To the Editor The retrospective cohort study by Chanderraj et al¹ compared empirical piperacillin-tazobactam vs cefepime in hospitalized adult patients with suspected sepsis. However, we urge caution in accepting the authors’ conclusion that empirical use of piperacillin-tazobactam was associated with higher mortality and increased duration of organ dysfunction compared to cefepime.

First, despite the source of infection being well balanced between groups, more than two-thirds of infection sources were classified as unclear in this study. Such a high ratio of unclear infection sources is uncommon compared to previous sepsis studies. Additionally, tissue penetration is a crucial determinant of antibiotic efficacy, making it essential to clarify the infection sources as much as possible.