ArticleCritical care (London, England)2013
Cefepime neurotoxicity in the intensive care unit: a cause of severe, underappreciated encephalopathy.
Article in Critical care (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02680600 (Pharmacokinetic Evaluation of Cefepime Administrered Intravenously in Intensive Care Patients), which is not on this map. Cited by 85 papers, 8 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pharmacokinetic Evaluation of Cefepime Administrered Intravenously in Intensive Care Patients
Who cites it
85 citing papers in PubMed, 8 syntheses or guidelines pooled it, 193 citations in OpenAlex.
- Cefepime and Mortality: A Systematic Review and Bayesian Meta-Analysis.JAMA network open · 2026Pooled it
- Symptom-guided approach to central nervous system complications in allogeneic hematopoietic cell transplant recipients: Best practice recommendations from the EBMT Practice Harmonisation and Guidelines committee.Bone marrow transplantation · 2026Guideline
- Drug- and Toxin-Induced Opsoclonus - a Systematized Review, including a Case Report on Amantadine-Induced Opsoclonus in Multiple System Atrophy.Tremor and other hyperkinetic movements (New York, N.Y.) · 2024Pooled it
- Too Much of a Good Thing: Defining Antimicrobial Therapeutic Targets to Minimize Toxicity.Clinical pharmacology and therapeutics · 2021Pooled it
- Optimization of the treatment with beta-lactam antibiotics in critically ill patients-guidelines from the French Society of Pharmacology and Therapeutics (Société Française de Pharmacologie et Thérapeutique-SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation-SFAR).Critical care (London, England) · 2019Guideline
- BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization.The Cochrane database of systematic reviews · 2018Pooled it
- Neurological Adverse Effects Attributable to β-Lactam Antibiotics: A Literature Review.Drug safety · 2017Pooled it
- Cefepime-induced neurotoxicity: a systematic review.Critical care (London, England) · 2017Pooled it
- Rethinking Cefepime Neurotoxicity: An Integrated PK-Neuromonitoring Approach for Neurocritical Care.Neurocritical care · 2026Article
- Pathophysiology and Prognostic Significance of Myoclonus in Hypoxic-Ischemic Encephalopathy.Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society · 2026Review
- Article
- Real-world validation of a reduced-dose continuous infusion cefepime regimen: pharmacodynamic target attainment, efficacy and neurotoxicity.The Journal of antimicrobial chemotherapy · 2026Observational
- Safety concerns associated with high-dose continuous infusion of cefepime among critically ill patients with mild renal impairment to augmented renal clearance at a level 1 trauma center: CEFTOX study.Antimicrobial agents and chemotherapy · 2026Article
- Encephalopathy in mechanically ventilated adult patients in the intensive care unit: the role of β-Lactam overdosing.Scientific reports · 2026Article
- Strategies for Safer Cefepime Use to Prevent Neurotoxicity Using the Electronic Health Record.Critical care explorations · 2026Article
- Cefepime-induced encephalopathy following pancreaticoduodenectomy: a case report of a rare postoperative complication in gastrointestinal surgery.Clinical journal of gastroenterology · 2026Article
- Cefepime neurotoxicity in elderly patient with renal impairment: a case report.Annals of medicine and surgery (2012) · 2026Article
- Delayed-Onset Cefepime Neurotoxicity in a Patient With Epilepsy and ESRD.Case reports in medicine · 2026Article
- Beta-lactam dose reductions in critically ill patients with acute kidney injury: a scoping review.Critical care (London, England) · 2025Article
- Article
25 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionCefepime, a broad spectrum antibiotic, is commonly prescribed in intensive care units (ICU) and may be an overlooked cause of neurologic symptoms such as encephalopathy, myoclonus, seizures, and coma. We aimed to characterize cefepime neurotoxicity in the ICU.
methodsWe performed a retrospective study of adult ICU patients treated with intravenous cefepime for at least 3 days between January 1, 2009 and December 31, 2011. The primary outcome was the development of cefepime neurotoxicity, with the likelihood of causality ascribed via a modified Delphi method.
resultsThis study included 100 patients. The mean age was 65.8 years (± 12.7 years). The median daily average dose of cefepime was 2.5 (IQR 2.0 to 3.5) grams. The median treatment duration was 6 (IQR 4 to 10) days. Renal failure in any form was present in 84 patients. Chronic kidney disease affected 40 patients, and 77 had acute kidney injury. Cefepime neurotoxicity occurred in 15 patients. Of these, seven were considered definite cases, three probable, and five possible. Neurotoxic symptoms included impaired consciousness (n = 13), myoclonus (n = 11), disorientation (n = 6), and nonconvulsive status epilepticus (n = 1). The dose of cefepime was appropriately adjusted for renal clearance in 64 patients (75.3%) without cefepime neurotoxicity and four patients (28.6%) with neurotoxicity (P = 0.001). Chronic kidney disease was present in 30 patients (35.3%) without neurotoxicity and in 10 (66.7%) of those with neurotoxicity (P = 0.04).
conclusionsCritically ill patients with chronic kidney disease are particularly susceptible to cefepime neurotoxicity. Myoclonus and impaired consciousness are the predominant clinical manifestations. Neurotoxic symptoms occur more often when the cefepime dose is not adjusted for renal function, but can still occur despite those modifications.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.