ro13-9904 and Renal-Insufficiency--Chronic

The profile of ceftriaxone-induced encephalopathy is not well understood.. To identify risk factors associated with ceftriaxone-induced encephalopathy.. In this observational study, anonymised patient data were retrieved from the open-access Japanese Adverse Drug Event Report database for ceftriaxone users aged 20 years or higher.. Data of 256,788 individuals and 12,160 cases of encephalopathy were extracted, and 2,939 ceftriaxone users, of whom 193 had encephalopathy, were identified. A disproportionate prevalence of encephalopathy was observed among the ceftriaxone users (reported odds ratio = 1.42; 95% confidence interval [CI] = 1.23-1.65; p < 0.001). Multivariate logistic regression analysis of 2,057 ceftriaxone users showed encephalopathy was associated with female sex (odds ratio [OR] = 1.52; 95% CI, 1.05-2.19; p = 0.027), chronic kidney disease (OR = 2.32; 95% CI, 1.47-3.67; p < 0.001), a ceftriaxone dosage of > 2 g/day (OR = 2.66; 95% CI, 1.66-4.26; p < 0.001), and a treatment duration of > 14 days (OR = 1.94; 95% CI, 1.21-3.11; p = 0.006).. Patients with chronic kidney disease, receiving ceftriaxone at a dosage of > 2 g/day, being treated for over 14 days, and/or females may be at an increased risk of ceftriaxone-induced encephalopathy.

Topics: Anti-Bacterial Agents; Brain Diseases; Ceftriaxone; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Japan; Renal Insufficiency, Chronic

The incidence of infective endocarditis is underestimated in solid organ transplant recipients. The spectrum of pathogens is different from the general population. The authors report the successful treatment of a 58-year-old woman with infective endocarditis caused by atypical microorganism and presented with atypical manifestations. Past history of the patient included alcoholic liver cirrhosis and cadaver liver transplantation in February 2000. One year after liver transplantation hepatitis B virus infection was diagnosed and treated with antiviral agents. In July 2007 hemodialysis was started due to progressive chronic kidney disease caused by calcineurin toxicity. In November 2013 the patient presented with transient aphasia. Transesophageal echocardiography revealed vegetation in the aortic valve and brain embolization was identified on magnetic resonance images. Initial treatment consisted of a 4-week regimen with ceftriaxone (2 g daily) and gentamycin (60 mg after hemodialysis). Blood cultures were all negative while serology revealed high titre of antibodies against Chlamydia pneumoniae. Moxifloxacin was added as an anti-chlamydial agent, but neurologic symptoms returned. After coronarography, valvular surgery and coronary artery bypass surgery were performed which resulted in full clinical recovery of the patient.

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Aortic Valve; Aphasia; Brain; Calcineurin; Ceftriaxone; Chlamydia; Coronary Artery Bypass; Drug Administration Schedule; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Fluoroquinolones; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Intracranial Embolism; Liver Transplantation; Magnetic Resonance Imaging; Middle Aged; Moxifloxacin; Renal Dialysis; Renal Insufficiency, Chronic; Treatment Outcome

Ceftriaxone is widely used in patients for the treatment of serious gram-negative infections. Ceftriaxone can induce some potential side effects, including neurotoxicity, however, nonconvulsive status epilepticus has rarely been reported. We report a case of acute reversible neurotoxicity associated with ceftriaxone. A 65-yr-old woman with chronic kidney disease developed altered consciousness during ceftriaxone treatment for urinary tract infection. The electroencephalogram demonstrated continuous bursts of generalized, high-voltage, 1 to 2 Hz sharp wave activity. Neurologic symptoms disappeared following withdrawal of ceftriaxone. The possibility of ceftriaxone-induced neurotoxicity should be considered in patients developing neurological impairment during ceftriaxone use, and the discontinuation of the drug could lead to complete neurological improvement.

Topics: Aged; Anti-Bacterial Agents; Anticoagulants; Ceftriaxone; Electroencephalography; Female; Humans; Nervous System Diseases; Renal Dialysis; Renal Insufficiency, Chronic; Seizures; Thrombosis; Tomography, X-Ray Computed; Urinalysis; Urinary Tract Infections