1050. Analysis of Seizure Activity with Cefepime Use in a Large Metropolitan Teaching Hospital
Session: Poster Abstract Session: Stewardship: Improving Treatments
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster 1050 Analysis of Seizure Activity with Cefepime Use in a Large Metropolitan Teaching Hospital.pdf (457.3 kB)
  • Background:

    In June 2012, the Food and Drug Administration (FDA) alerted health care professionals to the risk of nonconvulsive status epilepticus in patients receiving cefepime without proper dosage adjustments for renal dysfunction.  In most cases, seizures resolved after discontinuation of cefepime or initiation of hemodialysis.  The purpose of this study was to assess incidence of nonconvulsive status epilepticus in patients receiving cefepime and to evaluate proper dosing of cefepime at a large, tertiary care teaching hospital in New York City.

    Methods:

    In a retrospective analysis, cefepime use was assessed in 100 adults who received cefepime for a minimum of five days from March 1, 2012 through April 30, 2012.  Seizure activity was identified through orders for an electroencephalogram (EEG) or a new antiepileptic drug (AED) during or within seven days of cefepime exposure.  EEG results were reviewed for evidence of nonconvulsive status epilepticus.  Each course of cefepime therapy was assessed for seizure activity as well as appropriateness of dose for indication and renal function.  Cefepime dose was reassessed for appropriateness in any patient having a change in serum creatinine (SCr) ≥ 50% from baseline.

    Results:

    The median duration of cefepime therapy was seven days.  An EEG was ordered on three patients with one case each of cerebral hematoma, right sided structural lesion, and no epileptiform discharges.  A new AED was ordered for one patient who had recently suffered a subarachnoid hemorrhage. Inappropriate dosing was identified in 13 patients. Of these, 11 patients were receiving subtherapeutic doses and two were receiving supratherapeutic doses. Ten patients had a change in SCr ≥ 50% from baseline and required a dosage adjustment, which was accomplished for all but one patient.

    Conclusion:

    In our retrospective analysis, cefepime was not associated with nonconvulsive status epilepticus.  Cefepime dosing was appropriate in the majority of patients based on renal function and indication.  For patients with changing renal function, the cefepime dose was appropriately adjusted. Cefepime, which is commonly used as part of an empiric antibiotic regimen for hospital-acquired infections at our hospital, was not found to be associated with seizure risk when dosed appropriately.

    Rachel Staudt, PharmD, Gina Caliendo, PharmD, BCPS, Victoria Adams, PharmD, BCPS and Patricia Saunders-Hao, PharmD, BCPS, Mount Sinai Medical Center, New York, NY

    Disclosures:

    R. Staudt, None

    G. Caliendo, None

    V. Adams, None

    P. Saunders-Hao, None

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