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目的:探讨慢性肾脏病（CKD）患者抗菌药物相关脑病（AAE）的发生情况及临床特征。方法:收集2016年1月1日至12月31日在中南大学湘雅医院住院期间使用抗菌药物≥2 d的CKD 3~5期患者的电子病历，从中筛选出应用抗菌药物后出现神经精神症状或诊断为脑病者，由临床医师和药师应用Naranjo评定法进行评分，将评分≥4分者判定为AAE。提取AAE患者基本信息、基础疾病信息、抗菌药物应用情况以及AAE相关情况进行描述性统计分析。结果:2 438例CKD 3~5期住院患者中共有977例（40.07%）使用抗菌药物治疗。经综合评估判定发生AAE者33例（3.38%）。33例AAE患者中，男性15例，女性18例；年龄68（56，78）岁，范围27~88岁；CKD 3b期2例，4期6例，5期25例；行透析治疗者21例；血清肌酐（492±265）μmol/L，血尿素氮（16.9±10.7）mmol/L，估算肾小球滤过率（eGFR）10.4（7.0，14.9）ml/（min·1.73 mn 2）。涉及AAE的抗菌药物为β内酰胺类和氟喹诺酮类，其中AAE发生率最高的药物为头孢吡肟[28.57%（4/14），95%n CI：1.5~55.6）]，其次为头孢他啶[14.67%（11/75），95%n CI：6.5~22.9]。使用抗菌药物至发生AAE的时间为（6±3）d。AAE的主要临床表现有谵妄、躁狂（45.45%，15/33），肢体不自主运动和癫痫大发作（各18.18%，6/33），神志淡漠（15.15%，5/33），嗜睡（12.12%，4/33），妄想、幻觉（3.03%，1/33）。33例AAE患者经停药或更换抗菌药物并给予血液透析、血液滤过和对症治疗，截至出院，30例（90.90%）患者症状消失，3例（9.10%）未愈。n 结论:CKD患者是发生AAE的危险人群，尤其是使用β内酰胺类治疗的患者。需要抗菌药物治疗的CKD患者应按eGFR调整药物剂量，治疗期间注意监测，防止AAE的发生。“,”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 m n 2). 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.n 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.