Clinical analysis of antibacterial-associated encephalopathy in patients with chronic kidney disease

Abstract

Objective To explore the occurrence and clinical characteristics of antibacterial-associated encephalopathy (AAE) in patients with chronic kidney disease (CKD). Methods The electronic medical records of patients with CKD stages 3-5 and treated with antibacterials for more than 2 days during hospitalization in Xiangya Hospital of Central South University from January 1 to December 31, 2016 were collected. The patients who were with neuropsychiatric symptoms or diagnosed as encephalopathy after anti-bacterials treatments were screened out and scored by clinicians and pharmacists using Naranjo evaluation method. The patients with scores of ≥ 4 were judged as AAE. The AAE patients′ basic information, basic disease information, application of antibacterials, and AAE related information were extracted and analyzed descriptively. Results A total of 977 (40.07%) of 2 438 inpatients with CKD stages 3-5 were treated with antibacterials. Thirty-three patients (3.38%) were judged to have AAE by comprehensive evaluation. Among 33 patients with AAE, 15 patients were male and 18 were female, with age of 68 (56, 78) years (ranging from 27 to 88 years); 2 patients were with CKD stage 3b, 6 patients with stage 4, and 25 patients with stage 5; 21 patients underwent dialysis; their serum creatinine was (492±265) μmol/L, blood urea nitrogen was (16.9±10.7) mmol/L, and estimated glomerular filtration rate (eGFR) was 10.4 (7.0, 14.9) ml/(min·1.73 m2). The anti-bacterials related to AAE were beta-lactams and fluoroquinolones, of which cefepime had the highest incidence of AAE [28.57%(4/14), 95%CI: 1.5-55.6], followed by ceftazidime [14.67%(11/75), 95%CI: 6.5-22.9]. The time from the use of antibacterials to the occurrence of AAE was (6±3) days. The main clinical manifestations of AAE were delirium and mania (45.45%, 15/33), involuntary movement of limbs and epilepsy (18.18%, 6/33 for both), apathy (15.15%, 5/33), lethargy (12.12%, 4/33), delusion and hallucination (3.03%, 1/33). Thirty-three patients with AAE were treated with discontinuation or replacement of antibacterials, intensive dialysis, hemofiltration, and symptomatic treatments. By the time of discharge, the symptoms in 30 patients (90.9%) disappeared and 3 patients (9.10%) were not cured. Conclusions The patients with CKD were at increased risk for AAE, especially for those treated with beta-lactams. The dosage of antibacterials drugs should be adjusted according to eGFR in CKD patients and monitored during the treatment so as to prevent the occurrence of AAE. Key words: Renal insufficiency, chronic; Anti-bacterial agents; Beta-lactams; Neurotoxicity syndromes; Brain diseases