Cefepime Induced Neurotoxicity: A Case Series and Review of the Literature (P3.385)

Le résumé fourni par la source

Objective: Cefepime is a fourth generation cephalosporin which is bactericidal for broad spectrum of organisms. Neurotoxicity in patients with or without renal failure who are treated with Cefepime has been reported. Background: Neurotoxicity is a known but probably an underreported side effect of cefepime especially in patients with normal renal function. With this study, we aim to raise awareness in cefepime induced neurotoxicity. Methods: We conducted case series of 3 patients who presented to our hospital with confusion, aphasia secondary to Cefepime use to treat for UTI and Health Care associated pneumoniae. Results: We present 3 cases in whom diagnosis were made after excluding other common etiologies of altered mental status. In one patient, neurotoxicity manifested by new onset of progressive expressive aphasia which was seen within 4 days of initiating treatment. Two patients demonstrated asynchronous myoclonic activity of the limbs. The symptoms were seen within 4 days of initiating the treatment. The symptoms resolved completely within three days of discontinuation of cefepime. Acute structural abnormalities were excluded by CT and MRI of the head. EEG showed diffuse slowing activity with triphasic waves consistent with encephalopathy. In one patient renal function was within normal limits, whereas it was abnormal in two patients. Conclusions: To our knowledge, this is the first report of cefepime induced asynchronous myoclonus and expressive aphasia in a patient with normal kidney function. Recognizing cefepime induced neurotoxicity could be challenging given accompanied confounding causes of encephalopathies in acute care settings. We should maintain a heightened index of suspicion in patients with renal and hepatic impairments, even when cefepime is dosed appropriately.

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