds ratio: 1.18; 95% CI: 1.00-1.38; P= 0.04). A sensitivity analysis that considered adjustments for baseline receipt of medications that may impact neuro function was not found to be significant.

The study concluded that piperacillin-tazobactam administration was not linked to a higher occurrence of death, renal replacement therapy, or persistent renal dysfunction for adults in critical condition. It was not associated with more days alive and free from delirium and coma. There is a need for randomized trials to guide the selection of appropriate antibiotics for the empirical treatment of infections in critically ill adults.

Source: journals.sagepub.com/doi/full/10.1177/08850666231184177