Unisabana Center for Translational Science, Universidad de La Sabana, Chía, Colombia.
School of Medicine, Universidad de La Sabana, Chía, Colombia.
Sci Rep. 2024 Jun 11;14(1):13392. doi: 10.1038/s41598-024-64444-3.
Cefepime and piperacillin/tazobactam are antimicrobials recommended by IDSA/ATS guidelines for the empirical management of patients admitted to the intensive care unit (ICU) with community-acquired pneumonia (CAP). Concerns have been raised about which should be used in clinical practice. This study aims to compare the effect of cefepime and piperacillin/tazobactam in critically ill CAP patients through a targeted maximum likelihood estimation (TMLE). A total of 2026 ICU-admitted patients with CAP were included. Among them, (47%) presented respiratory failure, and (27%) developed septic shock. A total of (68%) received cefepime and (32%) piperacillin/tazobactam-based treatment. After running the TMLE, we found that cefepime and piperacillin/tazobactam-based treatments have comparable 28-day, hospital, and ICU mortality. Additionally, age, PTT, serum potassium and temperature were associated with preferring cefepime over piperacillin/tazobactam (OR 1.14 95% CI [1.01-1.27], p = 0.03), (OR 1.14 95% CI [1.03-1.26], p = 0.009), (OR 1.1 95% CI [1.01-1.22], p = 0.039) and (OR 1.13 95% CI [1.03-1.24], p = 0.014)]. Our study found a similar mortality rate among ICU-admitted CAP patients treated with cefepime and piperacillin/tazobactam. Clinicians may consider factors such as availability and safety profiles when making treatment decisions.
头孢吡肟和哌拉西林/他唑巴坦是 IDSA/ATS 指南推荐用于经验性治疗因社区获得性肺炎（CAP）入住重症监护病房（ICU）的患者的抗菌药物。人们对在临床实践中应使用哪种药物存在担忧。本研究旨在通过靶向最大似然估计（TMLE）比较头孢吡肟和哌拉西林/他唑巴坦在重症 CAP 患者中的疗效。共纳入 2026 例 ICU 收治的 CAP 患者。其中，（47%）出现呼吸衰竭，（27%）发生感染性休克。（68%）接受头孢吡肟治疗，（32%）接受哌拉西林/他唑巴坦治疗。在运行 TMLE 后，我们发现头孢吡肟和哌拉西林/他唑巴坦治疗的 28 天、住院和 ICU 死亡率相当。此外，年龄、PTT、血清钾和体温与更倾向于使用头孢吡肟而非哌拉西林/他唑巴坦有关（OR 1.14 95%CI [1.01-1.27]，p=0.03），（OR 1.14 95%CI [1.03-1.26]，p=0.009），（OR 1.1 95%CI [1.01-1.22]，p=0.039）和（OR 1.13 95%CI [1.03-1.24]，p=0.014）。我们的研究发现，使用头孢吡肟和哌拉西林/他唑巴坦治疗的 ICU 收治的 CAP 患者死亡率相似。临床医生在做出治疗决策时可以考虑药物的可及性和安全性等因素。
