Cefepime-induced encephalopathy in patients with haematological malignancies: Clinical features and risk factors

Ugai, Tomotaka; Morisaki, Kurimi; Tsuda, Kenji; Sugihara, Hiroyuki; Nishida, Yuhki; Yamakura, Masayuki; Takeuchi, Masami; Matsue, Kosei

doi:10.3109/00365548.2013.878032

Cited by 14 publications

(11 citation statements)

References 17 publications

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“…Many cases resolved spontaneously upon withdrawal of the medication, but fatal evolutions are also reported. Besides stopping cefepime, treatment generally has consisted of supportive measures and, occasionally, the administration of antiepileptic drugs (Table ) . A few cases have been treated with iHD (Table ) with a globally favorable outcome .…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Mani

Kissling

Viceic

et al. 2014

Hemodialysis International

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Cefepime is a broad-spectrum cephalosporin indicated for in-hospital treatment of severe infections. Acute neurotoxicity, an increasingly recognized adverse effect of this drug in an overdose, predominantly affects patients with reduced renal function. Although dialytic approaches have been advocated to treat this condition, their role in this indication remains unclear. We report the case of an 88-year-old female patient with impaired renal function who developed life-threatening neurologic symptoms during cefepime therapy. She was treated with two intermittent 3-hour high-flux, high-efficiency hemodialysis sessions. Serial pre-, post-, and peridialytic (pre- and postfilter) serum cefepime concentrations were measured. Pharmacokinetic modeling showed that this dialytic strategy allowed for serum cefepime concentrations to return to the estimated nontoxic range 15 hours earlier than would have been the case without an intervention. The patient made a full clinical recovery over the next 48 hours. We conclude that at least 1 session of intermittent hemodialysis may shorten the time to return to the nontoxic range in severe clinically patent intoxication. It should be considered early in its clinical course pending chemical confirmation, even in frail elderly patients. Careful dosage adjustment and a high index of suspicion are essential in this population.

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Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Mani

Kissling

Viceic

et al. 2014

Hemodialysis International

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“…In a prospective cohort study, the incidence of CIN in patients with medical illness was 1%; however, in patients with GFR 60 to 15 mL/min and GFR < 15 mL/min, CIN incidence increased to 4.5% and 16.6%, respectively [4]. Incidence in critically ill patients [6] and in patients with hematologic malignancies [24] was 15% and 4.1%. The incidence of CIN in a retrospective case-control study in Korean patients was 0.85% [25].…”

Section: Incidencementioning

confidence: 99%

“…Cefepime dose should be adjusted based on current renal function (Table 1). Normal renal function is defined as a creatinine clearance of 60 mL/min [23]. Moreover, the physician needs to take into account age, preexisting brain injury, hypoalbuminemia, and septic conditions.…”

Section: Dose Adjustmentsmentioning

confidence: 99%

“…However, it has also occurred in patients who have received appropriate doses based on renal function [12][13][14][15][16][17][18] and even in patients with normal renal function [5,[18][19][20][21][22]. Therefore, the U.S. Food and Drug Administration (FDA) issued a safety warning that recommended dose reduction in patients with renal dysfunction, that is, estimated glomerular filtration rate (GFR) < 60 mL/ min [23]. CIN is reversible in most cases if early detection and discontinuation of cefepime is possible, which is the only definitive treatment.…”

Section: Introductionmentioning

confidence: 99%

“…normalities, some described as CIN with TW or GPD [3,15,17,22,24,43,49,[70][71][72][73][74][75][76], whereas others reported these as CIN with NCSE [4][5][6]13,14,16,18,20,21,42,45,[77][78][79][80][81][82][83][84], depending on the author's view. Some investigators proposed that encephalopathies with GPD or severe metabolic encephalopathies with continuous epileptiform EEG abnormality are not NCSE, and that a coma with continuous generalized epileptiform discharges (coma-GED) should be differentiated from NCSE proper [67,69].…”

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confidence: 99%

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Cefepime-induced neurotoxicity

Lee

2019

J Neurocrit Care

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Cefepime, a fourth-generation cephalosporin antibiotic, was approved for use in 1996. It is widely used to treat severe bacterial infections because it acts against both gram-negative and gram-positive bacterial strains, and has antipseudomonal activity. Safety data of cefepime in clinical trials were relatively favorable when initially approved. Approximately 3% of 2,032 patients treated with cefepime experienced adverse central nervous system (CNS) effects including headache (2.4%), dizziness (0.7%), and

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Development of cefepime‐induced encephalopathy in a patient with depression and rectal cancer: A case report

Yamaguchi,

Sadahiro,

Wada

et al. 2024

Neuropsychopharm Rep

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BackgroundCefepime, a fourth‐generation cephalosporin, has neurotoxic side effects such as encephalopathy. Baseline conditions, including blood–brain barrier (BBB) impairment and renal dysfunction, are known to associate with elevated central nervous concentration of cefepime. Although BBB dysfunction occurs with depression or cancer, currently, neither is regarded as a risk factor for cefepime‐induced encephalopathy.Case PresentationA 79‐year‐old woman with a history of depression and rectal cancer was hospitalized for a bacterial liver abscess. Brain metastasis and other causes for delirium were excluded, and no renal dysfunction was observed. However, 11 days after cefepime and metronidazole administration, the patient suddenly developed confusion, disorientation, and myoclonus, with no apparent changes on brain magnetic resonance imaging. Electroencephalography revealed a consistent tri‐phasic wave pattern. Clinical symptoms were well consistent with cefepime‐induced encephalopathy; hence, cefepime and metronidazole were discontinued, followed by rapid physical and mental recovery, with no aftereffects.ConclusionsIn terms of BBB dysfunction, depression and cancer might be possible occult risk factors for cefepime‐induced encephalopathy. Doctors need to pay attention to encephalopathy risk when administering cefepime in patients with depression or cancer because the psychiatric symptoms of encephalopathy, depression, and delirium from other causes are often confusing, leading to misdiagnosis and a poor prognosis.

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Cefepime-induced encephalopathy in patients with haematological malignancies: Clinical features and risk factors

Abstract: This study indicated that the development of CIE is associated with severely impaired renal function in patients with HM.

Cited by 14 publications

References 17 publications

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Intermittent hemodialysis treatment in cefepime‐induced neurotoxicity: Case report, pharmacokinetic modeling, and review of the literature

Cefepime-induced neurotoxicity

Development of cefepime‐induced encephalopathy in a patient with depression and rectal cancer: A case report

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