Category: Professional Posters
Purpose: Sepsis is a clinical condition commonly occurs in patients admitted to the Intensive Care Unit (ICU). Timely initiation of adequate empiric antibiotic therapy is associated with improved clinical outcomes. Piperacillin/tazobactam and meropenem are both acceptable as initial empirical antibiotic coverage in sepsis due to their broad-spectrum activity, mainly against Gram-negative bacteria. we aimed to determine whether there is difference in clinical outcomes in adult patients admitted to the ICU with sepsis and started empirically on piperacillin/tazobactam or meropenem.
Methods: Data of all adult patients admitted to the ICU with sepsis between January 2015 and December 2017 were retrospectively reviewed. Collected variables included demographic data, underlying comorbidities, possible source of infection, culture results and susceptibilities of identified Gram-negative bacteria to piperacillin/tazobactam and to meropenem. Primary outcomes of interest were ICU length of stay and 30-day mortality. 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. A propensity score matching (PSM) analysis and multivariate analysis were performed to control for all potential confounders.
Results: There were 122 patients enrolled and who received either piperacillin/tazobactam (n=82) or meropenem (n=40) for sepsis. After adjusting for confounders, 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. Similarly, the 30-day mortality was not significantly different between the piperacillin/tazobactam and meropenem groups 73% vs. 76.3%, respectively, P=0.6. Additionally, other variables such as delta SOFA, CRP ratio, serum PCT and WBC count on admission and 48-72 hours later, also showed no significant difference as a response to initial empiric therapy between both groups. The propensity score matching analysis confirmed these findings, with no significant difference in the average treatment effect (ATE) nor the average treatment effect among treated (ATT) both for mortality and length of stay in the ICU.
Conclusion: The study showed no difference in ICU length of stay, 30-day mortality and other clinical outcomes in adult patients admitted to the ICU with sepsis and empirically 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. However, there is a definite need for a prospective, multicenter design study comparing the empirical use of piperacillin/tazobactam and meropenem in sepsis that could provide more definitive evidence.