Infectious Disease · Internal Medicine ·
Cefepime not linked to higher delirium or neurotoxicity risk
A retrospective cohort study emulating two target trials compared early cefepime treatment with piperacillin–tazobactam or meropenem in adults hospitalized with acute infection. In propensity score–matched analyses, cefepime was not associated with a higher risk of hospital-onset delirium or other coded neurotoxicity events.
- Matched analyses found no higher coded neurotoxicity risk with cefepime.
- Comparisons involved piperacillin–tazobactam and meropenem.
- The retrospective study used data from a 14-hospital system.
- Observational design and coded outcomes limit interpretation.
Researchers used electronic health record data from a 14-hospital health system to conduct a retrospective observational cohort study emulating two target trials. The analysis included adults treated initially with cefepime, piperacillin–tazobactam or meropenem in the emergency department or within 12 hours of ICU admission between January 2023 and December 2024. After propensity score matching, the comparisons included 4,447 patient pairs for cefepime versus piperacillin–tazobactam and 1,262 pairs for cefepime versus meropenem. The primary outcome was hospital-onset delirium or another neurotoxicity event identified through diagnostic codes.
Cefepime was not associated with a higher risk of the combined outcome versus piperacillin–tazobactam (relative risk 0.99, 95% CI 0.80–1.22) or meropenem (relative risk 1.09, 95% CI 0.75–1.59). The authors also reported no differences in 30-day mortality or hospital length of stay, with consistent findings in secondary, subgroup and sensitivity analyses.
The results suggest that neurotoxicity risk alone need not determine empiric antibiotic selection, but they do not establish equivalence or prove that cefepime carries no excess risk. The study was observational, conducted within one health system, and relied on coded outcomes; residual confounding and outcome misclassification remain possible.
In practice
For adults hospitalized with acute infection who receive early empiric broad-spectrum therapy, this study found no higher risk of hospital-onset delirium or other coded neurotoxicity events with cefepime than with piperacillin–tazobactam or meropenem. The findings do not establish equivalence or show that cefepime has no neurotoxicity risk. They come from retrospective, propensity-matched analyses in one health system, and outcomes were identified using diagnostic codes, leaving potential for residual confounding and misclassification. The evidence does not support changing practice on its own.
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Critical Care: Comparison of cefepime versus piperacillin-tazobactam or meropenem for risk for delirium and neurotoxicity among patients hospitalized for acute infection: two target trial emulation studies ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.