Comparisons involving subgroups with dichotomous or ordinal variables subgroups were performed with chi-square check or two-sided Fisher��s exact test. For comparisons of steady variables, we employed the Wilcoxon rank sum check. Probability (P) values <0.05 were considered statistically significant. We used JMP 9.0, a SAS-based statistical package (SAS The Real History Around The (+)-Bicuculline Successfulness Institute, Cary, NC, USA), to analyze the data.ResultsA total of 100 patients were included. Mean age was 65.8 years (�� 12.7 years) and 61 were men. The median daily average dose of cefepime was 2.5 grams (IQR 2.0 to 3.5 g). Indications for antibiotic therapy are shown in Table?1. Patients were hospitalized in the medical ICU (n=66), surgical ICU (n=19), trauma ICU (n=9), cardiovascular ICU (n=5), or neuroscience ICU (n=1).
The median acute physiology and continual health and fitness evaluation (APACHE) III score - out there for 93% - was 85 (IQR 71.five to 110.five) The median duration of treatment method was six days (IQR 4 to ten days). Renal failure in any kind was present in 84 sufferers. Continual kidney disorder affected forty individuals, and 77 had acute kidney injury. Thirty-three patients acquired renal replacement treatment through the course of cefepime. Of these, 18 underwent constant veno-venous hemofiltration and 15 have been taken care of with intermittent hemodialysis. The median baseline creatinine with the cohort was 1.0 mg/dL (IQR 0.8 to one.3 mg/dL). The median creatinine on the start of cefepime treatment was one.6 mg/dL (one.0 to two.three mg/dL), median blood urea nitrogen was 41 mg/dL (IQR 26.3 to 62.5 mg/dL) and median eGFR was 34 mL/min/1.73 m2 (IQR 24.three to 59.
5 ml/min/1.73 m2). Electroencephalograms (EEGs) were performed throughout the cefepime course in 17 sufferers of the entire cohort. Findings integrated moderate or extreme generalized slowing in twelve (70.6%), triphasic waves in eight (47.1%), multifocal sharp waves in five (29.4%), burst-suppression in two (eleven.8%), non-reactive alpha in 1 (n=5.8%), and nonconvulsive standing epilepticus (NCSE) in 1 (5.8%).Table 1Indication for cefepime administration in a hundred ICU patientsCefepime neurotoxicity occurred in 15 sufferers. Of those, seven were regarded as definite cases, three probable, and 5 probable. The day by day doses of cefepime had been precisely regarded for 14 cases (93.3%). The dose had been appropriately adjusted according to renal function in four (28.6%) individuals with cefepime neurotoxicity.
Neurologic symptoms started at median day 3 (variety 1 to 7 days) following cefepime initiation and included depressed degree of consciousness (n=13), myoclonus ( n=11), disorientation (n=6), and NCSE (n=1). Myoclonus was predominant while in the facial muscle tissues in six patients and generalized through the entire body in 5 sufferers. When predominant in facial muscle tissues, it normally involved the periocular muscular tissues, and half of patients had concomitant involvement of a single extremity or abdominal muscle tissues.