The Latest in Critical Care, 10/23/23 (Issue #17)
ACORN trial (cefepime vs. pip-tazo), Paxlovid for Omicron, MDROs on the rise
Piperacillin-Tazobactam vs. Cefepime for Kidney Injury and Neurologic Dysfunction (ACORN Trial)
Piperacillin-tazobactam, marketed as Zosyn, has been one of the most-prescribed broad spectrum antibiotics for many years, used for its bactericidal activity against most gram-negative and anaerobic bacteria, including Pseudomonas. Cefepime has similar antibacterial activity, and both are widely used in the ICU as empiric coverage in patients with potentially serious gram-negative infections.
Pip-tazo has been repeatedly associated with an increased risk for acute kidney injury over the past several years, based on retrospective observational studies with risk for confounding. Answering this research question has been made more difficult by pip-tazo’s possible status as a pseudo-nephrotoxin (elevating creatinine levels in the blood without harming the kidneys) and frequent co-administration with vancomycin, a known nephrotoxin. Over the years, dozens of copycat studies (which are relatively e…
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