Continuous kidney replacement therapy in neurotoxicity by cefepime: Case report
PDF (Español)

Keywords

Cefepime
Encephalopathy
Neurotoxicity
Dialysis
Renal Replacement Therapy

How to Cite

1.
Santiago Ausecha DR, García Velásquez CM, Ballesteros Castro DA, Mantilla Villareal AC. Continuous kidney replacement therapy in neurotoxicity by cefepime: Case report. Rev. Colomb. Nefrol. [Internet]. 2024 Mar. 8 [cited 2024 Jul. 25];11(1). Available from: https://revistanefrologia.org/index.php/rcn/article/view/692

Abstract

Background: Cefepime is an anti-pseudomonal cephalosporin, also classified as a fourth generation agent. Cefepime neurotoxicity is a rare adverse effect, usually occurring in patients with chronic renal disease, even with dose adjustment according to the glomerular filtration rate, although it can also occur when renal function is normal. The most frequent manifestations of cefepime encephalopathy are: Decreased level of consciousness, myoclonus and non-convulsive status epilepticus. Treatment includes cefepime discontinuation, dose reduction, benzodiazepines or renal replacement therapies. We present a patient with chronic kidney disease on peritoneal dialysis who presented with cefepime neurotoxicity and hemodynamic instability, who was treated with continuous renal replacement therapy.

Purpose: To describe the case of neurotoxicity due to cefepime in a patient with chronic kidney disease.

Case presentation: 63-year-old male patient with chronic kidney disease on peritoneal dialysis hospitalized for soft tissue infection under management with cefepime who presented a generalized tonic-clonic seizure episode followed by cardiorespiratory arrest witnessed with successful resuscitation, for which he was initiated with venovenous hemodiafiltration He continued for 72h and later hemodialysis due to volume overload, with which his neurological status improved, later the patient died of sepsis.

Discussion and conclusion: neurotoxicity due to cefepime is a rare event, however, it is necessary to become aware of the manifestations of the disease to carry out an early detection. Continuous renal replacement therapies can be used in some patients, thereby accelerating the elimination of cefepime.

https://doi.org/10.22265/acnef.11.1.692
PDF (Español)

References

Brunton LL, Hilal-Dandan RK, Knollmann BC. Goodman and Gilman the pharmacological basis of therapeutics. Estados Unidos: McGraw-Hill Education; 2018.

Appa AA, Jain R, Rakita RM, Hakimian S, Pottinger PS. Characterizing Cefepime Neurotoxicity: A Systematic Review. Open Forum Infect Dis. 2017;4(4):1-5. https://doi.org/10.1093/ofid/ofx170

Reddy Gangireddy VG, Mitchell LC, Coleman T. Cefepime neurotoxicity despite renal adjusted dosing. Scand J Infect Dis. 2011;43(10):827-9. https://doi.org/10.3109/00365548.2011.581308

Johnson E, Hannawi Y, Martinez NC, Ritzl EK. Cefepime-Associated SIRPIDs in a patient with normal renal function. Neurohospitalist. 2016;6(5):167-9. https://doi.org/10.1177/1941874415611180

Payne LE, Gagnon DJ, Riker RR, Seder DB, Glisic EK, Morris JG, et al. Cefepime-induced neurotoxicity: a systematic review. Crit Care. 2017;21(1):276. https://doi.org/10.1186/s13054-017-1856-1

Garin A, Bavozet F. Myoclonic status epilepticus induced by cefepime overdose requiring haemodialysis. BMJ Case Rep. 2019;12(6):2018-20. http://dx.doi.org/10.1136/bcr-2018-228108

FDA. Maxipime (cefepime hydrochloride) Injection, Powder, For Solution. FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/050679s028lbl.pdf

Avedissian SN, Pais G, Joshi MD, Rhodes NJ, Scheetz MH. A Translational Pharmacokinetic Rat Model of Cerebral Spinal Fluid and Plasma Concentrations of Cefepime. mSphere. 2019;4(1):1-11. https://doi.org/10.1128/mSphere.00595-18

WHO [Internet]. Ginebra, Suiza: Holloway K. et al; 2003 [updated 2004; cited 2024]. https://iris.who.int/bitstream/handle/10665/69224/WHO_EDM_PAR_2004.1_spa.pdf?sequence=1

Sugimoto M, Uchida I, Mashimo T, Yamazaki S, Hatano K, Ikeda F, et al. Evidence for the involvement of GABAA receptor blockade in convulsions induced by cephalosporins. Neuropharmacology. 2003;45(3):304-14. https://doi.org/10.1016/S0028-3908(03)00188-6

Fernández-Fernández FJ, Ameneiros-Lago E. Cefepime-Induced Encephalopathy: Could Carnitine Deficiency Contribute to Neurotoxicity? Neurohospitalist. 2020;10(2):81. https://doi.org/10.1177/1941874419896710

Schlidt K, Kadlec A, Bhandari S, Jha P. Cefepime-induced Neurotoxicity: Five Cases Reported in a Single Institution. Cureus. 2018;10(11):1-7. https://doi.org/10.7759/cureus.3666

Boschung-Pasquier L, Atkinson A, Kastner LK, Banholzer S, Haschke M, Buetti N, et al. Cefepime neurotoxicity: thresholds and risk factors. A retrospective cohort study. Clin Microbiol Infect. 2020;26(3):333-9. https://doi.org/10.1016/j.cmi.2019.06.028

Wong KM, Chan WK, Chan YH, Li CS. Cefepime-related neurotoxicity in a haemodialysis patient. Nephrol Dial Transplant. 1999;14(9):2265-6. https://doi.org/10.1093/ndt/14.9.2265

Barbhaiya RH, Knupp CA, Forgue T, Matzke GR, Guay DR, Pittman KA, et al. Pharmacokinetics of cefepime in subjects with renal insufficiency. Clin Pharmacol Ther. 1990;48(3):268-76. https://doi.org/10.1038/clpt.1990.149

Schmaldienst S, Traunmüller F, Burgmann H, Rosenkranz AR, Thalhammer-Scherrer R, Hörl WH, et al. Multiple-dose pharmacokinetics of cefepime in long-term hemodialysis with high-flux membranes. Eur J Clin Pharmacol. 2000;56(1):61-4. https://doi.org/10.1007/s002280050721

Barbhaiya RH, Knupp CA, Pfeffer M, Zaccardelli D, Dukes GM, Mattern W, et al. Pharmacokinetics of cefepime in patients undergoing continuous ambulatory peritoneal dialysis. Antimicrob Agents Chemother. 1992;36(7):1387-91. https://doi.org/10.1128/AAC.36.7.1387

Malone RS, Fish DN, Abraham E, Teitelbaum I. Pharmacokinetics of Cefepime during Continuous Renal Replacement Therapy in Critically Ill Patients. Antimicrob Agents Chemother. 2001;45(1):3148-55. https://doi.org/10.1128/AAC.45.11.3148-3155.2001

Isla A, Rodríguez Gascón A, Maynar J, Arzuaga A, Toral D, Pedraz JL. Cefepime and continuous renal replacement therapy (CRRT): in vitro permeability of two CRRT membranes and pharmacokinetics in four critically ill patients. Clin Ther. 2005;27(5):599-608. https://doi.org/10.1016/j.clinthera.2005.05.004

Allaouchiche B, Breilh D, Jaumain H, Gaillard B, Renard S, Saux MC. Pharmacokinetics of cefepime during continuous venovenous hemodiafiltration. Antimicrob Agents Chemother. 1997;41(11):2424-7. https://doi.org/10.1128/AAC.41.11.2424

Bresson J, Paugam-Burtz C, Josserand J, Bardin C, Mantz J, Pease S. Cefepime overdosage with neurotoxicity recovered by high-volume haemofiltration. J Antimicrob Chemother. 2008;62(4):849-50. https://doi.org/10.1093/jac/dkn256

Wilson FP, Bachhuber MA, Caroff D, Adler R, Fish D, Berns J. Low cefepime concentrations during high blood and dialysate flow continuous venovenous hemodialysis. Antimicrob Agents Chemother. 2012;56(4):2178-80. https://doi.org/10.1128/AAC.05987-11

Sharma S, Puri Vi, Bloom E, Raja R. Cefepime Induced Neurotoxicity: Impact of Early Nephrologic Intervention. Am J Kidney Dis. 2016;67(5):A1-118. https://doi.org/10.1053/j.ajkd.2016.03.328

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Dimensions


PlumX


Downloads

Download data is not yet available.