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Danger in plain sight: determining who is at highest risk for cefepime induced neurotoxicity and its associated morbidity and mortality

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Abstract

Cefepime is a fourth-generation cephalosporin that is widely used to treat sepsis but is associated with a potentially dangerous neurotoxicity syndrome, cefepime-induced neurotoxicity (CIN). As a result, patients treated with cefepime may be at higher risk for morbidity, including seizures, and mortality. Though the recent ACORN trial concluded that cefepime does not increase the risk of mortality, most of these patients were not critically ill or elderly, two of the most at risk populations for CIN. Further, diagnosis may be difficult in the critical care setting as patients may have multiple reasons for encephalopathy. Therefore, this population in particular should be studied and monitored closely for CIN. Importantly, there are not well defined diagnostic criteria for CIN to guide evaluation and management. Defining the risk factors for CIN and using laboratory and EEG to help support the clinical diagnosis could be helpful in early recognition of CIN to help institute treatment and to rule out seizures. In this mini review, we highlight risk factors for CIN, discuss the possible value of EEG, and propose a diagnostic and management approach in the evaluation and management of CIN.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, Jacksonville, FL, USA

    Brin E. Freund

  2. Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA

    Khalil S. Husari

  3. Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA

    Khalil S. Husari & Peter W. Kaplan

Authors
  1. Brin E. Freund
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  2. Khalil S. Husari
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  3. Peter W. Kaplan
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Correspondence to Brin E. Freund.

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Drs. Freund and Husari have no conflicts to report. Dr. Kaplan receives honoraria from Demos and Wiley textbooks, has served as expert witness on quantitative EEG and issues of coma and EEG, and is on the DSMB for EpiWatch.

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Freund, B.E., Husari, K.S. & Kaplan, P.W. Danger in plain sight: determining who is at highest risk for cefepime induced neurotoxicity and its associated morbidity and mortality. Acta Neurol Belg (2024). https://doi.org/10.1007/s13760-024-02546-5

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