当前位置:
X-MOL 学术
›
Clin. Microbiol. Infect.
›
论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Cefepime neurotoxicity: thresholds and risk factors. A retrospective cohort study.
Clinical Microbiology and Infection ( IF 14.2 ) Pub Date : 2019-07-05 , DOI: 10.1016/j.cmi.2019.06.028 L Boschung-Pasquier 1 , A Atkinson 2 , L K Kastner 3 , S Banholzer 3 , M Haschke 3 , N Buetti 4 , D I Furrer 5 , C Hauser 2 , P Jent 2 , Y A Que 6 , H Furrer 2 , B Babouee Flury 2
Clinical Microbiology and Infection ( IF 14.2 ) Pub Date : 2019-07-05 , DOI: 10.1016/j.cmi.2019.06.028 L Boschung-Pasquier 1 , A Atkinson 2 , L K Kastner 3 , S Banholzer 3 , M Haschke 3 , N Buetti 4 , D I Furrer 5 , C Hauser 2 , P Jent 2 , Y A Que 6 , H Furrer 2 , B Babouee Flury 2
Affiliation
OBJECTIVES
Toxic serum cefepime trough concentrations are not well defined in the current literature. We aimed to define a more precise plasma trough concentration threshold for this antibiotic's neurological toxicity and to identify individuals at risk for developing neurotoxic side effects.
METHODS
Retrospective study including all individuals who underwent cefepime therapeutic drug monitoring (TDM) between 2013 and 2017. Individuals with cefepime concentrations other than trough were excluded. The primary outcome was to assess the incidence of neurotoxicity and its relationship with cefepime plasma trough concentrations. Secondary outcomes were the relationship of renal function, cefepime daily dose, age, and cerebral and general co-morbidities with the occurrence of neurotoxicity. We also compared the mortality rate during hospitalization in individuals with and without neurotoxicity, and the possible impact of neuroprotective co-medications on outcomes.
RESULTS
Cefepime concentrations were determined in 584 individuals. Among 319 individuals with available trough concentrations included, the overall incidence of neurotoxicity was 23.2% (74 of 319 individuals). Higher cefepime plasma trough concentrations were significantly associated with risk of neurotoxicity (no neurotoxicity 6.3 mg/L (interquartile range (IQR) 4.1-8.6) versus with neurotoxicity 21.6 mg/L (IQR 17.0-28.6), p <0.001). Individuals with presumed cefepime neurotoxicity had a significantly lower renal function (estimated glomerular filtration rate 82.0 mL/min/1.73 m2 (IQR 45.0-105.0) versus 35.0 mL/min/1.73 m2 (IQR 23.3-53.3], p <0.001), and significantly higher in-hospital mortality (19 (7.8%) versus 26 (35.1%) individuals, p <0.001). No neurotoxic side effects were seen below a trough concentration of 7.7 mg/L. Levels ≥38.1 mg/L always led to neurological side effects.
CONCLUSION
In individuals with risk factors for cefepime neurotoxicity, such as renal insufficiency, TDM should be systematically performed, aiming at trough concentrations <7.5 mg/L.
中文翻译:
头孢吡肟神经毒性:阈值和危险因素。回顾性队列研究。
目的在当前文献中对有毒的血清头孢吡肟谷浓度尚未明确定义。我们旨在为这种抗生素的神经毒性定义一个更精确的血浆谷浓度阈值,并确定有发展神经毒性副作用风险的个体。方法回顾性研究包括2013年至2017年接受头孢吡肟治疗药物监测(TDM)的所有个体。头孢吡肟浓度除谷以外的个体均排除在外。主要结果是评估神经毒性的发生率及其与头孢吡肟血浆谷浓度的关系。次要结果是肾功能,头孢吡肟每日剂量,年龄,脑和一般合并症与神经毒性发生的关系。我们还比较了有或没有神经毒性的个体住院期间的死亡率,以及神经保护性联合用药对结局的可能影响。结果测定了584名患者的头孢吡肟浓度。在包括可用谷浓度的319个个体中,神经毒性的总发生率为23.2%(319个个体中的74个)。较高的头孢吡肟血浆谷浓度与神经毒性风险显着相关(无神经毒性6.3 mg / L(四分位间距(IQR)4.1-8.6),而神经毒性则为21.6 mg / L(IQR 17.0-28.6),p <0.001)。假定具有头孢吡肟神经毒性的个体的肾功能显着降低(肾小球滤过率估计为82.0 mL / min / 1.73 m2(IQR 45.0-105.0)与35.0 mL / min / 1.73 m2(IQR 23.3-53.3],p <0.001),且院内死亡率显着更高(19人(7.8%)比26人(35.1%),p <0.001)。谷浓度低于7.7 mg / L时未见神经毒性副作用。≥38.1mg / L的水平总是会导致神经系统的副作用。结论对于具有头孢吡肟神经毒性危险因素(例如肾功能不全)的个体,应系统性地进行TDM,其谷浓度<7.5 mg / L。
更新日期:2020-02-21
中文翻译:
头孢吡肟神经毒性:阈值和危险因素。回顾性队列研究。
目的在当前文献中对有毒的血清头孢吡肟谷浓度尚未明确定义。我们旨在为这种抗生素的神经毒性定义一个更精确的血浆谷浓度阈值,并确定有发展神经毒性副作用风险的个体。方法回顾性研究包括2013年至2017年接受头孢吡肟治疗药物监测(TDM)的所有个体。头孢吡肟浓度除谷以外的个体均排除在外。主要结果是评估神经毒性的发生率及其与头孢吡肟血浆谷浓度的关系。次要结果是肾功能,头孢吡肟每日剂量,年龄,脑和一般合并症与神经毒性发生的关系。我们还比较了有或没有神经毒性的个体住院期间的死亡率,以及神经保护性联合用药对结局的可能影响。结果测定了584名患者的头孢吡肟浓度。在包括可用谷浓度的319个个体中,神经毒性的总发生率为23.2%(319个个体中的74个)。较高的头孢吡肟血浆谷浓度与神经毒性风险显着相关(无神经毒性6.3 mg / L(四分位间距(IQR)4.1-8.6),而神经毒性则为21.6 mg / L(IQR 17.0-28.6),p <0.001)。假定具有头孢吡肟神经毒性的个体的肾功能显着降低(肾小球滤过率估计为82.0 mL / min / 1.73 m2(IQR 45.0-105.0)与35.0 mL / min / 1.73 m2(IQR 23.3-53.3],p <0.001),且院内死亡率显着更高(19人(7.8%)比26人(35.1%),p <0.001)。谷浓度低于7.7 mg / L时未见神经毒性副作用。≥38.1mg / L的水平总是会导致神经系统的副作用。结论对于具有头孢吡肟神经毒性危险因素(例如肾功能不全)的个体,应系统性地进行TDM,其谷浓度<7.5 mg / L。