title: Clinical and electroencephalographic assessment of cefepime during treatment of nosocomial infections in neurological patients.
abstract: OBJECTIVE
  Cefepime neurotoxicity usually occurs in patients with renal impairment. The aim of this study was to evaluate the neurotoxicity of cefepime administered by continuous intravenous infusion during treatment of nosocomial infections in neurological patients with normal renal function.
  
  
  METHODS
  This was an open pilot study of neurological patients with infections caused by cefepime sensitive bacteria. Patients had baseline neurological assessment and electroencephalogram (EEG). Cefepime plasma concentrations were determined 48 hours after infusion was initiated and at end of treatment (EOT).
  
  
  RESULTS
  Eleven patients were included. These were diagnosed with a brain tumor (9), cerebrovascular disease (1) and polyneuropathy (1). Infections were surgical site infection in 5, clinically defined nosocomial pneumonia in 4, and bacterial meningitis associated to postoperative CSF fistula in 2. Gram-negative organisms were isolated in 10 patients. Cefepime dose was 2 g/day in 9 patients and 4 g/day in 2. Mean cefepime plasma concentration at 48h was 13.6 ± 2.0 µg/mL (range 4.6 to 24.5 µg/mL), at EOT was 11.9 ± 1.8 µg/mL (range 3.0 to18.9 µg/mL ). EEG interpreted by two experts showed at baseline alpha background rhythm in 5 and theta-alpha rhythm in 6 patients. On EEG at EOT background rhythm was alpha in 4 and theta-alpha in 7, one patient presented isolated sharp and slow wave activity. No mental status changes or seizures occurred and all infections resolved.
  
  
  CONCLUSIONS
  Significant EEG change was observed in 1of 11 patients. A preserved mental status may correlate with cefepime safety in neurological patients with normal renal function during cefepime treatment.
authors.affiliation: Infectious Diseases Department, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico.
authors.forename: Susana Dimas
authors.initials: SD
authors.lastname: Alvarez
authors.forename: Maria Del Carmen Fernandez Gonzalez
authors.initials: Mdel C
authors.lastname: Aragon
authors.forename: Alvaro
authors.initials: A
authors.lastname: Moreno
authors.forename: Francisca
authors.initials: F
authors.lastname: Palomares-Alonso
authors.forename: Helgi Jung
authors.initials: HJ
authors.lastname: Cook
authors.forename: Graciela
authors.initials: G
authors.lastname: Cardenas
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Soto-Hernandez
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy*; D004569:Electroencephalography / Q000187:drug effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime