Background: Cefepime-induced encephalopathy (CIE), while reported in case reports, is considered an uncommon toxicity. Patients admitted to the hospital requiring broad spectrum antibiotics with cefepime who develop encephalopathy often have multiple other etiologies for this finding. However, prescribers often look to modify antibiotic therapy for patients that develop encephalopathy while on cefepime given the reported association with this toxicity, which may result in selection of more toxic or less efficacious antibiotics.
Methods: We evaluated cefepime orders modified based on concern for CIE reported to our antimicrobial stewardship service among adult inpatients between 1/1/2016 to 5/10/2017 to identify the incidence of suspected CIE. We also assessed the likelihood of the encephalopathy being related to cefepime (based on number of additional potential etiologies and symptom resolution following cefepime discontinuation). Data on type of infection, location at time of antibiotic modification, and alternative antibiotics initiated was also collected.
Results: Eighteen patients developed suspected CIE for which the antibiotic was modified to an alternative anti-Pseudomonal agent. During the assessment period, there were 4,446 encounters where patients received cefepime. The observed suspected CIE incidence was 0.4%. The average cefepime duration prior to discontinuation was 7.3 days. The average number of additional potential etiologies was 4.8. In 3 patients, after discontinuation of cefepime as the only modification, symptoms of encephalopathy improved or resolved within 3-4 days. An EEG was performed on 17 patients, 9 EEGs showed triphasic wave forms consistent with encephalopathy. The baseline characteristics and modifications in antimicrobial therapy are summarized in Table 1.
Conclusion: The incidence of suspected CIE in our analysis was 0.4%. After removing those patients where symptoms did not resolve after discontinuing cefepime in the absence of other interventions, the observed incidence was more likely 0.07%. Given that the patients reviewed had an average of 4-5 other likely etiologies for their encephalopathy makes it difficult to truly identify the cause of encephalopathy in these cases.
N. N. Pettit,
J. Pisano, None