Wang Chunjiang, Zhou Yulu, Zhou Ya, Ye Chao
Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, People's Republic of China.
Department of Pharmacy, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, 410028, People's Republic of China.
Infect Drug Resist. 2023 Jun 8;16:3649-3658. doi: 10.2147/IDR.S406852. eCollection 2023.
Neurotoxicity is a rare adverse event for ertapenem. Given the limited evidence, large patient data are needed to aid in the identification and management of this fatal complication. Aim of the review, we summarize the characteristics, risk factors, and treatment of ertapenem-induced neurotoxicity.
Pubmed, Web of Science, Embase, Cochrane library, Wanfang, CNKI, China VIP database were searched up from 31 October 2001 to 31 December 2022. All articles concerning neurotoxicity induced by ertapenem were included. The retrieved articles were screened by two experienced clinicians by reading the titles, abstracts, and full texts.
A total of 66 patients were included, with a median age of 71.5 years (range 40-92), of whom 45 (68.2%) were male. Twelve patients (18.2%) received irrational doses (exceeding the recommended dose), and 30 patients (45.5%) had chronic renal insufficiency. The median time to symptom onset was 5 (range 1-14). Epileptiform seizures (42.4%), visual hallucinations (36.4%), altered mental status (25.8%), and confusion (22.7%) were the most common symptoms of ertapenem-induced neurotoxicity. Of the 29 patients with reported albumin levels, 25 had serum albumin <3.5 g/dl. Ertapenem was discontinued in 95.5% of patients, and 90.9% recovered completely. Median time to symptom recovery was 7 days (range 1-42) after intervention including antiepileptic administration, or hemodialysis.
Neurotoxicity is a rare adverse event for ertapenem, especially in patients with advanced age, renal insufficiency, pre-existing neurological disease, and hypoalbuminemia. This adverse reaction usually resolves with medication interruption, or antiepileptic administration and hemodialysis.
神经毒性是厄他培南罕见的不良事件。鉴于证据有限，需要大量患者数据来帮助识别和处理这种致命并发症。本综述的目的是总结厄他培南诱导的神经毒性的特征、危险因素及治疗方法。
检索2001年10月31日至2022年12月31日期间的PubMed、Web of Science、Embase、Cochrane图书馆、万方、知网、中国维普数据库。纳入所有关于厄他培南诱导神经毒性的文章。由两名经验丰富的临床医生通过阅读标题、摘要和全文对检索到的文章进行筛选。
共纳入66例患者，中位年龄71.5岁（范围40 - 92岁），其中45例（68.2%）为男性。12例患者（18.2%）接受了不合理剂量（超过推荐剂量），30例患者（45.5%）患有慢性肾功能不全。症状出现的中位时间为5天（范围1 - 14天）。癫痫样发作（42.4%）、视幻觉（36.4%）、精神状态改变（25.8%）和意识模糊（22.7%）是厄他培南诱导神经毒性最常见的症状。在报告白蛋白水平的29例患者中，25例血清白蛋白<3.5 g/dl。95.5%的患者停用了厄他培南，90.9%的患者完全康复。在包括给予抗癫痫药物或血液透析在内的干预后，症状恢复的中位时间为7天（范围1 - 42天）。
神经毒性是厄他培南罕见的不良事件，尤其是在老年、肾功能不全、既往有神经系统疾病和低白蛋白血症的患者中。这种不良反应通常通过停药、给予抗癫痫药物或血液透析来解决。
