CIN Occurs Fairly Commonly Among Brain-Injured Patients

Background: Cefepime is an effective β-lactam with broad antibacterial spectrum and cerebrospinal fluid penetration. High doses of cefepime (6 g daily by continuous infusion) are sometimes recommended for serious infections, particularly among young trauma and brain-injured patients, who often demonstrate augmented renal clearance (ARC). However, the efficacy of these high doses ought to be balanced against the possibility of cefepime-induced neurotoxicity (CIN), which may present with diverse symptoms such as confusion, aphasia, encephalopathy, myoclonus, or seizures—all of which could also be misattributed to the primary brain injury. Objective: To assess the prevalence of cefepime plasma concentrations >35 mg/L among trauma and brain-injured patients receiving 6 g of cefepime daily, according to their creatinine clearance, and to examine the prevalence and risk factors for CIN associated with dose adjustments. Design: Retrospective, single-center, electronic medical record–dire more...