Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Toyoake, Japan.
Department of Anesthesiology and Intensive Care Medicine, Nishichita General Hospital, 3-1-1, Nakanoike, Tokai, Aichi, 477-8522, Japan.
J Anesth. 2022 Jun;36(3):432-435. doi: 10.1007/s00540-022-03068-1. Epub 2022 Apr 29.
Prolonged neurological symptoms such as "brain fog" and cognitive impairment have occurred after coronavirus disease 2019 (COVID-19) infection. In this report, we describe impaired consciousness caused by cefepime hydrochloride (CFPM) in a patient with cognitive sequalae of COVID-19. A 56-year-old male patient was diagnosed with penile abscess after COVID-19 infection, and a blood culture detected two drug-resistant Pseudomonas aeruginosa strains. Therefore, CFPM 2 g × twice/day was administered on day 71 after intensive care unit admission. Approximately 48 h after CFPM administration, the patient showed disturbances in consciousness. Contrast-enhanced computed tomography, magnetic resonance imaging, and spinal fluid examination revealed no obvious abnormalities. Therefore, CFPM-induced neurotoxicity was suspected. CFPM was discontinued and ceftazidime 2 g × three times/day was initiated. The patient's consciousness improved 30 h after the final administration of CFPM. Serum CFPM concentrations were 14.2, 21.7, 21.7, and 11.9 μg/mL on days 1, 2, and 3 after the initiation of CFPM and on the day after CFPM was discontinued, respectively. In conclusion, intensivists should pay attention to new neurological symptoms such as CFPM-induced encephalopathy in patients with prolonged neurological symptoms after COVID-19 infection.
新冠病毒病（COVID-19）感染后可出现长期神经症状，如“脑雾”和认知障碍。在此报告中，我们描述了 COVID-19 认知后遗症患者因注射盐酸头孢吡肟（CFPM）而导致意识障碍的病例。一名 56 岁男性患者在 COVID-19 感染后被诊断为阴茎脓肿，血培养检出两株耐多药铜绿假单胞菌。因此，在入住重症监护病房后第 71 天给予 CFPM 2 g，一日两次。在 CFPM 给药后约 48 h，患者出现意识障碍。增强 CT、磁共振成像和脑脊液检查均未见明显异常。因此，疑似 CFPM 诱导的神经毒性。停用 CFPM 并开始给予头孢他啶 2 g，一日三次。在 CFPM 末次给药后 30 h，患者意识改善。CFPM 起始后第 1、2、3 天及第 1 天 CFPM 停药后，血清 CFPM 浓度分别为 14.2、21.7、21.7 和 11.9 μg/mL。总之，对于 COVID-19 感染后长期出现神经症状的患者，重症监护医生应注意 CFPM 引起的脑病等新的神经症状。
