Cefepime-induced encephalopathy in end-stage renal disease patients

Cefepime-induced neurotoxicity

“…CNS penetration of cefepime may be increased in patients with a previous brain injury. The incidence of CIN in ESRD patients with preexisting CNS morbidity was 22.2%, which is three times higher than that in ESRD patients without previous CNS injury [17]. From the data of a meta-analysis, 8% of the reported patients had preexisting CNS disease [10].…”

“…The incidence of CIN in a retrospective case-control study in Korean patients was 0.85% [25]. The incidence in ESRD patients was 7.5%, but was 22.2% in ESRD patients with preexisting CNS morbidity [17]. In a recent retrospective study, the incidence of CIN was 0.2% [9].…”

“…Impaired renal function and excessive dose are the most important and common predisposing factors of CIN. Preexisting brain injury, old age, high-dose therapy, and increased CNS penetration of cefepime are known risk factors [6,9,10,17,38]. However, CIN has also been reported in patients with normal renal function [5,[18][19][20][21][22]39,40] and in those administered the appropriate dose based on renal function [12][13][14][15][16][17][18][41][42][43].…”

“…Dose adjustment is not necessary in patients on continuous renal replacement therapy (CRRT) [2,50]. However, it is reasonable to consider the severity of the infectious disease during dose adjustment to prevent treatment failure [17].…”

“…CIN mainly occurs in patients with impaired renal function who have been administered cefepime without dose adjustment, because 85% of cefepime is removed through renal excretion [3][4][5][6][7][8][9][10][11]. 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].…”