Perfil da encefalopatia pela cefepima em hospital terciário: padrão sócio-clínico e correlação eletroencefalográfica

Abstract

The Cefepime is an antibiotic widely used in intra-hospital environment in the course of severe infections. However, its use can be associated with encephalopathy, which can be presented in a varied clinical way, being the electroencephalogram (EEG) a key tool for its diagnosis. Objective: To establish the socio-clinical pattern of the Cefepime encephalopathy and its electroencephalographic correlation in a tertiary hospital. Material and methods: Fourty one patients who were diagnosed with Cefepime encephalopathy with possible and probable diagnosis according to the criteria established by Naranjo et al. were analyzed. Each patient was studied according to: the socioeconomic profile, indication for using Cefepime, onset of symptons, clinical manifestations presented, renal function and eletroencefalographic findings, as well as the clinical outcome and the correlation betwenn these variables. Results: The Cefepime was clinically indicated for the treatment of pneumonia (65.9%), followed by urinary tract infection (12.2%), febrile neutropenia (9.8%), intra-abdominal infection (2.4%), soft tissue infection (4.8%), bloodstream infection (4.8%). The average time to onset of symptoms was 5.34 ± 2.86 days and was clinically noted: decreased level of consciousness in 80.5% of patients, epileptic manifestations in 12.2% of patients and symptoms of agitation in 7.3% of patients, with no correlation between the indication of Cefepime and the patient's clinic. The average dose of Cefepime was 4.14 ± 1.81 and a rate of 36.6% of patients was found with an uncorrected dose according to renal function. All Cephalopathy encephalopathy tracings had the presence of generalized periodic discharges (GPD), with 70.7% of this exams with criteria for non-convulsive status epilepticus. It was found that with the discontinuation of the Cefepima, 85.3% of the patients achieved clinical improvement, in what 48.8% had a favorable outcome and 36.5% had an unfavorable outcome progressing to death. Conclusion: This study showed that encephalopathy by Cephepime is a clinical manifestation that should be considered among patients in use of this antibiotic. It is presented under a broad spectrum of manifestation, being the EEG an indispensible tool for diagnosis. Its identification and treatment have a positive impact on the clinical outcome of patients.