Open AccessErtapenem-Induced Delirium
Author(s) -
Mariana Bilreiro,
Luís Marote Correia
Publication year - 2022
Publication title -
gazeta médica/gazeta médica
Language(s) - English
Resource type - Journals
eISSN - 2184-0628
pISSN - 2183-8135
DOI - 10.29315/gm.v1i1.543
Subject(s) - ertapenem , medicine , meropenem , delirium , neurotoxicity , intensive care medicine , encephalopathy , klebsiella pneumoniae , anesthesia , antibiotics , biochemistry , chemistry , antibiotic resistance , toxicity , escherichia coli , gene , microbiology and biotechnology , biology
Neurotoxicity is an unusual iatrogenic effect associated with carbapenems, typically manifested as seizures or hyperactive delirium. We present an 89-year-old female patient with a medical history of hypertension and chronic kidney disease who was admitted for acute tracheobronchitis and anemia related to diverticular disease. As a complication, she developed acute cystitis caused by extended spectrum ß-lactamases producing Klebsiella pneumoniae, so intravenous ertapenem was started. On the second day of antibiotic therapy, the patient manifested visual hallucinations followed by an inattentive and lethargic state suggestive of a hypoactive delirium. An ertapenem-induced neurotoxicity was suspected. Upon substitution by meropenem, the patient improved, and symptom reversal occurred after 72 hours. We present a review of ertapenem-induced hallucinations and address pharmacokinetics aspects namely renal dysfunction and hypoalbuminemia that could potentiate encephalopathy. Although rare, clinicians should be aware of non-seizure ertapenem related neurotoxicity. Ready recognition can lead to rapid improvement and prevent dire outcomes.