Renal failure is a risk factor for cefepime-induced encephalopathy.
BACKGROUND
Cefepime is a widely used antibiotic. However, it can cause encephalopathy, which has been increasingly described in the literature, occurring mainly in patients with impaired renal function. The primary objective in this study was to measure the incidence of cefepime-induced encephalopathy and determine potential risk factors for its occurrence.


METHODS
In the period from February 2005 to February 2006, a prospective cohort study was conducted, which followed 498 patients using cefepime. Other metabolic problems were ruled out for all patients with clinical suspicion of encephalopathy and, when cefepime was the probable cause, electroencephalographic (EEG) tests were performed to assist in the diagnosis, with the first performed during cefepime use and another performed at least 48 hours following drug discontinuation and/or clinical improvement.


RESULTS
Among patients selected for this study (n=498), 5 were diagnosed with cefepime-induced encephalopathy, thus indicating a cumulative incidence of approximately 1% (0.01), 387 had glomerular filtration rate (GFR) >or=60 ml/min and 111 had GFR <60 ml/min. Among the latter, 5 patients developed cefepime-induced encephalopathy. Mean GFR value in patients with encephalopathy (n=5) was 17.20 ml/min (SD +/-10.75 ml/min) and, in patients without encephalopathy (n=106) it was 32.59 ml/min (SD +/-14.89 ml/min) (p=0.025).


CONCLUSIONS
The development of cefepime-induced encephalopathy seems to be related to the severity of impairment in glomerular filtration.
Garces
E O
EO
Post-Graduation Program in Medical Sciences, Universidade Federal de Rio Grande do Sul, Porto Alegre, RS - Brazil.
Andrade de Anzambuja
M F
MF
da Silva
D
D
Bragatti
J A
JA
Jacoby
T
T
Saldanha Thomé
F
F
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001928:Brain Diseases, Metabolic / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D000077723:Cefepime; D002511:Cephalosporins / Q000009:adverse effects*; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime