Unveiling predisposing factors for cefepime-induced neurotoxicity: A systematic review and meta-analysis.

IF 3.1 3区医学 Q2 PHARMACOLOGY & PHARMACY

British journal of clinical pharmacology Pub Date : 2025-06-16 DOI:10.1002/bcp.70120

Harri Hardi, Melva Louisa, Indah Suci Widyahening, Julia Remi Chandra, Liganda Endo Mahata, Vivian Soetikno, Anggi Gayatri, Instiaty Instiaty

{"title":"Unveiling predisposing factors for cefepime-induced neurotoxicity: A systematic review and meta-analysis.","authors":"Harri Hardi, Melva Louisa, Indah Suci Widyahening, Julia Remi Chandra, Liganda Endo Mahata, Vivian Soetikno, Anggi Gayatri, Instiaty Instiaty","doi":"10.1002/bcp.70120","DOIUrl":null,"url":null,"abstract":"Aims: The aim of this study was to elucidate the risk factors associated with the development of cefepime-induced neurotoxicity (CIN).Methods: This systematic review utilized keywords \"cefepime\" and \"neurotoxicity\", sourced from PubMed, Scopus, Web of Science and Google Scholar. Meta-analysis was conducted using a random effects model utilizing Mantel-Haenszel and inverse variance analysis for dichotomous and continuous outcomes, respectively.Results: Analysis of 23 articles revealed that estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 is the primary factor in CIN, with an odds ratio of 10.06 (95% confidence interval [CI] = 5.05-20.03, P < 0.0001). Other significant factors include central nervous system (CNS) abnormalities, age, body weight, albumin levels, diabetes mellitus, hypertension, chronic lung disease and inappropriate dosing. Subgroup analysis of continuous cefepime infusion utilization, based on several risk factors, indicated a lower odds ratio in comparison to intermittent infusion. For cefepime therapeutic drug monitoring (TDM) to determine potential CIN cases, the proposed trough concentration (Ctrough) threshold for intermittent infusion is 20 mg/L, while the steady-state concentration (Css) threshold for continuous infusion is 63 mg/L.Conclusions: Numerous risk factors are significantly associated with CIN, with renal impairment being the most significant. Continuous cefepime infusion is a potential strategy to mitigate CIN, in addition to dose adjustment and TDM.","PeriodicalId":9251,"journal":{"name":"British journal of clinical pharmacology","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"British journal of clinical pharmacology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/bcp.70120","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}

引用次数: 0

Abstract

Aims: The aim of this study was to elucidate the risk factors associated with the development of cefepime-induced neurotoxicity (CIN).

Methods: This systematic review utilized keywords "cefepime" and "neurotoxicity", sourced from PubMed, Scopus, Web of Science and Google Scholar. Meta-analysis was conducted using a random effects model utilizing Mantel-Haenszel and inverse variance analysis for dichotomous and continuous outcomes, respectively.

Results: Analysis of 23 articles revealed that estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² is the primary factor in CIN, with an odds ratio of 10.06 (95% confidence interval [CI] = 5.05-20.03, P < 0.0001). Other significant factors include central nervous system (CNS) abnormalities, age, body weight, albumin levels, diabetes mellitus, hypertension, chronic lung disease and inappropriate dosing. Subgroup analysis of continuous cefepime infusion utilization, based on several risk factors, indicated a lower odds ratio in comparison to intermittent infusion. For cefepime therapeutic drug monitoring (TDM) to determine potential CIN cases, the proposed trough concentration (C_trough) threshold for intermittent infusion is 20 mg/L, while the steady-state concentration (C_ss) threshold for continuous infusion is 63 mg/L.

Conclusions: Numerous risk factors are significantly associated with CIN, with renal impairment being the most significant. Continuous cefepime infusion is a potential strategy to mitigate CIN, in addition to dose adjustment and TDM.

查看原文本刊更多论文

揭示头孢吡肟诱导神经毒性的易感因素：一项系统回顾和荟萃分析。

目的：本研究的目的是阐明与头孢吡肟诱导神经毒性（CIN）发展相关的危险因素。方法：本系统综述使用关键词“头孢吡肟”和“神经毒性”，检索自PubMed、Scopus、Web of Science和谷歌Scholar。meta分析采用随机效应模型，分别采用Mantel-Haenszel和反方差分析对二分结局和连续结局进行meta分析。结果：对23篇文献的分析显示，估计肾小球滤过率（eGFR） 2是CIN的主要影响因素，优势比为10.06（95%可信区间[CI] = 5.05-20.03， P谷），间歇输注阈值为20 mg/L，持续输注的稳态浓度（Css）阈值为63 mg/L。结论：许多危险因素与CIN显著相关，其中肾功能损害最为显著。除了调整剂量和TDM外，持续输注头孢吡肟是缓解CIN的潜在策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

British journal of clinical pharmacology 医学-药学

CiteScore

6.30

自引率

8.80%

发文量

419

审稿时长

1 months

期刊介绍： Published on behalf of the British Pharmacological Society, the British Journal of Clinical Pharmacology features papers and reports on all aspects of drug action in humans: review articles, mini review articles, original papers, commentaries, editorials and letters. The Journal enjoys a wide readership, bridging the gap between the medical profession, clinical research and the pharmaceutical industry. It also publishes research on new methods, new drugs and new approaches to treatment. The Journal is recognised as one of the leading publications in its field. It is online only, publishes open access research through its OnlineOpen programme and is published monthly.