Cefotaxime-associated encephalopathy in peritoneal dialysis patients: A case report

Cefotaxime is a widely used 3rd-generation cephalosporin antibiotic that is primarily excreted through urine. Third-generation cephalosporins (e.g., ceftazidime, ceftriaxone) and the 4th-generation cefepime are associated with neurological complications. Although cephalosporin-associated encephalopathy (CAE) is well-documented, cases specifically induced by cefotaxime remain remarkably rare. To our knowledge, this is the 1st documented case of cefotaxime-induced CAE in a patient undergoing peritoneal dialysis.

A 72-year-old female patient on peritoneal dialysis developed delirium and impaired consciousness 7 days after receiving cefotaxime as part of her anti-infective therapy for a pulmonary infection. The patient expressed concern regarding the onset of impaired consciousness and intermittent delirium as well as her prognosis and potential sequelae.

This investigation focused on the potential role of cefotaxime in triggering CAE in peritoneal dialysis patients. The likelihood of cefotaxime causing drug reactions was confirmed using the Naranjo Scale score.

Following the suspicion of cefotaxime-induced encephalopathy, the treatment regimen was modified, which included discontinuation of cefotaxime, initiation of intravenous piperacillin/bactam as an alternative antibiotic therapy, and symptomatic treatment with olanzapine. Close monitoring and adjustments to the peritoneal dialysis regimen are essential for managing neurological symptoms.

After discontinuation of cefotaxime and appropriate adjustments to the treatment regimen, the patient's clinical condition gradually improved. Symptoms of delirium subsided, consciousness returned to normal, and laboratory indicators stabilized.

This case emphasizes the importance of considering the potential adverse effects of antibiotics, particularly in patients with kidney insufficiency undergoing dialysis. This highlights the necessity of vigilance in monitoring drug-related complications for timely detection of encephalopathic symptoms and development of individualized treatment strategies. We acknowledge that cefotaxime may increase the risk of CAE in patients on peritoneal dialysis, necessitating heightened awareness among physicians.