ACORN
Trial question
What is the role of cefepime in patients hospitalized with acute infection?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
43.0% female
57.0% male
N = 2511
2511 patients (1071 female, 1439 male)
Inclusion criteria: adult patients having an indication for antipseudomonal antibiotics within 12 hours of presentation to the hospital, in the emergency department or ICU
Key exclusion criteria: allergy to cephalosporins or penicillins; receipt of > 1 dose of antipseudomonal cephalosporin or penicillin within the previous 7 days
Interventions
N=1214 cefepime (IV 2 g every 8 hours)
N=1297 piperacillin/tazobactam (IV 3.375 g every 8 hours)
Primary outcome
Rate of stage 3 acute kidney injury or death by day 14
14.6
13.5
14.6 %
10.9 %
7.3 %
3.6 %
0.0 %
Cefepime
Piperacillin/tazobactam
No significant difference ↔
No significant difference in the rate of stage 3 AKI or death by day 14 (14.6% vs. 13.5%; OR 0.95, 95% CI 0.8 to 1.13)
Secondary outcomes
No significant difference in major adverse kidney events at day 14 (10.2% vs. 8.8%; AD 1.4%, 95% CI -1 to 3.8)
Significant decrease in mean delirium- and coma-free days within 14 days (11.9 days vs. 12.2 days; OR 0.79, 95% CI 0.65 to 0.95)
Significant increase in delirium or coma (20.8% vs. 17.3%; AD 3.4%, 95% CI 0.3 to 6.6)
Safety outcomes
No significant difference in allergic drug reactions.
Conclusion
In adult patients having an indication for antipseudomonal antibiotics within 12 hours of presentation to the hospital, in the emergency department or ICU, cefepime was not superior to piperacillin/tazobactam with respect to the rate of stage 3 AKI or death by day 14.
Reference
Edward T Qian, Jonathan D Casey, Adam Wright et al. Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023 Oct 14:e2320583.
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