Article (Scientific journals)
Continuous infusion of cefepime and neurotoxicity: a retrospective cohort study.
Vercheval, Christelle; Sadzot, Bernard; MAES, Nathalie et al.
2021In Clinical Microbiology and Infection
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Keywords :
Cefepime; Continuous infusion; Neurotoxicity; Steady-state concentration; Therapeutic drug monitoring; Toxicity threshold
Abstract :
[en] Objectives: Neurotoxicity related to cefepime is increasingly reported in the literature but specific data concerning continuous infusion (CI) of the drug are still lacking. Our primary objective was to evaluate the incidence of neurotoxicity related to CI of cefepime and the associated risk factors. Our secondary objectives were to analyse the plasma cefepime concentrations and to define the threshold above which neurotoxicity occurs. Methods: In this single-centre retrospective cohort study, all adult patients who underwent at least one cefepime therapeutic drug monitoring (TDM) and were treated with CI of 4 g/day between January 2017 and June 2019 were included. Neurotoxicity was evaluated according to a strict definition and was correlated with steady-state concentration at the time of toxicity presentation. Results: Ninety-eight patients with 201 cefepime TDM studies were included, with an incidence of neurotoxicity of 14.3% (14/98). Patients with neurotoxicity had more often underlying brain disease (35.7% (5/14) vs 11.9% (10/84), p = 0.030)) and higher steady-state concentrations (mean ± standard deviation 71.8 ± 32.9 mg/L vs 49.6 ± 30.6, p = 0.036) than the others. A receiver operating characteristic curve analysis yielded a cefepime steady-state concentration of 63.2 mg/L as the best cut-off point between patients with or without neurotoxicity. A mean steady-state concentration of 46.4 mg/L was achieved if the dosages of cefepime were adapted to renal function which was under our threshold concentration but above our highest pharmacokinetic/pharmacodynamic target of 32-40 mg/L. Conclusions: Our results suggest that 4 g/day of cefepime adapted to renal function and infused over 24 h is a trade-off for the risk/benefit ratio, when used empirically.
Disciplines :
Pharmacy, pharmacology & toxicology
Author, co-author :
Vercheval, Christelle ;  Centre Hospitalier Universitaire de Liège - CHU > Département de pharmacie hospitalière > Service de pharmacie clinique
Sadzot, Bernard ;  Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
MAES, Nathalie ;  Centre Hospitalier Universitaire de Liège - CHU > Département de gestion des systèmes d'informations (GSI) > Secteur d'appui à la recherche clinique et biostatistique
Denooz, Raphaël ;  Université de Liège - ULiège > Département de pharmacie > Pharmacocintéique et pharmacovigilence
Damas, Pierre ;  Université de Liège - ULiège > Département des sciences cliniques > Département des sciences cliniques
FRIPPIAT, Frédéric  ;  Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service des maladies infectieuses - médecine interne
Language :
English
Title :
Continuous infusion of cefepime and neurotoxicity: a retrospective cohort study.
Publication date :
2021
Journal title :
Clinical Microbiology and Infection
ISSN :
1198-743X
eISSN :
1469-0691
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Available on ORBi :
since 06 January 2021

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