厄他培南致视幻觉及癫痫发作1例并文献复习

Ertapenem-induced hallucinations and seizures: one case report and literature review

目的报道1例患者在接受厄他培南治疗时出现神经系统不良反应,提示临床应予注意。方法报道了1例老年女性复杂泌尿系统感染,在厄他培南用药第3天出现言语混乱、视幻觉,第5天突发意识丧失、四肢强直阵挛伴尿失禁,停用厄他培南2 d后患者神志好转。同时总结了19例已报道的厄他培南引起精神症状的病例。结果厄他培南导致中枢神经系统不良反应的临床表现主要包括不同程度的精神异常,如幻觉、兴奋性增高甚至出现谵妄、妄想、定向力及计算力障碍,震颤、癫痫,严重者可出现意识障碍,其临床表现无特异性。神经系统症状约在用药3～7d时出现,停药2d左右缓解,在终末期肾病患者中,神经系统症状可持续约2周。结论厄他培南致中枢神经系统不良反应的危险因素包括:高剂量、与其他致神经系统不良反应的抗生素联用、肾功能不全、高龄、既往神经系统疾病。本例患者具有高龄、肾功能不全等因素,在应用厄他培南过程中未按说明书减量也是原因之一。

Objective To report one case of adverse reactions in central nervous system during ertapenem treatment and to remind clinicians of such toxicity when prescribing ertapenem. Methods We described an 87 year-old woman with complicated urinary tract infection who received ertapenem treatment (1 g, qd). On the third day after treatment, the patient began to talk nonsense and have visual hallucination. She developed tonic-clonic seizures on day 5, associated with urinary incontinence. Her conscious status improved 2 days after discontinuation of ertapenem. We also reviewed another 19 cases of ertapenem-induced neurological adverse reactions. Results The related CNS symptoms included various types of mental abnormalities, including hallucination, delirium, delusion, disorientation, dyscalculia, tremor, seizures, and altered mental status, which were not specific. In most of the reported cases, CNS symptoms occurred about 3-7 days after initiation of ertapenem treatment, and alleviated 2 days after withdrawal of the antibiotic. However, in patients with end-stage kidney disease, the symptoms could last up to two weeks. Conclusions The risk factors for ertapenem-induced neurological adverse reactions include high dosage, co-administration with other antibiotics causing CNS symptoms, impaired renal function, advanced age, and underlying nervous system abnormalities. Advanced age, renal dysfunction, and factual overdosage of ertapenem were the risk factors in this case.