Comparing the mortality of patients with sepsis using empirical piperacillin/tazobactam and cefepime: analysis of the MIMIC-IV database

Abstract Objectives We compared the effectiveness of piperacillin/tazobactam and cefepime as empirical antibiotics for sepsis. Patients and methods This retrospective cohort study included adult patients diagnosed with sepsis, receiving either piperacillin/tazobactam or cefepime as empirical treatment. Relevant data were extracted from the Medical Information Mart for Intensive Care IV database. Stabilized inverse probability of treatment weighting was used to adjust for the imbalance in covariates between both groups. The primary outcome was 90-day mortality, and Clostridium difficile infection and vancomycin-resistant enterococci colonization rates were the secondary outcomes. Results Among 2485 eligible patients, 1161 received piperacillin/tazobactam and 1324 received cefepime as empirical treatment for sepsis. After stabilized inverse probability of treatment weighting, 90-day mortality did not significantly differ between the groups. The Kaplan–Meier curve showed no difference in 90-day mortality between the two groups (log-rank test, P = 0.947). Similarly, the rate of C. difficile infection and vancomycin-resistant enterococci colonization did not significantly differ. Conclusions No significant difference was observed in the risk of mortality in the empirical use of either antibiotic, suggesting comparable efficacy in sepsis. Therefore, individual patient characteristics should be considered when treating sepsis rather than systematically recommending antibiotics.