Acute Kidney Injury With Empirical Antibiotics for Sepsis

Abstract

Sepsis describes life-threatening organ dysfunction due to a dysregulated host response to infection. It is a global health priority affecting 55 million people worldwide causing 11 million deaths annually. 1 Failure to initiate timely antibiotic therapy for sepsis can result in progression to septic shock, which is associated with a mortality rate of 30% to 40%. 2 Accordingly, sepsis is recognized as a time-critical medical emergency.Current management focuses on "bundles" 3 of care incorporating early recognition, timely antibiotic administration, and fluid resuscitation. Two commonly prescribed antibiotics for empirical treatment of sepsis are the β-lactams piperacillin-tazobactam and cefepime. Both provide broad in vitro activity against gram-positive and gram-negative organisms, including Pseudomonas aeruginosa. They are often used in combination with vancomycin to include activity against methicillin-resistant Staphylococcus aureus.Both β-lactam antibiotics are associated with risk. The purported increased risk of acute kidney injury (AKI) from the combination of piperacillin-tazobactam plus vancomycin compared with other β-lactam agents has led to a cultural shift away from the empirical use of piperacillin-tazobactam among many prescribers. Meta-analyses of observational studies found vancomycin plus piperacillin-tazobactam is associated with greater incidence of AKI with odds ratios (ORs) of up to 3.6 4 and an absolute AKI incidence of 22.2% compared with 12.9% in comparators. 5 Based on these data, the US Food and Drug Administration warns that coadministration of piperacillin-tazobactam with vancomycin may increase the incidence of AKI.

Porous Microspheres as Pathogen Traps for Sepsis Therapy: Capturing Active Pathogens and Alleviating Inflammatory Reactions

“…The treatment strategies for sepsis typically encompass anti-infection therapy, fluid resuscitation, administration of vasoactive drugs, and organ supportive care. Among them, anti-infection treatment generally uses empirical broad-spectrum antibiotics . However, the long-term usage of antibiotics is associated with several side effects and an increased risk of drug-resistant bacteria development. − As a result, researchers have turned their attention to alternative therapies for combating bloodstream infections, which include antimicrobial peptides, , metal ion, , bacteriophages, , and other therapies.…”

Cefepime vs Piperacillin-Tazobactam for Acute Infection in Hospitalized Adults

“…We believe that these points are important and should be added to the list of limitations already discussed in the article and Editorial . Randomization stratification could have been used to minimize the risk of imbalance in major baseline predictors of antibiotic-associated toxicity between the groups.…”