ERTAPENEM-INDUCED ENCEPHALOPATHY IN A PATIENT WITH BORDERLINE RENAL FUNCTION AND MULTIPLE RISK FACTORS

TOPIC: Pharmacotherapeutics TYPE: Medical Student/Resident Case Reports INTRODUCTION: Carbapenem is a bactericidal antibiotic against gram positive, negative, and anaerobic bacteria. Its use has increased in the recent years due to increasing prevalence of extended spectrum beta lactamase (ESBL) resistant bacteria (1). It important recognize its reversible neurotoxic side effect. Neurotoxicity rare presents as seizure encephalopathy. This case report patient with moderate renal impairment showing encephalitic signs despite renally dosed ertapenem. CASE PRESENTATION: Patient was an 88-year-old female intact cognitive function past medical history hypertension, diabetes mellitus, heart failure recovered ejection fraction 60%, breast cancer bladder remission. She presented initially for right face cellulitis osteomyelitis discharged ertapenem 1g daily based on her creatinine clearance (CrCl) 31 mL/min. On day 6 ertapenem, she became progressively more altered eventually brought back hospital 10. Upon examination, agitated, oriented person, had visual hallucinations. CT head MRI brain without contrast showed ischemic changes no intracranial hemorrhage, acute infarct, or space occupying lesions. Video electroencephalogram epileptiform activity. Infectious workup also negative. treated quetiapine 12.5 mg at bedtime improvement. Ertapenem induced encephalopathy suspected. switched ampicillin/sulbactam 3g every 8 hours. Within 24 hours, mental status improved hallucinations resolved. DISCUSSION: Neurotoxic effect can be attributed lipophilic property resulting high blood barrier penetration Furthermore, there are many potentiating factors, such impairment, prior CNS disease, concurrent nephrotoxic threshold lowering medications (2). In this report, our patient's symptoms resolved within stopping We used Naranjo Scale evaluate adverse drug reactions. A score 7 further supported suspicion. The current guideline recommends dose 500 CrCl greater than less 30mL/min respectively. Our make prone neurotoxicity. Her slightly above 30 Any type insult decrease supratherapeutic. CONCLUSIONS: aware potential neurotoxicity borderline functions risk factors. patient, after discontinuation REFERENCE #1: Hammond M, Ertapenem: Group 1 carbapenem distinct antibacterial pharmacological properties. Journal Antimicrobial Chemotherapy 2004;53, suppl 2: ii7-ii9 #2: Sutton S, Jumpar Cook Edun B, Wyatt Ertapenem-Induced Encephalopathy With Normal Renal Function. Investigative Medicine High Impact 2017;January-March:1-5 DISCLOSURES: No relevant relationships by Emily Bahler, source=Web Response Krishna Prasad Kurpad, ARCHANA SREEKANTAN NAIR, Phoenix Xu,