Cefoxitin-Serum Creatinine Interference in a Patient With Nontuberculous Mycobacteria Ventriculomeningitis. (August 2021)

• Record Type: Journal Article
• Authors: Wang, Dan; Emanuel, Anthony J.; Neyens, Ron R.; Bakharev, Eugene; Babic, Nikolina
• Is Part Of: Journal of pharmacy practice. Volume 34:Number 4(2021)
• Page Start: 658
• Page End: 661
• Publication Date: 2021-08
• Subjects: creatinine -- Jaffe reaction -- enzymatic reaction -- cefoxitin -- preanalytical error; Pharmacy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1177/0897190020921613
• Languages: English
• ISSNs: 0897-1900

Abstract

Cefoxitin is a second-generation cephamycin antibiotic, which at concentrations ≥100 µg/mL is known to modestly interfere, for up to 2 hours post-infusion, with serum creatinine measurement via the traditional Jaffe-based assay. We report a case of a severe serum creatinine elevation while utilizing cefoxitin as a component of an antimicrobial regimen in a critically ill patient with Mycobacterium abscessus ventriculomeningitis. Our results, both via patient serum analysis and a cefoxitin spiking experiment, demonstrate interference despite the utilization of improved modern Jaffe-based assays. In fact, the cefoxitin-creatinine interference may be clinically relevant at concentrations 3 times lower than that listed in the package insert and may display more than a modest interference at typical therapeutic concentrations.