Ceftazidime/avibactam neurotoxicity in an adult patient with normal renal function

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To date, ceftazidime-avibactam (CAZ-AVI) neurotoxicity in patients with normal renal function has not been reported in the literature, and no data about its penetration into the CNS through the blood-brain barrier are available. We report the occurrence of severe encephalopathy in a patient with normal renal function, after the infusion of CAZ-AVI to treat a Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) sepsis. The radiological and clinical pictures of our patient, and particularly the encephalopathy resolution after drug discontinuation, support the hypothesis of a drug-induced aseptic meningitis (DIAM). The brain MRI-supported meningeal inflammation, along with the increase in blood-CSF-barrier permeability detected on the CSF analysis, could have paved the way for the drug's neurotoxicity by increasing its CNS entering (the CSF CAZ-AVI level in our patient was higher than the highest value reported in a study on children with meningitis). Neurotoxicity of CAZ-AVI and, by analogy, of other cephalosporins should be recognized as a potential adverse effect even in patients with normal renal function, with an increased risk of severe encephalopathy.


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