Dose-Adjusted Beta-Lactam Antibiotic-Induced Encephalopathy in a Patient with End-Stage Renal Impairment: A Case Report
  • Chris Anthony
    Department of Cardiology, St Vincent’s Hospital, Sydney
  • Meenal Sharma
    Department of Cardiology, St Vincent’s Hospital, Sydney
  • Roberto Spina
    Department of Cardiology, St Vincent’s Hospital, Sydney
  • Peter S Macdonald
    Department of Cardiology, St Vincent’s Hospital, Sydney
  • Jacob Sevastos
    Department of Nephrology, St Vincent’s Hospital, Sydney

Abstract

Introduction: Despite adherence to current guidelines regarding dose adjustment and drug-level monitoring, beta-lactam-induced encephalopathy can still occur in the setting of chronic renal impairment.

Case Report: We report what we believe is the first case of piperacillin- and tazobactam-induced encephalopathy in a patient with pre-existing cefepime-induced encephalopathy in the context of end-stage kidney disease despite adequate dose adjustment for renal impairment.

VIEW THE ENTIRE ARTICLE

References

  • Bloomer A, Barton L, Maddock RK Jr. Penicillin-induced encephalopathy in uremic patients, JAMA 1967;200:121–123.
  • Fossieck B, Parker RH. Neurotoxicity during intravenous infusion of penicillin. A review, J Clin Pharma 1974;14:504–512.
  • Marks MI, Hirshfeld S. Neurotoxicity of penicillin, N Engl J Med 1968;279:1002–1003.
  • Tong MK, Siu YP, Yung CY, Kwan TH. Piperacillin/tazobactam-induced acute delirium in a peritoneal dialysis patient, Nephrol Dial Transplant 2004;19:1341.
  • Gibson TP, Demetriades JL, Bland JA. Imipenem/cilastatin: pharmacokinetic profile in renal insufficiency, Am J Med 1985;78:54–61.
  • Sanders WE Jr, Sanders CC. Piperacillin/tazobactam: a critical review of the evolving clinical literature, Clin Infect Dis 1996;22:107–123.
  • Fugate JE, Kalimullah EA, Hocker SE, Clark SL, Wijdicks EF, Rabinstein AA. Cefepime neurotoxicity in the intensive care unit: a cause of severe, underappreciated encephalopathy, Crit Care 2013;17:R264.
  • Gangireddy VG, Mitchell LC, Coleman T. Cefepime neurotoxicity despite renal adjusted dosing, Scand J Infect Dis 2011;43:827–829.
  • Munar M, Singh H. Drug dosing adjustments in patients with chronic kidney disease, Am Fam Physician 2007;75:1487–1496.
  • Bresson J, Paugam-Burtz C, Josserand J, Bardin C, Mantz J, Pease S. Cefepime overdosage with neurotoxicity recovered by high-volume haemofiltration, J Antimicrob Chemother 2008;62:849–850.
  • Chatellier D, Jourdain M, Mangalaboyi J, Ader F, Chopin C, Derambure P, Fourrier F. Cefepime-induced neurotoxicity: an underestimated complication of antibiotherapy in patients with acute renal failure, Intensive Care Med 2002;28:214–217.
  • Garces EO, de Azambuja MFA, da Silva D, Bragatti JA, Jacoby T, Thome FS. Renal failure is a risk factor for cefepime-induced encephalopathy, J Nephrol 2008;21:526–534.
  • Abanades S, Nolla J, Rodríguez-Campello A, Pedro C, Valls A, Farré M. Reversible coma secondary to cefepime neurotoxicity, Ann Pharmacother 2004;38:606–608.
  • Sonck J, Laureys G, Verbeelen D. The neurotoxicity and safety of treatment with cefepime in patients with renal failure, Nephrol Dial Transplant 2008;23:966–970.
  • Durand-Maugard C, Lemaire-Hurtel AS, Gras-Champel V, Hary L, Maizel J, Prud'homme-Bernardy A et al. Blood and CSF monitoring of cefepime-induced neurotoxicity: nine case reports, J Antimicrob Chemother 2012;67:1297–1299.
  • Smith NL, Freebairn RC, Park MA, Wallis SC, Roberts JA, Lipman J. Therapeutic drug monitoring when using cefepime in continuous renal replacement therapy: seizures associated with cefepime, Crit Care Resusc 2012;14:312–315.
  • FDA Drug Safety Communication: Cefepime and risk of seizure in patients not receiving dosage adjustments for kidney impairment.U.S. Department of Health and Human Services. Available at http://www.fda.gov/Drugs/DrugSafety/ucm309661.htm.
  • Chapuis TM, Giannoni E, Majcherczyk PA, Chioléro R, Schaller MD, Berger MM et al. Prospective monitoring of cefepime in intensive care unit adult patients, Crit Care 2010;14:R51.
  • Barradell LB, Bryson HM. Cefepime. A review of its antibacterial activity, pharmacokinetic properties and therapeutic use, Drugs 1994;47:471–505.
  • Views: 1205
    HTML downloads: 735
    PDF downloads: 577
    Dose Adjusted Beta Lactam Antibiotic Induced Encephalopathy in a Patient with End Stage Renal Impairment. A Case Report downloads: 0


    Published: 2015-02-11
    Issue: Vol. 2 No. 1 (2015) (view)


    How to cite:
    1.
    Anthony C, Sharma M, Spina R, Macdonald PS, Sevastos J. Dose-Adjusted Beta-Lactam Antibiotic-Induced Encephalopathy in a Patient with End-Stage Renal Impairment: A Case Report. EJCRIM 2015;2 doi:10.12890/2015_000172.

    Most read articles by the same author(s)