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Pseudomonal Bacteremia and Cefepime-Induced Neurotoxicity: A Case Report

Megan Smith, Chris Mehdizadeh, Avrodet Mourkus, Saad Ansari A

Cefepime is a broad-spectrum fourth-generation cephalosporin with activity against both gram positive and negative bacteria, including Pseudomonas aeruginosa [1]. Cefepime is most commonly used for urinary tract infections, soft tissue infections, and febrile neutropenia [2]. Up to 15% of ICU patients on cefepime may experience cefepime-induced neurotoxicity, with risk factors including renal dysfunction, excessive dosage, elevated serum cefepime concentrations, and history of prior brain injury [3].

The adverse effects of cefepime-induced neurotoxicity including encephalopathy, seizures, and coma can be resolved with drug cessation, antiepileptics, or hemodialysis [3]. Here, we present the case of cefepime induced neurotoxicity in a 59-year-old female patient with long-term cefepime antibiotic prescription for Pseudomonal endocarditis and bacteremia with multiple risk factors for reduced renal function. We discuss the relevant risk factors and preventive measures that may have prevented her from developing encephalopathy, as well as the importance of early recognition and prevention of cefepime-induced neurotoxicity in patient care.