Appa Ayesha A, Jain Rupali, Rakita Robert M, Hakimian Shahin, Pottinger Paul S
Division of Allergy and Infectious Diseases.
School of Pharmacy, and.
Open Forum Infect Dis. 2017 Oct 10;4(4):ofx170. doi: 10.1093/ofid/ofx170. eCollection 2017 Fall.
Neurotoxicity due to cefepime has not been well characterized. We performed a systematic review of the literature and included 5 additional cases from our center. Of the 198 cases found, the mean age was 67 years and 87% of patients had renal dysfunction. The most common clinical features were diminished level of consciousness (80%), disorientation/agitation (47%), and myoclonus (40%). It is worth noting that nonconvulsive status epilepticus was relatively common with 31% of cases, whereas only 11% had convulsive seizures. Single-center estimate of incidence was 1 in 480 courses of cefepime. Cefepime neurotoxicity should be considered in older patients with renal dysfunction and new onset encephalopathy, especially if concurrent myoclonus is present. More work is needed to prospectively assess incidence and outcomes related to cefepime neurotoxicity.
头孢吡肟所致神经毒性尚未得到充分的描述。我们对文献进行了系统回顾，并纳入了来自我们中心的另外5例病例。在找到的198例病例中，平均年龄为67岁，87%的患者存在肾功能不全。最常见的临床特征是意识水平下降（80%）、定向障碍/激越（47%）和肌阵挛（40%）。值得注意的是，非惊厥性癫痫持续状态相对常见，占病例的31%，而仅有11%有惊厥性发作。头孢吡肟单中心发病率估计为每480个疗程中有1例。对于存在肾功能不全和新发脑病的老年患者，尤其是伴有肌阵挛时，应考虑头孢吡肟神经毒性。需要开展更多工作以前瞻性评估与头孢吡肟神经毒性相关的发病率和结局。
