Abstracts

Rationale: Cefepime is a widely used fourth generation cephalosporin. It is commonly used as a first line antibiotic to treat a variety of infectious diseases such as neutropenic fever, hospital-aquired pneumonia, urinary tract infection, and bacterial meningitis. There are reports suggestive of cefepime induced encephalopathy (CIE) presenting with seizure, encephalitis, myoclonus and coma. We sought to evaluate the prevalence and potential risk factors of cefepime induced encephalopathy in a tertiary medical center in Korea. Methods: We enrolled 639 consecutive patients who were diagnosed with an infectious disease and were treated with cefepime at Dongsan medical center in Korea, from January 2013 to March 2014. Medical records were reviewed by neurologists to find patients with newly developed acute neurologic deterioration or altered level of consciousness during cefepime treatment. Definite CIE group (D-CIE) was defined as alteration of consciousness developed upon receiving cefepime treatment and full recovery after stopping it. Patients with D-CIE had been seen by consulting neurologists at the time and had been diagnosed with CIE. Patients with altered level of consciousness on cefepime but without neurology consult were categorized as suspected CIE group (S-CIA). All patients in the S-CIE group also had recovered after stopping cefepime treatment. Patients without any sign/symptom of encephalopathy during cefepime treatment were the control. Results: Five of 639 patients (0.8%) were identified as D-CIE and eight patients (1.2%) as S-CIE. Mean duration of D-CIE was 6.8±5.26 days and two patients (2/5, 40%) had non-convulsive status epilepticus with generalized sharp and wave complexes on the electroencephalogram. Patients with D-CIE were all female and were older than the control (71.80±4.03 yr vs. 65.9±14.40 yr, p=0.027). D-CIE group had higher blood urea nitrogen (BUN) values (45.8±38.97 vs. 25.63±21.80, p=0.04) and lower values of estimated glomerular filtration rate (eGRF) (25.6±15.53 vs. 88.38±44.08, p=0.001) than the control. The S-CIE and control group did not show significant difference in sex, age, BUN and eGRF. Only c-reactive protein level was higher in S-CIE group than control (15.3±9.41 vs. 8.5±8.46, p=0.025). Conclusions: The prevalence of D-CIE is 0.8%. Cautions about CIE are needed especially in cases with decreased renal function and in the elderly.