Strategies for Safer Cefepime Use to Prevent Neurotoxicity Using the Electronic Health Record

Area of Science:

• Critical Care Medicine
• Neuroscience
• Clinical Informatics

Background:

• Cefepime is a vital antibiotic in critical care settings.
• Cefepime-induced neurotoxicity (CIN) is an underrecognized adverse effect, especially in elderly patients.
• Current monitoring and diagnostic criteria for CIN are insufficient, hindering timely intervention.

Purpose of the Study:

• To highlight the clinical significance of cefepime-induced neurotoxicity (CIN).
• To propose informatics-based strategies for early detection and prevention of CIN.
• To improve patient safety and neurological outcomes in critically ill patients.

Main Methods:

• Analysis of data from the Antibiotic Choice on Renal Outcomes (ACORN) trial.
• Proposal of three informatics-based strategies: EHR-integrated datasets with ML/NLP, automated EEG alerts, and dynamic risk scores.
• Focus on scalable identification and real-time clinical decision support.

Main Results:

• The ACORN trial indicated that cefepime recipients had significantly fewer delirium- and coma-free days compared to piperacillin-tazobactam recipients.
• Existing guidelines lack recommendations for active CIN surveillance.
• Informatics approaches offer potential for large-scale CIN identification and prevention.

Conclusions:

• Cefepime-induced neurotoxicity poses a significant threat to patient recovery in critical care.
• Proactive informatics solutions are needed to enhance CIN monitoring and management.
• Implementing these strategies can improve neurological outcomes and patient safety, with potential applicability to other neurotoxic antibiotics.