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Cefepime-induced neurotoxicity: a systematic review

Overview of attention for article published in Critical Care, November 2017
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  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (97th percentile)
  • High Attention Score compared to outputs of the same age and source (92nd percentile)

Mentioned by

1 news outlet
2 blogs
148 tweeters
7 Facebook pages


102 Dimensions

Readers on

205 Mendeley
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Cefepime-induced neurotoxicity: a systematic review
Published in
Critical Care, November 2017
DOI 10.1186/s13054-017-1856-1
Pubmed ID

Lauren E. Payne, David J. Gagnon, Richard R. Riker, David B. Seder, Elizabeth K. Glisic, Jane G. Morris, Gilles L. Fraser


Cefepime is a widely used antibiotic with neurotoxicity attributed to its ability to cross the blood-brain barrier and exhibit concentration-dependent ϒ-aminobutyric acid (GABA) antagonism. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, myoclonus, seizures, and coma. Data suggest that up to 15% of ICU patients treated with cefepime may experience these adverse effects. Risk factors include renal dysfunction, excessive dosing, preexisting brain injury, and elevated serum cefepime concentrations. We aimed to characterize the clinical course of cefepime neurotoxicity and response to interventions. A librarian-assisted search identified publications describing cefepime-associated neurotoxicity from January 1980 to February 2016 using the CINAHL and MEDLINE databases. Search terms included cefepime, neurotoxicity, encephalopathy, seizures, delirium, coma, non-convulsive status epilepticus, myoclonus, confusion, aphasia, agitation, and death. Two reviewers independently assessed identified articles for eligibility and used the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) for data reporting. Of the 123 citations identified, 37 (representing 135 patient cases) were included. Patients had a median age of 69 years, commonly had renal dysfunction (80%) and required intensive care (81% of patients with a reported location). All patients exhibited altered mental status, with reduced consciousness (47%), myoclonus (42%), and confusion (42%) being the most common symptoms. All 98 patients (73% of cohort) with electroencephalography had abnormalities, including non-convulsive status epilepticus (25%), myoclonic status epilepticus (7%), triphasic waves (40%), and focal sharp waves (39%). As per Food and Drug Administration (FDA)-approved dosing guidance, 48% of patients were overdosed; however, 26% experienced neurotoxicity despite appropriate dosing. Median cefepime serum and cerebrospinal fluid (CSF) concentrations were 45 mg/L (n = 21) and 13 mg/L (n = 4), respectively. Symptom improvement occurred in 89% of patients, and 87% survived to hospital discharge. The median delay from starting the drug to symptom onset was 4 days, and resolution occurred a median of 2 days after the intervention, which included cefepime discontinuation, antiepileptic administration, or hemodialysis. Cefepime-induced neurotoxicity is challenging to recognize in the critically ill due to widely varying symptoms that are common in ICU patients. This adverse reaction can occur despite appropriate dosing, usually resolves with drug interruption, but may require additional interventions such as antiepileptic drug administration or dialysis.

Twitter Demographics

The data shown below were collected from the profiles of 148 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 205 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 205 100%

Demographic breakdown

Readers by professional status Count As %
Other 42 20%
Researcher 36 18%
Student > Master 17 8%
Student > Postgraduate 16 8%
Student > Doctoral Student 14 7%
Other 46 22%
Unknown 34 17%
Readers by discipline Count As %
Medicine and Dentistry 80 39%
Pharmacology, Toxicology and Pharmaceutical Science 32 16%
Biochemistry, Genetics and Molecular Biology 9 4%
Neuroscience 9 4%
Nursing and Health Professions 8 4%
Other 20 10%
Unknown 47 23%

Attention Score in Context

This research output has an Altmetric Attention Score of 108. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 16 September 2021.
All research outputs
of 18,958,811 outputs
Outputs from Critical Care
of 5,538 outputs
Outputs of similar age
of 329,319 outputs
Outputs of similar age from Critical Care
of 215 outputs
Altmetric has tracked 18,958,811 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,538 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 17.3. This one has done particularly well, scoring higher than 97% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 329,319 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 97% of its contemporaries.
We're also able to compare this research output to 215 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 92% of its contemporaries.