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Ceftazidime-related neurotoxicity in a patient with renal impairment: a case report and literature review

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Abstract

Purpose

We present the case of a 67-year-old woman with severely reduced renal clearance suffering from ceftazidime-induced encephalopathy. Subsequently, we search the literature to review and describe the neurotoxicity of ceftazidime.

Methods

A search string was developed to search PubMed for relevant cases from which relevant information was extracted. Using the collected data a ROC analysis was performed in R to determine a neurotoxicity threshold.

Results

Our patient suffered from progressive loss of consciousness and myoclonic seizures, with improvements noted a few days after discontinuation of treatment. The dose was not appropriately reduced to take into account her reduced renal function. The highest ceftazidime concentration recorded was 234.9 mg/mL. Using the Naranjo score we found a probable relationship between our patient’s encephalopathy and ceftazidime administration. In the literature we found a total of 32 similar cases, most of which also had some form of renal impairment. Using our collected data and ceftazidime concentrations provided in the literature, a ROC analysis provided a neurotoxicity threshold of 78 mg/L for ceftazidime neurotoxicity.

Conclusion

Ceftazidime-related neurotoxicity is a known issue, especially in patients with severe renal impairment. Yet no concrete toxicity threshold has been reported so far. We propose the first toxicity threshold for ceftazidime of 78 mg/L. Future prospective studies are needed to validate and optimize the neurotoxicity threshold as upper limit for ceftazidime therapeutic drug monitoring.

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Data availability

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical reasons.

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000, Louvain, Belgium

    Dorian Vanneste, Matthias Gijsen & Isabel Spriet

  2. Pharmacy Department, UZ Leuven, 3000, Louvain, Belgium

    Matthias Gijsen & Isabel Spriet

  3. Haematology Unit, UZ Leuven, 3000, Louvain, Belgium

    Johan Maertens

  4. Laboratory for Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000, Louvain, Belgium

    Johan Maertens

  5. Neurology Department, UZ Leuven, 3000, Louvain, Belgium

    Wim Van Paesschen

  6. Laboratory for Epilepsy Research, Department of Neurosciences, KU Leuven, 3000, Louvain, Belgium

    Wim Van Paesschen

  7. Intensive Care Unit, UZ Leuven, 3000, Louvain, Belgium

    Yves Debaveye

  8. Laboratory for Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, 3000, Louvain, Belgium

    Yves Debaveye

  9. Medical Intensive Care Unit, UZ Leuven, 3000, Louvain, Belgium

    Joost Wauters

  10. Laboratory for Clinical Infectious and Inflammatory Diseases, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000, Louvain, Belgium

    Joost Wauters

Authors
  1. Dorian Vanneste
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  2. Matthias Gijsen
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  7. Isabel Spriet
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Contributions

Conceptualization: DV, MG, IS; methodology: DV, MG; data curation: DV, MG, IS; writing—original draft preparation: DV, MG, IS; writing—review and editing: DV, MG, JM, WP, YD, JW, IS. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Dorian Vanneste.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical approval

Approval was obtained from the ethics committee of KU Leuven (S68320). The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from the patient in accordance with the local ethics committee policy.

Supplementary Information

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Supplementary file1 (DOCX 34 KB)

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Vanneste, D., Gijsen, M., Maertens, J. et al. Ceftazidime-related neurotoxicity in a patient with renal impairment: a case report and literature review. Infection 52, 1113–1123 (2024). https://doi.org/10.1007/s15010-023-02167-9

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  • DOI: https://doi.org/10.1007/s15010-023-02167-9

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