Cefepime-induced neurotoxicity: an underestimated complication of antibiotherapy in patients with acute renal failure

Objectives: To describe five new cases of life-threatening cefepime-induced neurotoxicity observed in a 2-year period. Setting: A university intensive care unit. Patients: Five patients recently treated with cefepime, admitted for seizures and coma. All suffered from acute renal failure, induced by sepsis and combined aminoside therapy, or by cefepime itself in one case. Interventions: All patients underwent hemodialysis, which led to complete neurological improvement in four of them. One patient remained comatose and subsequently died. Measurements: Blood and CSF cefepime levels were measured by high performance liquid chromatography before and after hemodialysis. Conclusion: The frequency of cefepime-induced neurotoxicity is probably underestimated. Monitoring of renal function and close neurological survey in treated patients should allow an early diagnosis of this complication. Urgent hemodialysis seems the best therapeutic method to obtain a rapid neurological improvement.