Continuous kidney replacement therapy in neurotoxicity by cefepime: case report

Abstract

Background: Cefepime is an anti-pseudomonal cephalosporin, also classified as a fourth generation agent. Cefepime neurotoxicity is a rare adverse effect, usually occurring in patients with chronic renal disease, even with dose adjustment according to the glomerular filtration rate, although it can also occur when renal function is normal. The most frequent manifestations of cefepime encephalopathy are: Decreased level of consciousness, myoclonus and non-convulsive status epilepticus. Treatment includes cefepime discontinuation, dose reduction, benzodiazepines or renal replacement therapies. We present a patient with chronic kidney disease on peritoneal dialysis who presented with cefepime neurotoxicity and hemodynamic instability, who was treated with continuous renal replacement therapy. Purpose: To describe the case of neurotoxicity due to cefepime in a patient with chronic kidney disease. Case presentation: 63-year-old male patient with chronic kidney disease on peritoneal dialysis hos-pitalized for soft tissue infection under management with cefepime who presented a generalized tonic-clonic seizure episode followed by cardiorespiratory arrest witnessed with successful resuscitation, for which he was initiated with venovenous hemodiafiltration He continued for 72h and later hemodialysis due to volume overload, with which his neurological status improved, later the patient died of sepsis. Discussion and conclusion: neurotoxicity due to cefepime is a rare event, however, it is necessary to become aware of the manifestations of the disease to carry out an early detection. Continuous renal replacement therapies can be used in some patients, thereby accelerating the elimination of cefepime.