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Cefepime is Associated with Acute Encephalopathy in Critically Ill Patients: A Retrospective Case–Control Study

BACKGROUND: Acute encephalopathy (AE) is a common complication of critical illness and is associated with increased short and long-term mortality. In this study, we evaluated the role of cefepime in causing AE. METHODS: Retrospective case–control study involving consecutive patients enrolled in the...

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Autores principales: Singh, Tarun D., O’Horo, John C., Day, Courtney N., Mandrekar, Jay, Rabinstein, Alejandro A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329265/
https://www.ncbi.nlm.nih.gov/pubmed/32613426
http://dx.doi.org/10.1007/s12028-020-01035-w
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author Singh, Tarun D.
O’Horo, John C.
Day, Courtney N.
Mandrekar, Jay
Rabinstein, Alejandro A.
author_facet Singh, Tarun D.
O’Horo, John C.
Day, Courtney N.
Mandrekar, Jay
Rabinstein, Alejandro A.
author_sort Singh, Tarun D.
collection PubMed
description BACKGROUND: Acute encephalopathy (AE) is a common complication of critical illness and is associated with increased short and long-term mortality. In this study, we evaluated the role of cefepime in causing AE. METHODS: Retrospective case–control study involving consecutive patients enrolled in the intensive care units (ICUs) of Mayo Clinic Rochester, MN between July 1, 2004 and December 31, 2015. AE was defined by the presence of delirium or depressed level of consciousness in the absence of deep sedation. Controls were identified as patients not developing AE and were matched by propensity score for age, Charlson Comorbidity Index, 24-h Apache III score and invasive ventilation use. RESULTS: The total number of eligible ICU admissions during our study period was 152,999. AE was present in 57,726 (37.7%) with a median AE duration of 17 (interquartile range [IQR] 4.0–51.8) hours. We matched 14,645 cases with AE with the same number of controls. Cefepime was used in 1241 (4.2%) patients and its use was associated with greater incidence of AE [713 (4.9%) vs 528 (3.6%), p < 0.001] and duration [unit estimate 0.73; (95% CI 0.542–0.918)]. On multivariate analysis, cefepime was associated with an increased likelihood of AE after controlling for shock, midazolam infusion and acute kidney injury [OR 1.24 (95% CI 1.10–1.27)]. These associations were also present after controlling for prior chronic kidney disease. CONCLUSION: The use of cefepime is associated with increased likelihood and duration of AE. These associations are stronger among patients with impaired renal function, but can also occur in patients without renal impairment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12028-020-01035-w) contains supplementary material, which is available to authorized users.
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spelling pubmed-73292652020-07-02 Cefepime is Associated with Acute Encephalopathy in Critically Ill Patients: A Retrospective Case–Control Study Singh, Tarun D. O’Horo, John C. Day, Courtney N. Mandrekar, Jay Rabinstein, Alejandro A. Neurocrit Care Original Work BACKGROUND: Acute encephalopathy (AE) is a common complication of critical illness and is associated with increased short and long-term mortality. In this study, we evaluated the role of cefepime in causing AE. METHODS: Retrospective case–control study involving consecutive patients enrolled in the intensive care units (ICUs) of Mayo Clinic Rochester, MN between July 1, 2004 and December 31, 2015. AE was defined by the presence of delirium or depressed level of consciousness in the absence of deep sedation. Controls were identified as patients not developing AE and were matched by propensity score for age, Charlson Comorbidity Index, 24-h Apache III score and invasive ventilation use. RESULTS: The total number of eligible ICU admissions during our study period was 152,999. AE was present in 57,726 (37.7%) with a median AE duration of 17 (interquartile range [IQR] 4.0–51.8) hours. We matched 14,645 cases with AE with the same number of controls. Cefepime was used in 1241 (4.2%) patients and its use was associated with greater incidence of AE [713 (4.9%) vs 528 (3.6%), p < 0.001] and duration [unit estimate 0.73; (95% CI 0.542–0.918)]. On multivariate analysis, cefepime was associated with an increased likelihood of AE after controlling for shock, midazolam infusion and acute kidney injury [OR 1.24 (95% CI 1.10–1.27)]. These associations were also present after controlling for prior chronic kidney disease. CONCLUSION: The use of cefepime is associated with increased likelihood and duration of AE. These associations are stronger among patients with impaired renal function, but can also occur in patients without renal impairment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12028-020-01035-w) contains supplementary material, which is available to authorized users. Springer US 2020-07-01 2020 /pmc/articles/PMC7329265/ /pubmed/32613426 http://dx.doi.org/10.1007/s12028-020-01035-w Text en © Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Work
Singh, Tarun D.
O’Horo, John C.
Day, Courtney N.
Mandrekar, Jay
Rabinstein, Alejandro A.
Cefepime is Associated with Acute Encephalopathy in Critically Ill Patients: A Retrospective Case–Control Study
title Cefepime is Associated with Acute Encephalopathy in Critically Ill Patients: A Retrospective Case–Control Study
title_full Cefepime is Associated with Acute Encephalopathy in Critically Ill Patients: A Retrospective Case–Control Study
title_fullStr Cefepime is Associated with Acute Encephalopathy in Critically Ill Patients: A Retrospective Case–Control Study
title_full_unstemmed Cefepime is Associated with Acute Encephalopathy in Critically Ill Patients: A Retrospective Case–Control Study
title_short Cefepime is Associated with Acute Encephalopathy in Critically Ill Patients: A Retrospective Case–Control Study
title_sort cefepime is associated with acute encephalopathy in critically ill patients: a retrospective case–control study
topic Original Work
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329265/
https://www.ncbi.nlm.nih.gov/pubmed/32613426
http://dx.doi.org/10.1007/s12028-020-01035-w
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