Is Piperacillin-Tazobactam More Likely Than Cefepime to Be Associated with Acute Kidney Injury?

Cefepime or piperacillin-tazobactam (PTZ) are common empirical antibiotic choices for hospitalized patients with sepsis or suspected infection. Because their effectiveness is comparable, their potential adverse effects are important considerations. PTZ has been associated with kidney injury (especially when given with vancomycin), but this relation is somewhat controversial. Neurotoxicity — with delirium or change in level of consciousness — has been described with cefepime.

In this open-label trial from Vanderbilt University, researchers randomized 2500 adults with sepsis or suspected serious infection to receive either cefepime or PTZ; in all cases, treating physicians believed that either antibiotic would be acceptable. Treatment was init…