Clinician Response to EEG Findings in Patients on Cefepime
Abstract number :
1.492
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2023
Submission ID :
1294
Source :
www.aesnet.org
Presentation date :
12/2/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Conor Kelly, MD – University of Pittsburgh Medical Center
Wesley Kerr, MD, PhD – University of Pittsburgh Medical Center; Rishabh Jain, MS – University of Pittsburgh Medical Center; Rafeed Alkawadri, MD – University of Pittsburgh Medical Center; james Castellano, MD, PhD – University of Pittsburgh Medical Center; Vijayalakshmi Rajasekaran, MD – University of Pittsburgh Medical Center; Lori Shutter, MD, FNCS, FCCM – University of Pittsburgh Medical Center; Alexandra Urban, MD, FAAN, FAES – University of Pittsburgh Medical Center; Anto Bagić, MD, PhD, FAES, FACNS – University of Pittsburgh Medical Center; Joanna Fong-Isariyawongse, MD, FAES, FAAN – University of Pittsburgh Medical Center
Rationale:
Cefepime is a fourth-generation cephalosporin antibiotic with broad spectrum coverage, which crosses the blood-brain-barrier and is known to induce neurotoxicity via concentration-dependent Υ-aminobutyric acid (GABA) antagonism. Cefepime-induced neurotoxicity is associated with encephalopathy, myoclonus, seizures and status epilepticus (both electroclinical and electrographic), with EEG findings of periodic discharges, often with triphasic morphology. To date there is minimal data assessing treatment strategies utilized and outcomes. In the present study we seek to characterize clinician response to EEG findings consistent with Cefepime toxicity, and associated outcomes.
Methods:
A retrospective analysis of patients treated within the UPMC system between June 2019 and May 2022 who were received cefepime before or during continuous EEG (cEEG), with EEG findings of periodic discharges (PDs) in our cEEG database. Baseline demographic data, cEEG features, clinician response (e.g. cefepime cessation, antiseizure medication (ASM) initiation), and outcomes data (e.g. length of ICU stay, length of hospital stay, death) were collected.
Results:
A total of 96 patients treated with cefepime with PDs on cEEG were identified. Patients had a median age of 64 years with 55% female. A total of 66 patients (72.53%) had renal dysfunction with GFR ≤90.48 patients (50%) had PDs with triphasic morphology, majority (71%) were generalized PDs. A total of 23 patients (29.17%) were noted to have ictal activity (including findings consistent with seizure, status epilepticus (SE), ictal-interictal continuum (IIC), or myoclonic SE) on the initial EEG report. Cefepime was stopped prior to EEG in 15 patients (15.63%), stopped within one day of EEG in 59 patients (61.46%), and continued in 22 patients (22.92%). New ASMs were initiated in 53 patients (55.21%). Average length of ICU stay was 13.63 (SD 14.56) days, and average length of hospitalization was 28.45 days (SD 27.98). A total of 42 patients (43.75%) either died or were transitioned to comfort-focused care. Increased frequency of PDs was associated with 2.1 times increased likelihood of initiating new ASMs (p< 0.01). Not stopping Cefepime within one day is associated with 2.3 times more likelihood to have generalized PDs (p< 0.01). The presence of SE on first EEG was associated with better patient outcomes in both length of stay in ICU and hospital (OR -10.0, -24.1, p< 0.01, respectively). Clinical decisions on starting ASM and stopping Cefepime did not show significant effects on length of stay in ICU, hospitalization and mortality.
Conclusions:
cEEG is an important tool to guide treatment of patients who are encephalopathic in the setting of ongoing or recent Cefepime treatment. Our study demonstrates differences in clinician response to EEG data with unclear direct impact on outcomes. However, the identification of SE upon initial EEG was associated with improved patient outcomes, likely due to the immediate medical intervention facilitated by this EEG diagnosis. This underscores the significance of early intervention for suspected cases of Cefepime-induced neurotoxicity.
Funding: N/A
Neurophysiology