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Review
. 2017 Oct 10;4(4):ofx170.
doi: 10.1093/ofid/ofx170. eCollection 2017 Fall.

Characterizing Cefepime Neurotoxicity: A Systematic Review

Ayesha A Appa  1 , Rupali Jain  1   2 , Robert M Rakita  1 , Shahin Hakimian  3 , Paul S Pottinger  1
Affiliations
Review

Characterizing Cefepime Neurotoxicity: A Systematic Review

Ayesha A Appa et al. Open Forum Infect Dis. .

Abstract

Neurotoxicity due to cefepime has not been well characterized. We performed a systematic review of the literature and included 5 additional cases from our center. Of the 198 cases found, the mean age was 67 years and 87% of patients had renal dysfunction. The most common clinical features were diminished level of consciousness (80%), disorientation/agitation (47%), and myoclonus (40%). It is worth noting that nonconvulsive status epilepticus was relatively common with 31% of cases, whereas only 11% had convulsive seizures. Single-center estimate of incidence was 1 in 480 courses of cefepime. Cefepime neurotoxicity should be considered in older patients with renal dysfunction and new onset encephalopathy, especially if concurrent myoclonus is present. More work is needed to prospectively assess incidence and outcomes related to cefepime neurotoxicity.

Keywords: cefepime; cephalosporins; encephalopathy; seizures.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram. This flowchart details our search strategy, inclusion and exclusion criteria, and final cohort size.
Figure 2.
Figure 2.
Characterization of cefepime neurotoxicity. Clinical manifestations of cefepime neurotoxicity were tabulated and reported as a percentage of the total cohort (n = 198), from most to least frequently observed.
See this image and copyright information in PMC

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