The ACRON Trial

Population: 

The study focused on hospitalized adults who required antipseudomonal antibiotics. This group included 2511 patients from an emergency department or medical intensive care unit, with a median age of 58 years and a diverse demographic profile including 42.7% female, 16.3% Non-Hispanic Black, and 5.4% Hispanic.

Intervention: 

Patients receiving Cefepime. In this group, 7.0% experienced stage 3 acute kidney injury and 7.6% died. For neurological outcomes, patients on Cefepime had an average of 11.9 days alive and free of delirium and coma within 14 days.

Comparison: 

Patients receiving Piperacillin-Tazobactam. The outcomes for this group showed 7.5% with stage 3 acute kidney injury and 6.0% mortality. Neurologically, they had an average of 12.2 days alive without delirium and coma within the same period.

Outcome: 

The study measured acute kidney injury, death, and neurological dysfunction (delirium and coma). There was no significant difference in the highest stage of acute kidney injury or death between the two groups. However, the Cefepime group experienced more neurological dysfunction compared to the Piperacillin-Tazobactam group.

Overall Implications for Clinical Practice

This study provides critical insights for intensivists in making informed decisions about antibiotic choices in a hospital setting. It highlights the comparable risks of acute kidney injury and mortality between Cefepime and Piperacillin-Tazobactam while drawing attention to the higher incidence of neurological dysfunction associated with Cefepime. These findings are pivotal in tailoring patient care, especially in critical care scenarios where both infection control and the management of side effects are crucial.