The Beans or Brain?- The ACORN trial and effects of cefepime and pip-tazo on neuro and renal outcomes
Feb 20, 2024
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Dive into the critical examination of cefepime and piperacillin-tazobactam in treating sick patients. Unpack the ACORN Trial's findings on acute kidney injury and neurologic dysfunction. Discover how these antibiotics impact patient outcomes in the Emergency Department. A fabricated patient case sheds light on the trial's implications for clinical practice. It's a fascinating discussion that weighs the risks and benefits of these common antibiotic choices.
The ACORN trial reveals no significant difference in acute kidney injury rates between piperacillin-tazobactam and cefepime in hospitalized adults.
Cefepime is linked to a higher incidence of neurologic dysfunction compared to piperacillin-tazobactam, highlighting the importance of antibiotic selection.
Deep dives
Overview of the ACORN Trial
The ACORN trial investigates the safety profile of two commonly used antibiotics, piperacillin-tazobactam (PipTazo) and cefepime, in hospitalized adults with suspected infections. This trial addresses a critical concern regarding potential acute kidney injury (AKI) and neurologic dysfunction associated with these medications. The study involves a pragmatic, open-label, randomized design, enrolling over 2,500 patients across emergency and intensive care settings, which helps ensure robust and clinically relevant results. The primary aim is to determine if one antibiotic leads to better renal outcomes or reduced rates of neurologic complications in this patient population.
Findings on Acute Kidney Injury and Neurologic Dysfunction
The results indicate no significant difference in the incidence of AKI or death between patients treated with PipTazo and those receiving cefepime, thereby questioning previous concerns regarding renal safety linked to PipTazo. Approximately 75% of both groups experienced no AKI or mortality by day 14, underscoring the safe usage of either antibiotic. However, cefepime was associated with a higher risk of neurologic dysfunction, with 20.8% of patients experiencing delirium or coma, compared to 17.3% in the PipTazo group. These findings suggest a nuanced consideration for clinicians when selecting antibiotics, as the choice may impact patient outcomes related to neurologic health.
Implications for Clinical Practice
The trial emphasizes the relevance of tailoring antibiotic selection based on safety profiles rather than assumed risks, particularly in acute scenarios such as sepsis. Practitioners can be reassured by the evidence indicating that PipTazo does not elevate AKI risk compared to cefepime, thus alleviating long-standing concerns associated with its use alongside vancomycin. The findings also suggest a need for further exploration into the necessity of anti-pseudomonal coverage for community-acquired infections. Ultimately, the results advocate for a preference toward PipTazo for treating undifferentiated patients with sepsis, unless specific indications for cefepime arise.
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Exploring Antibiotic Impact on Kidney and Neurologic Health in Hospitalized Patients
In the Emergency Department, we often have to initiate empiric antibiotic treatment for sick, undifferentiated patients. Cefepime and Piperacillin-Tazobactam (pip-tazo) are common antibiotic options for coverage of gram-negative organisms, such as pseudomonas. But is one better than the other?
In this podcast, we will critically appraise The ACORN Trial- an article that examines the risks of acute kidney injury and/or neurologic dysfunction in patients treated empirically with one of these antibiotics.