Bausch Severin, Araschmid Laura J, Hardmeier Martin, Osthoff Michael
Division of Internal Medicine, University Hospital Basel, Basel, CHE.
Department of Neurology, University Hospital Basel, Basel, CHE.
Cureus. 2022 Jun 28;14(6):e26392. doi: 10.7759/cureus.26392. eCollection 2022 Jun.
Neurotoxicity is a well-described adverse effect of cefepime. Clinical presentation includes mild neurological deficits, aphasia, impairment of consciousness, and even nonconvulsive status epilepticus. Impaired kidney function is considered the most important risk factor for cefepime-induced neurotoxicity (CIN) and frequently occurs during the course of critical diseases with concomitant acute kidney injury (AKI). Physicians should be aware of situations with increased risk of AKI and the preventive actions required to reduce the risk of CIN. We present three patients with AKI who were treated with cefepime for healthcare-associated infections. Subsequently, two patients developed CIN demonstrating very high cefepime levels in plasma. In the third patient, CIN was likely prevented as the increased risk of neurotoxicity was noted and cefepime treatment was ceased immediately. Diagnosis of CIN might be challenging due to various causes of encephalopathy, in particular in the setting of severely ill patients. Electroencephalogram may assist in establishing the diagnosis, in particular when cefepime therapeutic drug monitoring is not available. As CIN is potentially reversible, it is an important differential diagnosis to consider especially in patients with impaired renal function or being susceptible to AKI. Preventive measures of CIN include therapeutic drug monitoring, consideration of a therapeutic alternative, awareness regarding a potential overestimation of the glomerular filtration rate, and electronic health record alerts about risk constellations for potential overdosing.
神经毒性是头孢吡肟一种已被充分描述的不良反应。临床表现包括轻度神经功能缺损、失语、意识障碍，甚至非惊厥性癫痫持续状态。肾功能损害被认为是头孢吡肟诱导的神经毒性（CIN）最重要的危险因素，且常发生在伴有急性肾损伤（AKI）的危重病过程中。医生应意识到AKI风险增加的情况以及降低CIN风险所需采取的预防措施。我们报告了3例因医疗相关感染接受头孢吡肟治疗的AKI患者。随后，2例患者发生CIN，血浆中头孢吡肟水平极高。在第3例患者中，由于注意到神经毒性风险增加并立即停止了头孢吡肟治疗，CIN可能得到了预防。由于脑病病因多样，尤其是在重症患者中，CIN的诊断可能具有挑战性。脑电图可能有助于确诊，特别是在无法进行头孢吡肟治疗药物监测时。由于CIN可能是可逆的，因此它是一个重要的鉴别诊断，尤其在肾功能受损或易患AKI的患者中需加以考虑。CIN的预防措施包括治疗药物监测、考虑治疗替代方案、注意可能高估肾小球滤过率的情况，以及关于潜在用药过量风险组合的电子健康记录警报。
