In hospitals nationwide, doctors face urgent decisions about which antibiotics to administer when patients show signs of severe infection.
These choices, crucial for saving lives, recently came under scrutiny in a study conducted by Michigan Medicine.
The study, initiated in response to a national shortage of the antibiotic piperacillin/tazobactam (marketed as Zosyn) lasting from 2015 to 2016, aimed to understand the consequences of antibiotic selection on patient outcomes, particularly in cases of sepsis, a dangerous infection complication.
Piperacillin/tazobactam, widely used for treating sepsis, was compared with another antibiotic, cefepime, commonly substituted during the shortage.
While both antibiotics target sepsis-causing pathogens, piperacillin/tazobactam also affects anaerobic gut bacteria, which play vital roles in metabolism and immunity.
Dr. Robert Dickson, part of the research team, emphasized the significance of the study, highlighting the depletion of anaerobic bacteria by piperacillin/tazobactam and its potential impact on patient health.
The gut microbiome, predominantly composed of anaerobic bacteria, maintains health and prevents infections. Previous research by the team revealed that piperacillin/tazobactam significantly reduces these bacteria after just one dose, raising concerns about its effects on patients.
Dr. Rishi Chanderraj, along with Dr. Michael Sjoding and their multidisciplinary team, analyzed medical records of over 7,500 patients, comparing outcomes between those treated with piperacillin/tazobactam and those given cefepime.
The results were striking: patients receiving piperacillin/tazobactam experienced a 5% increase in 90-day mortality, along with prolonged ventilator use and organ failure. These findings underscored the potential harm associated with depleting anaerobic gut bacteria.
Dr. Chanderraj emphasized the widespread use of these antibiotics in hospitals and urged clinicians to consider their impact on patient outcomes. He likened antibiotic selection to chemotherapy, stressing the need for careful consideration before prescribing.
While a previous clinical trial found no short-term differences between the two antibiotics, the Michigan Medicine study revealed significant disparities in outcomes after three months. This longer-term perspective highlighted the importance of reevaluating antibiotic choices for septic patients.
Overall, the study suggests that using piperacillin/tazobactam instead of cefepime may lead to one additional death for every 20 septic patients treated. Given the prevalence of sepsis, these findings have significant implications for clinical practice.
Dr. Dickson emphasized the daily dilemma faced by clinicians in selecting antibiotics for sepsis treatment. With thousands of lives at stake, thoughtful consideration of antibiotic choices is essential to improve patient outcomes and prevent unnecessary harm.
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The research findings can be found in JAMA Internal Medicine.
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