Naeije Gilles, Lorent Sophie, Vincent Jean-Louis, Legros Benjamin
Department of Neurology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Arch Neurol. 2011 Oct;68(10):1303-7. doi: 10.1001/archneurol.2011.204.
To test the hypothesis that treatment with cefepime hydrochloride leads to higher incidence of periodic epileptiform discharges compared with treatment with other β-lactams.
Data from hospital pharmacy databases of patients treated with cefepime or meropenem during a 42-month period (from January 1, 2007, through June 30, 2010) were retrospectively crossed with data from the electroencephalography database for the same period.
Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Patients who underwent electroencephalographic testing while taking cefepime or meropenem were selected. Only electroencephalographic tests performed during the antibiotic treatment period were considered. Matches were compared with nurses' medication records to ensure that the antibiotic considered was effectively given.
Proportions of patients with continuous epileptiform discharges in the 2 groups were compared using the Fisher exact test.
A total of 1120 patients were treated with cefepime and 1572 patients with meropenem. Electroencephalographic testing was performed during treatment in 59 patients treated with cefepime and 80 treated with meropenem (5.26% vs 5.08%, P = .85). Continuous epileptiform discharges were present in 14 patients in the cefepime group and 3 in the meropenem group (1.25% vs 0.19%, P < .001). Blood creatinine concentration was elevated in 5 of the 17 patients (range, 1.5-4.2 mg/dL; reference range, 0.7-1.2 mg/dL), and liver enzyme levels were elevated in 5 patients. No patient had major electrolyte disturbances.
Our study showed a prevalence of electroencephalographic test results with continuous epileptiform discharges in 14 of 1120 patients receiving cefepime (1.25%) but only 3 of 1572 patients receiving meropenem (0.19%). Contrary to the results of previous case series, these electroencephalographic patterns occurred, in most cases, in patients with normal renal function. These results suggest that cefepime may be an independent risk factor for periodic epileptiform discharges, which are associated with worse outcomes. This finding could provide a partial explanation for the higher mortality rates reported in patients treated with cefepime compared with other β-lactams.
检验与其他β-内酰胺类药物治疗相比，盐酸头孢吡肟治疗导致周期性癫痫样放电发生率更高这一假设。
回顾性交叉分析2007年1月1日至2010年6月30日这42个月期间接受头孢吡肟或美罗培南治疗患者的医院药房数据库数据与同期脑电图数据库数据。
比利时布鲁塞尔自由大学埃拉斯穆斯医院。
选取服用头孢吡肟或美罗培南期间接受脑电图检查的患者。仅考虑抗生素治疗期间进行的脑电图检查。将匹配结果与护士用药记录进行比较，以确保所考虑的抗生素确实已给药。
使用Fisher精确检验比较两组持续性癫痫样放电患者的比例。
共有1120例患者接受头孢吡肟治疗，1572例患者接受美罗培南治疗。头孢吡肟治疗的59例患者（5.26%）和美罗培南治疗的80例患者（5.08%）在治疗期间进行了脑电图检查（P = 0.85）。头孢吡肟组14例患者出现持续性癫痫样放电，美罗培南组3例患者出现持续性癫痫样放电（1.25% 对0.19%，P < 0.001）。17例患者中有5例血肌酐浓度升高（范围为1.5 - 4.2mg/dL；参考范围为0.7 - 1.2mg/dL），5例患者肝酶水平升高。无患者出现严重电解质紊乱。
我们的研究显示，1120例接受头孢吡肟治疗的患者中有14例（1.25%）出现持续性癫痫样放电的脑电图检查结果，而1572例接受美罗培南治疗的患者中只有3例（0.19%）出现该结果。与先前病例系列结果相反，这些脑电图模式在大多数情况下发生于肾功能正常的患者。这些结果表明，头孢吡肟可能是周期性癫痫样放电的独立危险因素，而周期性癫痫样放电与更差的预后相关。这一发现可为头孢吡肟治疗患者与其他β-内酰胺类药物治疗患者相比报告的更高死亡率提供部分解释。
