Abstracts

Rationale: Cefepime is used for treatment of resistant gram negative bacterial infections. Cefepime induced neurotoxicity is common in patients with renal impairment or with administration of higher-than recommended doses. We report four patients with no prior history of epilepsy presenting with Cefepime-induced non-convulsive status epilepticus.

Methods: A retrospective observational review of adult patients developing acute change in mental status on therapeutic dosage of Cefepime for the management of Sepsis from January 1^st 2021 and April 30^th 2021. We reviewed the socio-demographic information and presence of comorbid conditions of each patient. All patients underwent brain imaging and V-EEGs. All EEGs were performed for standard indications (e.g. altered mental status, suspected seizures). All EEGs were reviewed by neurology resident and Epileptologist/Clinical Neurophysiologist. Endpoint included responder rates after discontinuation of cefepime, administration of antiseizure medications based on clinical judgement, resolution of NCSE EEG patterns and improved mental status.

Results: 4 patients with sepsis on Cefepime treatment were included in the analysis; mean age, 70.75 years; 25% of patient were male and 75% were female. All patients were admitted to critical care unit for a non-neurological condition with sepsis and 50% had some degree of renal failure. All patients had Brain imaging without acute intracranial abnormalities at admission and at neurological deterioration. Clinical manifestations of Cefepime neurotoxicity were delayed in 100% of patients with a median onset of four to five days after starting the drug, and trend towards a progressive course. All patients had altered mental status and reduced consciousness (n=4; 100%). Other commonly reported clinical findings included myoclonus (n = 2, 50%). All patients EEG (4 showed NCSE (non-convulsive status epilepticus) with a pattern consisting of non-state dependent ~ 2 to 2.5 Hertz generalized spike and wave discharges and corresponding clinical correlate of altered awareness and decreased responsiveness to surroundings. The most effective intervention in all cases of Cefepime induced NCSE was discontinuation of therapy in conjunction with non-sedative antiseizure medications (n=4; 100%). These interventions led to clinical resolution or improvement of symptoms in all patients. Time to symptom improvement occurred at a median of 2 days in all patients, and emergent hemodialysis was not needed in any case.

Conclusions: Cefepime use in critically ill patients can cause severe but reversible neurotoxicity presenting with NCSE. Discontinuation of Cefepime, EEG confirming NCSE Pattern in conjunction with antiseizure medication guided by EEG is necessary in most cases. In order to reduce the likelihood of this adverse effect in critical ill patients, we should limit Cefepime use where the risk outweigh the benefit and no alternative, less neurotoxic antibiotics are feasible. References: *Payne et al. Cefepime-Induced Neurotoxicity: a systematic review. Critical Care (2017)21:276. *Sonck et al. The neurotoxicity and safety of treatment with cefepime in patients with renal failure. Nephol Dial Transplant (2008)23:966-970.

Funding: Please list any funding that was received in support of this abstract.: None.