Objective:

Background:

Cefepime is a 4^th generation broad spectrum cephalosporin used to treat both gram-negative and gram-positive bacteria. Elderly people, patients with impaired renal function, past neurological comorbidities and critically ill patients are at risk of cefepime induced neurotoxicity.

Design/Methods:

This is a retrospective review of case records of all consecutive patients treated with cefepime over a period of 12 months were screened for neurotoxicity. Patients fulfilling Salzburg electroencephalographic (EEG) criteria for diagnosis of NCSE were identified and further analyzed. Demographic data, comorbidities, clinical details, diagnosis, indication for cefepime, treatment given and outcomes assessed by modified Rankin Scale (mRS) were recorded.

Results:

During study period 71 patients received treatment with cefepime for various infections. 7(9.85%) of them fulfilled the criteria for NCSE. The mean age was 76.28 years, and majority were females (F:M 4:3). Mean duration of symptom reported by treating physician from initiating cefepime was 68.57hrs. All the seven patients with NCSE had renal impairment, 5/7(71.42%) had history of previous stroke, and one had history of post stroke epilepsy. Based on Salzburg criteria, a) 5/7(71.42%) had Epileptiform Discharges (ED’s) ≤2.5Hz with EEG and clinical response to IV benzodiazepine (BZD), b) 1/7(14.28%) had ED’s >2.5Hz, c) 1/7(14.28%) had ED’s of ≤2.5Hz with subtle clinical phenomena. Treatment was denied by care givers for 2(28.57%) patients, 2(28.57%) patients improved to baseline status after stopping cefepime and treating with anti-seizure medications and IV anesthetic agents but succumbed due to sepsis and underlying malignancy, remaining 3 patients had an outcome with mRS-4. 

Conclusions:

This paper determines the frequency of NCSE in patients receiving cefepime (9.85%). The common comorbidities were renal impairment and stroke. Patients with delayed diagnosis had poor outcome.