Approach to Cefepime-Induced Neurotoxicity in the Setting of Chronic Kidney Disease: A Case Report and Review of Literature

Abstract

Cefepime-induced neurotoxicity is well-known, but an under-recognized event that can present with a myriad of neurological findings ranging from myoclonus to seizures to comatose state. It is more prevalent in patients with impaired renal clearance as it is mainly cleared by the kidneys. We present a case of a 52-year-old female who was managed in the intensive care unit with severe encephalopathy following empiric antibiotic therapy with cefepime. Although we encountered some unforeseen difficulties executing our initial plan of renal replacement therapy, our patient was successfully treated with fluids and intravenous diuresis with furosemide and was ultimately discharged home with full recovery.

Cefepime-induced encephalopathy in an older patient with polypharmacy and renal insufficiency: a case report

“…The most common EEG findings are generalized slowing of the background rhythm, multifocal sharp waves, and generalized periodic discharges with or without a triphasic morphology. 12 , 16 , 19 , 23 – 25 …”

“…The initial and definitive treatment approaches involve either discontinuing treatment with cefepime or reducing the dosage of the drug. 14 , 19 , 23 , 27 However, hemodialysis is recommended to rapidly enhance the elimination of cefepime from both the bloodstream and cerebrospinal fluid, especially in life-threatening scenarios. This is attributed to the ability of dialysis to remove cefepime, enabling extraction of up to 70% of a given dose during a 3-hour hemodialysis session.…”

“…Reliable data strongly support the early initiation of hemodialysis to expedite removal of cefepime from the circulation, leading to accelerated recovery and a favorable prognosis. 12 , 19 , 23 , 28 , 29 …”

“…Clinical and EEG improvements typically occur within 2 to 3 days, mainly due to discontinuation of cefepime; thus, anticonvulsant therapy is essential primarily for patients experiencing convulsive seizures or exhibiting definite non-convulsive status epilepticus. 12 , 14 , 19 , 23 , 30 …”

Neurotoxicidade induzida por cefepima em paciente com disfunção renal: um relato de caso

“…A hemodiálise remove rapidamente o cefepima do sangue e do Líquor Cefalorraquidiano, podendo ser utilizada para acelerar a recuperação, especialmente quando há risco de vida 17 . Em uma única sessão de 3 horas é possível remover 70% da dose devido a baixa ligação a proteínas plasmáticas (20%) 13 , baixo peso molecular e baixo volume de distribuição (18L ou 0.26 L/Kg em adultos) 13,16 .…”