Clinical and Electrographic Features in Beta-Lactam Antibiotic Induced Neurotoxicity
Objective:
To characterize clinical and electrographic features of patients with beta-lactam antibiotic-induced neurotoxicity in presence of and without renal impairment (RI).
Background:
EEG findings like periodic discharges, triphasic waves, or status epilepticus have been associated with beta-lactam neurotoxicity in critically ill patients with renal impairment.
Design/Methods:
Medical records of patients undergoing EEG due to encephalopathy while receiving cefepime, cefazoline and meropenem at the KUMC from 2009-2018 were reviewed. Demographic data, creatinine levels, clinical information, electrographic findings, and AEDs used were obtained. Exclusion criteria included unknown antibiotic start date, no clinical changes after antibiotic onset, worsening unrelated to antibiotics, or mental improvement on antibiotics. Patients were divided into with and without RI. Descriptive statistical methods and Chi-square/Fisher’s exact tests were applied.
Results:
196 patients were identified. After applying our exclusion criteria, 39 patients were included, of which 14 (36%) were males and 25 (64%) were females. Thirty-three patients (85%) were on cefepime. Further analysis was focused on cefepime only since the number of patients on other antibiotics was nonsignificant. Symptoms reported were altered mental status (64%) [43% had RI], myoclonus (15%) [100% had RI] and seizures (9%) [67% had RI]. A tendency to have myoclonus was seen in patients with RI (p=0.049). EEG findings were generalized slowing (91%), triphasic waves (56%), GPDs (42%), and LPDs (12%). Six patients were found with NCSE, of which 4 (67%) had RI (p=0.490). Twenty-four (73%) patients symptomatically improved after stopping cefepime. Improvements in EEG were seen in 14 out of 22 patients who had repeat EEGs or were followed with EEG monitoring.
Conclusions:
Seizures were infrequently seen in patients with beta-lactam neurotoxicity. Removal of offending agents can improve clinical outcomes and prognosis in cefepime induced neurotoxicity.