Evaluating Meropenem and Piperacillin/Tazobactam for Empiric Sepsis Treatment

Every year at least 1.7 million adults in the United States develop sepsis, according to the US Centers for Disease Control and Prevention. Of these individuals, nearly 270,000 will die from the condition.

It is estimated that 1 in 3 patients who die in a hospital setting have a sepsis, making the condition common in the intensive care units (ICU) of United States hospitals.

However, administration of appropriate antibiotics in a timely manner has been associated with improved clinical outcomes among patients with sepsis. Piperacillin/tazobactam and meropenem are both accepted as options for empirical antibiotic therapy due to their broad-spectrum activity.

In a new study a team of investigators set out to evaluate whether there is a difference in clinical outcomes between adults receiving piperacillin/tazobactam and meropenem for empiric sepsis treatment in the ICU. Their findings were presented in a poster session at the American Society of Health-Systems Pharmacists (ASHP) Midyear Clinical Meeting.

The investigators conducted a retrospective review of data from 122 adult sepsis patients admitted to the ICU between January 2015 and December 2017. In total, 82 patients were treated with piperacillin/tazobactam and 40 individuals received meropenem.

The investigators assessed information including demographic data, underlying comorbidities, potential sources of infection, along with culture results and susceptibility to piperacillin/tazobactam and to meropenem. The study team performed propensity score matching (PSM) analysis and multivariate analysis to control for all potential confounders.

The primary outcomes were ICU length of stay and 30-day mortality. After adjusting for confounders, the investigators found that there was no significant difference in ICU length of stay between piperacillin/tazobactam (median 12, Interquartile Range [IQR] 7, 20), and meropenem (median 15.5, IQR 8.5, 27) treated groups (P = 0.2).

Additionally, the investigators report that 30-day mortality was not significantly different between individuals treated with piperacillin/tazobactam (73%) and meropenem (76.3%), respectively (P = 0.6).

Secondary outcomes included the delta Sequential Organ Function Assessment (SOFA) score, C-reactive protein (CRP) ratio, and difference between serum procalcitonin (PCT) concentrations and white blood cell (WBC) count on admission and 48-72 hours later. According to the investigators, there were no significant differences between the 2 groups among secondary outcomes.

“The propensity score matching analysis confirmed these findings, with no significant difference in the average treatment effect nor the average treatment effect among treated both for mortality and length of stay in the ICU,” the authors wrote.

Based on these findings, the authors conclude that there was no difference in ICU length of stay or 30-day mortality among patients with sepsis treated with either piperacillin/tazobactam or meropenem.

“These findings support the use of carbapenem sparing agent, such as piperacillin/tazobactam, as an initial empiric antibiotic therapy to treat sepsis in ICU and avoid meropenem overuse,” the authors noted in their conclusion.

However, the authors indicated that there is a need for a prospective, multicenter study comparing the 2 agents that could provide more information on the impact of empirical use for sepsis treatment.

The abstract, Clinical Outcomes of Empirical Use of Piperacillin/tazobactam versus Meropenem in Adult Patients Admitted to the Intensive Care Unit with Sepsis, was presented in a poster session on Monday, December 9, 2019, at ASHP Midyear in Las Vegas, Nevada.