Cefepime-induced neurotoxicity: an underestimated complication of antibiotherapy in patients with acute renal failure.
OBJECTIVE
To describe five new cases of life-threatening cefepime-induced neurotoxicity observed in a 2-year period.


METHODS
A university intensive care unit.


METHODS
Five patients recently treated with cefepime, admitted for seizures and coma. All suffered from acute renal failure, induced by sepsis and combined aminoside therapy, or by cefepime itself in one case.


METHODS
All patients underwent hemodialysis, which led to complete neurological improvement in four of them. One patient remained comatose and subsequently died.


METHODS
Blood and CSF cefepime levels were measured by high performance liquid chromatography before and after hemodialysis.


CONCLUSIONS
The frequency of cefepime-induced neurotoxicity is probably underestimated. Monitoring of renal function and close neurological survey in treated patients should allow an early diagnosis of this complication. Urgent hemodialysis seems the best therapeutic method to obtain a rapid neurological improvement.
Chatellier
D
D
Service de Réanimation Polyvalente, Hôpital Roger Salengro, CHRU Université Lille 2, 59037 Lille, France.
Jourdain
M
M
Mangalaboyi
J
J
Ader
F
F
Chopin
C
C
Derambure
P
P
Fourrier
F
F
D058186:Acute Kidney Injury / Q000188:drug therapy* / Q000628:therapy; D000293:Adolescent; D000368:Aged; D000077723:Cefepime; D002511:Cephalosporins / Q000009:adverse effects* / Q000097:blood / Q000134:cerebrospinal fluid; D002851:Chromatography, High Pressure Liquid; D003422:Critical Care; D005260:Female; D006801:Humans; D008297:Male; D009420:Nervous System / Q000187:drug effects*; D006435:Renal Dialysis
D002511:Cephalosporins; D000077723:Cefepime