New manuscript in JAMA Internal Medicine: Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime
New in JAMA Internal Medicine: a study led by Rishi Chanderraj and Mike Sjoding using a 15-month drug shortage (piperacillin-tazobactam) to determine the effects of unneeded anti-anaerobic antibiotics in the empiric treatment of sepsis.
In prior animal models (link, link) and observational cohort studies (link, link), depleting the gut of anaerobic commensals has been associated with worse outcomes. Our team used the 2015-16 national piperacillin-tazobactam shortage as a natural experiment. We found that treatment with piperacillin-tazobactam (which has potent activity against gut anaerobes) was associated with a 5% increase in 90-day mortality when compared to cefepime (which has no activity against anaerobes).
Most patients with sepsis have no indication for anti-anaerobic antibiotics, yet most get them anyway. Our findings suggest that we should reserve them for patients with a legitimate indication.