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Renally Dosed Cefepime Leading to Cefepime-Induced Neurotoxicity: A Case Report
Megan Smith1, Chris Mehdizadeh2, Avrodet Mourkus2
1Internal Medicine, California University of Science and Medicine, Colton, USA.
Abstract:
Cefepime is a broad-spectrum fourth-generation cephalosporin with activity against both gram-positive and gram-negative bacteria, including Pseudomonas aeruginosa. Cefepime is most commonly used for urinary tract infections, soft tissue infections, and febrile neutropenia. Up to 15% of ICU patients on cefepime may experience cefepime-induced neurotoxicity (CIN), with risk factors including renal dysfunction, excessive dosage, elevated serum cefepime concentrations, and history of prior brain injury. The adverse effects of CIN, including encephalopathy, seizures, and coma can be resolved with drug cessation, antiepileptics, or hemodialysis. Here, we present the case of CIN in a 59-year-old female patient with long-term cefepime antibiotic prescription for Pseudomonas bacteremia and endocarditis with multiple risk factors for reduced renal function. We discuss the relevant risk factors and preventive measures that may have prevented her from developing CIN, as well as the importance of early recognition and prevention of CIN in patient care.
Insights
Cefepime-induced neurotoxicity (CIN) can occur in ICU patients, especially those with kidney problems. Early recognition and management are key to preventing severe neurological adverse effects from this antibiotic.
Area of Science:
- Pharmacology
- Neurology
- Infectious Diseases
Background:
- Cefepime is a fourth-generation cephalosporin antibiotic effective against Gram-positive and Gram-negative bacteria.
- It is frequently prescribed for infections such as urinary tract infections, soft tissue infections, and febrile neutropenia.
- Cefepime-induced neurotoxicity (CIN) is a potential adverse effect, particularly in intensive care unit (ICU) patients.
Observation:
- Risk factors for CIN include renal dysfunction, excessive dosage, high serum cefepime levels, and a history of brain injury.
- This case report details CIN in a 59-year-old female patient with Pseudomonas bacteremia and endocarditis on long-term cefepime therapy.
- The patient presented with multiple risk factors predisposing to reduced renal function.
Findings:
- Cefepime-induced neurotoxicity can manifest as encephalopathy, seizures, and coma.
- These neurological adverse effects are often reversible upon discontinuation of cefepime, administration of antiepileptic drugs, or hemodialysis.
- The patient's clinical presentation and risk factors highlight the potential for CIN in specific patient populations.
Implications:
- Understanding and identifying risk factors for CIN is crucial for patient safety.
- Preventive measures, such as careful dosage adjustment in patients with renal impairment, are essential.
- Early recognition and prompt management of CIN can mitigate severe neurological complications and improve patient outcomes.
