Sonck J, Laureys G, Verbeelen D
Department of Medicine, Section of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium.
Nephrol Dial Transplant. 2008 Mar;23(3):966-70. doi: 10.1093/ndt/gfm713. Epub 2008 Jan 5.
Cases of cefepime neurotoxicity have been sporadically reported in patients with renal failure. The neurotoxicity of cefepime might be underestimated and the frequency of its neurotoxic effects may be insufficiently recognized.
We retrospectively reviewed the files of patients with renal failure who were treated with cefepime and who developed neurological complications.
All 8 patients developed decreased conscience, confusion, agitation, global aphasia, myoclonus, chorea-athetosis, convulsions and coma. The latency, the period between the start of treatment and neurological deterioration, was 4,75 +/- 2,55 days (range: 1-10 days). All patients died 17 +/- 14,7 days (range: 1-42 days) after becoming symptomatic. Three of them died shortly after neurological deterioration. Five patients developed a neurological "tableau" with global aphasia. Three patients showed clinical improvement after the discontinuation of cefepime. Electroencephalography revealed diffuse slow-wave activity (delta) and triphasic sharp wave activity. These findings confirm the possible neurotoxicity of treatment with cefepime in patients with renal failure. In none of the deceased patients have we been able to directly demonstrate a causal relationship between neurotoxicity and mortality. However, when a patient treated with cefepime develops neurological deterioration or aphasia, one must be aware of cefepime's potential neurotoxicity and treatment should be stopped.
We recommend that, in view of the high and unexplained mortality, the use of cefepime in patients with kidney failure should be carefully considered.
肾衰竭患者中偶有头孢吡肟神经毒性的病例报道。头孢吡肟的神经毒性可能被低估，其神经毒性作用的发生率可能未得到充分认识。
我们回顾性分析了接受头孢吡肟治疗且出现神经系统并发症的肾衰竭患者的病历。
所有8例患者均出现意识减退、精神错乱、躁动、完全性失语、肌阵挛、舞蹈手足徐动症、惊厥和昏迷。潜伏期，即治疗开始至神经功能恶化的时间为4.75±2.55天（范围：1 - 10天）。所有患者在出现症状后17±14.7天（范围：1 - 42天）死亡。其中3例在神经功能恶化后不久死亡。5例患者出现伴有完全性失语的神经症状“表现”。3例患者在停用头孢吡肟后临床症状改善。脑电图显示弥漫性慢波活动（δ波）和三相尖波活动。这些发现证实了头孢吡肟治疗肾衰竭患者可能存在神经毒性。在所有死亡患者中，我们均未能直接证明神经毒性与死亡率之间存在因果关系。然而，当接受头孢吡肟治疗的患者出现神经功能恶化或失语时，必须意识到头孢吡肟潜在的神经毒性，应停止治疗。
鉴于高死亡率且原因不明，我们建议应谨慎考虑在肾衰竭患者中使用头孢吡肟。
