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MEDTECH An elderly patient exhibited signs of cognitive disarray, which emerged three days subsequent to a hospital discharge following osteomyelitis treatment.
An elderly man’s confusion post-osteomyelitis treatment prompts an exploration into the potential neurotoxic effects of cefepime, a frequently used fourth-generation cephalosporin, especially in patients with renal dysfunction.
Key Points:
- The patient was an 87-year-old male who presented confusion and decreased responsiveness three days after being discharged from an osteomyelitis treatment involving IV cefepime.
- Despite not having cefepime levels obtained, the improvement of the patient’s mental status after the antibiotic change to ertapenem indicated cefepime-induced neurotoxicity.
- Cefepime-induced neurotoxicity can occur in up to 0.15% of all patients and 15% of ICU patients, with symptoms typically delayed by a median of four days from treatment initiation.
- One primary risk factor for cefepime-induced neurotoxicity is renal dysfunction which increases the unbound, active form of cefepime in the blood.
Additional Points:
- Cefepime neurotoxicity mechanism involves the competitive inhibition of the γ-aminobutyric acid (GABA) receptor, which can lower the seizure threshold and lead to encephalopathy.
- The blood-brain barrier can be disrupted by renal dysfunction, sepsis, uremia, or prior central nervous system infection, allowing for greater penetration of cefepime, from 10% in normal conditions up to 45%.
- Cefepime toxicity treatment includes stopping the offending agent, managing seizure activity with antiepileptics, and in some cases, initiating hemodialysis.
Conclusion:
- The connection between cefepime and neurotoxicity, especially in patients with renal impairment, emphasizes the importance of monitoring cefepime levels in high-risk patients.
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Did You Know?
Neurotoxicity affects up to 15% of people over the age of 60, with polypharmacy and pre-existing neurological and renal conditions significantly increasing the risk.
