Abstract Details

Title EEG Abnormalities in Patients with Suspected Encephalopathy Receiving Cefepime vs Piperacillin-Tazobactam

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) S13 - Epilepsy/Clinical Neurophysiology (EEG) 1 (2:48 PM-3:00 PM)

Poster/Presentation
Number 010

Objective

To compare EEG abnormalities pertinent to encephalopathy in patients who received either cefepime (CFP) or piperacillin/tazobactam (PT).

Background Beta lactams can cause encephalopathy which is associated with increased morbidity, mortality, and length of hospital stay. Nonetheless, CFP and PT are often needed for antipseudomonal antibiotic coverage for hospital acquired infections. Since EEGs can be used to quantify the degree of encephalopathy, we reviewed EEG abnormalities in patients receiving CFP or PT as an objective measure to identify which of these antibiotics is associated with a higher risk of encephalopathy, as this can impact antibiotic selection in vulnerable patients.

Design/Methods This was a retrospective analysis of our institution’s clinical data warehouse that included adult inpatients who received either CFP or PT for antipseudomonal antibiotic coverage and who had an EEG study during their antibiotic treatment. We compared EEG findings indicative of encephalopathy between both groups, and as a function of dose/eGFR. Patients who required renal replacement therapy, or had a eGFR<10 mL/min/BSA were excluded. Linear or logistic regression was performed in STATA.

Results 2367 patients met inclusion criteria, of whom 1525 received CFP and 842 received PT during the 22-month period of data collection. Of those patients, 66 (4.3%) had an EEG in the CFP group, and 28 (3.3%) had an EEG in the PT group. Triphasic waves (TPWs) were present in 19 (29%) of EEGs in the CFP group, and in none of the EEGs from the PT group. CFP dose/eGFR accounted for only a small fraction of the variance in background frequency (BFS; R²=0.05), whereas in the PT group, BFS was not correlated with PT dose/eGFR (R²=0.01).

Conclusions TPWs were more likely to be present in patients receiving CFP than PT, suggesting that in the absence of other metabolic abnormalities, TPWs may be specific for CFP-associated encephalopathy.

Authors/Disclosures
Jumana T. Alshaikh, MD (University of Utah) PRESENTER	Dr. Alshaikh has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Naoum P. Issa, MD, PhD (University of Chicago)	Dr. Issa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CVS/Caremark. The institution of Dr. Issa has received research support from NIH. Dr. Issa has received intellectual property interests from a discovery or technology relating to health care. Dr. Issa has a non-compensated relationship as a Scientific advisory board member with Theta Neurotech that is relevant to AAN interests or activities.

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