Abstract Details

Title Cefepime-induced Neurotoxicity in the Critically Ill: A Modifiable Risk Factor

Topic General Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-001

Objective

Our case series demonstrates the importance of rapidly recognizing the signs of acute neurologic change in patients with acute kidney injury and cefepime usage.

Background Cefepime is a standard treatment of neutropenic fever as well as urinary tract infection, pneumonia, and skin and tissue infections. The US Food and Drug Administration issued a safety announcement in 2012 alerting health care professionals about the need to adjust the dosage of cefepime in patients with kidney impairment, yet it is still commonly used in patients with acute kidney injury. Cefepime-related neurotoxicity involves a wide range of symptoms, including impaired consciousness, encephalopathy, myoclonus, seizures, nonconvulsive status epilepticus (NCSE), and coma.

Design/Methods Case-Series

Results The four patients in our series—3 females and 1 male—had an age range of 45 to 73 years. All patients exhibited acute kidney injury that was marked by elevated creatinine from baseline (range, 3.4 to 14). All received cefepime to treat infections. The most common clinical features after cefepime administration were decreased level of consciousness, myoclonus, seizures (particularly NCSE), and altered mental status. Discontinuation improved outcomes in 3 of the 4 cases; in the fourth case, care had to be withdrawn.

Conclusions Cefepime may be linked to neurotoxicity because of its ability to cross the blood brain barrier and inhibit gamma-aminobutyric acid A (GABA-A) receptors or possibly inhibit GABA release. This suppression of the primary inhibitory receptor in the central nervous system likely lowers the threshold of excitation that can result in seizures or global encephalopathy. Discontinuing cefepime and initiating an antiepileptic drug can potentially improve patient outcomes, as cefepime-induced neurotoxicity is reversible. By adding our case series to the literature, providers will be able to better recognize acute kidney injury as a potential risk factor for cefepime neurotoxicity and treat patients accordingly.

Authors/Disclosures
Mohona Reza, MD PRESENTER	Dr. Reza has nothing to disclose.
Bridget Bagert, MD, MPH	Dr. Bagert has nothing to disclose.
Gregory Reese, MD	Dr. Reese has nothing to disclose.
Mary Ann Reeves	Miss Reeves has nothing to disclose.

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