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Cefepime-Induced Neurotoxicity
Tanjot Saini1, Monica N Gaines1, Aalam Sohal1
1Internal Medicine, University of California, San Francisco, Fresno, USA.
Abstract:
Cefepime is a common antibiotic used to treat various infections such as pneumonia, skin infections, and intra-abdominal infections due to its broad gram-positive and gram-negative spectrum. However, patients with acute kidney injury, end-stage renal disease, and renal transplantation are disproportionately at higher risk of developing complications from administration of cefepime, secondary to its predominant renal excretion. Current guidelines prescribe cefepime renal-dosing, dependent on the glomerular filtration rate, to prevent toxicity. This study presents a rare case where an acutely hospitalized patient undergoing chronic renal transplant rejection was administered renal-dose cefepime. Despite renal dosing, the patient developed neurotoxicity that manifested as delirium, inability to tolerate oral intake, and non-convulsive status epilepticus. Solely adjusting for renal dysfunction may be inadequate to prevent the accumulation of cefepime metabolites, which may present in an atypical manner in the patient. Such possibilities emphasize the need for continued evaluation of a patient's mentation in case of cefepime administration. Cefepime-induced neurotoxicity incidences need to be evaluated and researched thoroughly.
Insights
Even with adjusted doses for kidney function, cefepime can cause neurotoxicity in renal transplant patients. This case highlights the need for careful monitoring of mental status during cefepime treatment.
Area of Science:
- Pharmacology
- Nephrology
- Neuroscience
Background:
- Cefepime is a broad-spectrum antibiotic frequently used for bacterial infections.
- Renal impairment, including in transplant recipients, increases cefepime accumulation risk.
- Standard guidelines recommend dose adjustments based on glomerular filtration rate (GFR) to prevent toxicity.
Observation:
- A rare case of cefepime-induced neurotoxicity occurred in a hospitalized patient with chronic renal transplant rejection.
- The patient received cefepime dosed according to renal function (renal-dose cefepime).
- Neurotoxicity manifested as delirium, feeding intolerance, and non-convulsive status epilepticus despite dose adjustment.
Findings:
- Renal-dosing of cefepime may not be sufficient to prevent neurotoxicity in all patients with renal dysfunction.
- Accumulation of cefepime metabolites might occur even with adjusted doses, leading to atypical presentations.
- This case underscores the potential for cefepime neurotoxicity despite adherence to current dosing guidelines.
Implications:
- Continuous neurological monitoring is crucial for patients receiving cefepime, especially those with renal impairment or transplant.
- Current renal dosing guidelines for cefepime may require re-evaluation for specific patient populations.
- Further research into cefepime neurotoxicity incidence and mechanisms is warranted to improve patient safety.
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