Antibiotic-associated Encephalopathy Research Articles

Drugs with a negative impact on cognitive functions (part 3): antibacterial agents in patients with chronic kidney disease.

The relationship between chronic kidney disease (CKD) and cognitive function has received increased attention in recent years. Antibacterial agents (ABs) represent a critical component of therapy regimens in patients with CKD due to increased susceptibility to infections. Following our reviewing work on the neurocognitive impact of long-term medications in patients with CKD, we propose to focus on AB-induced direct and indirect consequences on cognitive function. Patients with CKD are predisposed to adverse drug reactions (ADRs) due to altered drug pharmacokinetics, glomerular filtration decline, and the potential disruption of the blood-brain barrier. ABs have been identified as a major cause of ADRs in vulnerable patient populations. This review examines the direct neurotoxic effects of AB classes (e.g. beta-lactams, fluoroquinolones, aminoglycosides, and metronidazole) on the central nervous system (CNS) in patients with CKD. We will mainly focus on the acute effects on the CNS associated with AB since they are the most extensively studied effects in CKD patients. Moreover, the review describes the modulation of the gut microbiota by ABs, potentially influencing CNS symptoms. The intricate brain-gut-kidney axis emerges as a pivotal focus, revealing the interplay between microbiota alterations induced by ABs and CNS manifestations in patients with CKD. The prevalence of antibiotic-associated encephalopathy in patients with CKD undergoing intravenous AB therapy supports the use of therapeutic drug monitoring for ABs to reduce the number and seriousness of ADRs in this patient population. In conclusion, elucidating AB-induced cognitive effects in patients with CKD demands a comprehensive understanding and tailored therapeutic strategies that account for altered pharmacokinetics and the brain-gut-kidney axis.

The incidence and predictors of antibiotic-associated encephalopathy: a multicenter hospital-based study

This study aimed to evaluate the incidence and likelihood of antibiotic-associated encephalopathy (AAE), comparing rates among the classes of antibiotics in monotherapy or in combination therapy. We also investigated the associations between the incidence of AAE and the glomerular filtration rate (GFR) and electroencephalogram features. Consecutive admissions that used any kind of antibiotics to treat infectious diseases were identified from six hospitals. We classified antibiotics according to three distinct pathophysiologic mechanisms and clinical subtypes. We searched for the incidence of AAE as the primary outcome. A total of 97,433 admission cases among 56,038 patients was identified. Cases that received type 1 antibiotics had significantly more frequent AAE compared to those that received type 2 antibiotics (adjusted odds ratio [OR], 2.62; 95% confidence interval [CI] 1.15–5.95; P = 0.021). Combined use of type 1 + 2 antibiotics was associated with a significantly higher incidence of AAE compared to the use of type 2 antibiotics alone (adjusted OR, 3.44; 95% CI 1.49–7.93; P = 0.004). Groups with GFR < 60 mL/min/1.73 m2 had significantly higher incidence rates of AAE compared to those with GFRs ≥ 90 mL/min/1.73 m2 among cases that received type 1 + 2 antibiotics. Detection of spike-and-wave or sharp-and-wave patterns on electroencephalogram was significantly more common in the combination therapy group. Combination use of antibiotics was associated with a higher incidence of AAE compared to monotherapy. The incidence of AAE significantly increased as renal function decreased, and epileptiform discharges were more likely to be detected in cases receiving combined antibiotics.

1-Minute Pearls/Pitfalls for the Clinician

Antibiotic-associated encephalopathy and heparin resistance are sometimes seen in hospitalized patients. This article describes some pearls/pitfalls pertinent to these conditions.

Cephalosporin-induced antibiotic-associated encephalopathy during treatment of peritonitis in a peritoneal dialysis patient

Cephalosporin-induced antibiotic-associated encephalopathy during treatment of peritonitis in a peritoneal dialysis patient

Retrospective case–control study on screening risk factors of antibiotic-associated encephalopathy in patients with chronic kidney disease

ObjectiveThe renal excretion function of patients with chronic kidney disease (CKD) is reduced, and the nervous system toxic reactions of antibiotics are prone to occur. The purpose of this study...

Clinical characteristics and outcomes of antibiotic-associated encephalopathy in patients with end-stage kidney disease

Objective End-stage kidney disease (ESKD) patients have a higher risk of antibiotic-associated encephalopathy (AAE) than other patients. We aimed to evaluate the prevalence, risk factors and outcomes of AAE in ESKD patients. Method A retrospective study of ESKD patients treated with intravenous antibiotics in our hospital from Jan. 1, 2006, to Dec. 31, 2015 was performed. AAE was diagnosed by the modified Delphi method. Control individuals were randomly selected from the remaining patients who did not exhibit neurologic symptoms. Logistic regression analysis was used to identify risk factors for AAE as well as the association between AAE and outcome. Result A total of 2104 patients were included in the study. The prevalence of AAE in our study was 4.4% (92/2104). The multivariate logistic regression analysis revealed that anuria (OR = 8.04, 95% CI: 4.13–15.65, p < 0.001), history of central nervous system disorder (OR = 3.03, 95% CI: 1.21–7.56, p = 0.018) and hypoalbuminemia (OR= 1.87, 95% CI: 1.01–3.47, p = 0.046) were independent factors associated with AAE in ESKD patients. After adjustment for confounders, AAE was associated with composite outcomes of in-hospital mortality and treatment withdrawal (OR = 4.36, 95% CI: 2.09–9.10, p < 0.001). Conclusion The prevalence of AAE was 4.4% in ESKD patients and varied among different antibiotics. Anuria, history of central nervous system disorder and hypoalbuminemia were associated with AAE in ESKD patients. AAE is associated with worse outcomes in ESKD patients.

Responses to antibiotics in human iPSC-derived neurons based on the clinical antibiotic-associated encephalopathy classification.

Antibiotic-associated encephalopathy (AAE) is a central nervous system disorder caused by antibiotics administration and classified into three types based on clinical symptoms. Type 1 AAE causes seizures and myoclonus, type 2 causes psychiatric symptoms, and type 3 is characterized by cerebellar ataxia. In this study, we investigated whether the electrical activity of in vitro human iPSC-derived neurons to antibiotics could be classified based on the 3 types of AAEs classified by clinical symptoms. Glutamatergic, GABAergic neurons and astrocytes differentiated from human iPS cells were seeded on micro-electrode array (MEA). The cumulative administration of 13 different antimicrobials detected changes in neural activity that differed according to AAE type. Next, we classified the antimicrobials by principal component analysis (PCA) and confirmed the AAE type of each agent. We found that Types 1-3 AAE agents were distributed separately. The classification of antibiotics depending on electrophysiological response characteristics was consistent with the clinical practice classification of AAEs. In conclusion, the combination of electrophysiological responses of human iPS cell-derived neural networks measured by MEA plus multivariate analysis methods will effectively detect and classify antibiotics developmental risks.

Pharmaceutical care of a patient with antibiotic-associated encephalopathy

Pharmaceutical care of a patient with antibiotic-associated encephalopathy

Psychotic disorders in COVID-19: mechanisms of development, clinical and treatment features

The purpose of this review was to study the mechanisms of development, clinical features and treatment of psychotic disorders during the disease caused by the SARS-CoV-2 virus. In the first part of the review, especial attention was paid to the available literature data on the mechanisms of development of mental disorders in COVID-19. Among the main pathogenetic mechanisms of the onset of psychotic disorders in coronavirus infections, there are direct effects of a viral infection (including a brain infection), cerebrovascular diseases, hypoxia, an immunological response, the consequences of medical interventions, social isolation, the psychological impact of a severe and potentially fatal illness, fears of infecting another’s and stigmatization. The second part of the publication is devoted to a review of clinical studies and syndromokinesis in infectious and coronavirus psychoses. Particular attention is paid to delirious syndrome, including pharmacogenic delirium and antibiotic-associated encephalopathy. The article describes the features of therapy for psychotic disorders in COVID-19, taking into account drug‑drug interactions and the effect on the cardiovascular and respiratory systems. The analyzed literature allows us to make a reasonable conclusion that the management of coronavirus psychoses should be aimed at treating the underlying disease while eliminating psychotic symptoms with antipsychotics while ensuring maximum safety of psychopharmacotherapy.

Ceftaroline-associated Encephalopathy in Patients With Severe Renal Impairment.

Encephalopathy complicates beta-lactam therapy, particularly with impaired renal function, though no studies have reported ceftaroline-associated encephalopathy. Among 28 patients with estimated glomerular filtration rates <30 mL/min who received ≥5 days of ceftaroline, 3 developed encephalopathy. Ceftaroline, when dosed supra-therapeutically for serious infections, may be a cause of antibiotic-associated encephalopathy.

Orthostatic myoclonus associated with Caspr2 antibodies.

Editors' Note: Critiquing “Orthostatic myoclonus associated with Caspr2 antibodies,” van Gerpen et al. disagree with the diagnosis of orthostatic myoclonus (OM), which, according to their experience, clinically manifests as low-amplitude, tremulous movements, restricted to the legs during standing; appears as semirhythmic bursts lasting less than 50 milliseconds on surface EMG; and lacks prominent action myoclonus in the legs. Govert et al., authors of the case report, defend their diagnosis and explain that OM can be present in the arms and can have subtle action myoclonus. In reference to “Antibiotic-associated encephalopathy,” Dr. Stip argues that there is no clear evidence to link macrolides to altered dopamine levels or NMDA receptor activity and that macrolides have poor CSF …

Antibiotic-associated encephalopathy.

Bhattacharyya et al. described a type II antibiotic-associated encephalopathy (AAE) where macrolides, among others, were involved.1 The authors suggested that “type 2 AAE closely resemble[d] drug-induced psychotic syndromes caused by perturbations of the D2 dopamine and NMDA glutamate receptors.”1 Where was the evidence of such a mechanism found? Additionally, penetration of clarithromycin into the CSF and brain tissue of a healthy animal is relatively low or absent. It is only when …

Antibiotic-associated encephalopathy.

In the Views & Reviews article “Antibiotic-associated encephalopathy” by S. Bhattacharyya et al. …

Nursing for renal insufficiency paitents with antibiotic-associated encephalopathy by hemodialysis

目的 探讨血液透析治疗肾功能不全患者抗生素相关性脑病的观察与护理要点.方法 收集5例应用抗生素引起脑病的肾功能不全患者,对维持性血液透析患者加强血液透析治疗,未透析患者予以血液透析治疗,透析过程中做好精心的护理.结果 5例患者意识状态均恢复正常、神经系统症状消失,1例停止血液透析,4例过度到维持性血液透析.结论 血液透析对治疗抗生素相关性脑病效果良好,而精心的护理可以使患者早日康复。