cefepime and Bronchiectasis

We report a case of cefepime neurotoxicity characterised by myoclonic status epilepticus with coma, in a context of acute renal failure and requiring one discontinuous conventional haemodialysis. Cefepime is a fourth-generation broad-spectrum cephalosporin mainly used to treat hospital-acquired Gram-negative infections. Acute neurotoxicity is an increasingly reported adverse effect which occurs predominantly in patients with renal impairment. Renal replacement therapy has been proposed to treat this condition.

Topics: Acute Kidney Injury; Aged, 80 and over; Anti-Bacterial Agents; Bronchiectasis; Cefepime; Drug-Related Side Effects and Adverse Reactions; Epilepsies, Myoclonic; Fatal Outcome; Female; Humans; Neurotoxicity Syndromes; Renal Dialysis; Status Epilepticus

Despite popular use of piperacillin, the dire neurotoxicity associated with piperacillin still goes unrecognized, leading to a delay in appropriate management. We report a 57-year-old woman with end-stage renal disease receiving continuous ambulatory peritoneal dialysis (CAPD), who developed slurred speech, tremor, bizarre behavior, progressive mental confusion, and 2 episodes of generalized tonic-clonic seizure (GTCS) after 5 doses of piperacillin/tazobactam (2 g/250 mg) were given for bronchiectasis with secondary infection. The laboratory data revealed normal plasma electrolyte and ammonia levels but leukocytosis. Neurologic examinations showed dysarthria and bilateral Babinski sign. Computed tomography of brain and electroencephalogram were unremarkable. Despite the use of antiepileptic agents, another GTCS episode recurred after the sixth dose of piperacillin/tazobactam. Brain magnetic resonance imaging did not demonstrate acute infarction and organic brain lesions. Initiation of high-flux hemodialysis rapidly reversed the neurologic symptoms within 4 hours. Piperacillin-induced encephalopathy should be considered in any uremic patients with unexplained neurological manifestations. CAPD is inefficient in removing piperacillin, whereas hemodialysis can rapidly terminate the piperacillin-induced encephalopathy.

Topics: Anti-Bacterial Agents; Brain; Bronchiectasis; Cefazolin; Cefepime; Cephalosporins; Electroencephalography; Epilepsies, Myoclonic; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Molecular Structure; Penicillanic Acid; Penicillin G; Peritoneal Dialysis, Continuous Ambulatory; Piperacillin; Piperacillin, Tazobactam Drug Combination; Renal Dialysis; Tomography, X-Ray Computed