Ryo Nakagawa1, Kenichiro Sato2, Yoshikazu Uesaka3, Takashi Mitsuki4, Kanya Kondo4, Atsushi Wake4, Yoshifumi Ubara5, Mami Kanzaki3. 1. Department of Neurology, Toranomon Hospital, Tokyo, Japan. 2. Department of Neurology, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan. Electronic address: kenisatou-tky@umin.ac.jp. 3. Department of Neurology, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Tokyo, Japan. 4. Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan. 5. Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.
Abstract
OBJECTIVES: Impaired renal function is a risk factor for cefepime (CFPM)-induced encephalopathy (CFPMIE) in patients treated with CFPM; dose-titration to renal function is recommended to prevent CFPMIE. However, available evidence on the incidence of CFPMIE or preventive efficacy of dose adjustment against CFPMIE in end-stage renal disease (ESRD) patients is limited. METHODS: Single-centre, retrospective observational study. We reviewed consecutive in-hospital adult patients treated with adjusted-dose of CFPM in the period between September 2012 and September 2016, and assessed the CFPMIE in ESRD patients treated with adjusted-dose of CFPM. RESULTS: Out of 422 eligible patients, 6 patients (1.4%) were diagnosed with CFPMIE. The incidence of CFPMIE in ESRD patients was 7.5% (5/67). Among ESRD patients, pre-existing central nervous system (CNS) morbidity was significantly associated with the risk of CFPMIE. CFPMIE occurred in ESRD patients regardless of daily dose, and even with 0.5g/day of CFPM. CONCLUSIONS: Pre-existing CNS morbidity may be associated with an increased risk of CFPMIE in ESRD patients. No significant association was observed between CFPM dose and incidence of CFPMIE in ESRD patients, and future investigation on the safer dose-adjustment strategy in ESRD patients is required for achieving balance between successful infectious treatment and reducing CFPMIE.
OBJECTIVES: Impaired renal function is a risk factor for cefepime (CFPM)-induced encephalopathy (CFPMIE) in patients treated with CFPM; dose-titration to renal function is recommended to prevent CFPMIE. However, available evidence on the incidence of CFPMIE or preventive efficacy of dose adjustment against CFPMIE in end-stage renal disease (ESRD) patients is limited. METHODS: Single-centre, retrospective observational study. We reviewed consecutive in-hospital adult patients treated with adjusted-dose of CFPM in the period between September 2012 and September 2016, and assessed the CFPMIE in ESRDpatients treated with adjusted-dose of CFPM. RESULTS: Out of 422 eligible patients, 6 patients (1.4%) were diagnosed with CFPMIE. The incidence of CFPMIE in ESRDpatients was 7.5% (5/67). Among ESRDpatients, pre-existing central nervous system (CNS) morbidity was significantly associated with the risk of CFPMIE. CFPMIE occurred in ESRDpatients regardless of daily dose, and even with 0.5g/day of CFPM. CONCLUSIONS: Pre-existing CNS morbidity may be associated with an increased risk of CFPMIE in ESRDpatients. No significant association was observed between CFPM dose and incidence of CFPMIE in ESRDpatients, and future investigation on the safer dose-adjustment strategy in ESRDpatients is required for achieving balance between successful infectious treatment and reducing CFPMIE.
Authors: Gwendolyn M Pais; Jack Chang; Erin F Barreto; Gideon Stitt; Kevin J Downes; Mohammad H Alshaer; Emily Lesnicki; Vaidehi Panchal; Maria Bruzzone; Argyle V Bumanglag; Sara N Burke; Marc H Scheetz Journal: Clin Pharmacokinet Date: 2022-06-29 Impact factor: 5.577