Cargando…

2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study

BACKGROUND: Numerous reports have emerged about the neurotoxic effects of ertapenem. A recent study supports carbapenem use for the treatment of extended spectrum β-lactamase (ESBL)- producing Gram-negative bacteremia. This will likely bolster the use of ertapenem as it is a convenient choice to com...

Descripción completa

Detalles Bibliográficos
Autores principales: Fong, Raymond K C, Donoghue, Stephen G, Shafi, Humaira, Yen Tan, Seow, Boon Lee, Wee, Chiu Kit Wong, Edmund, Alalageri, Vijaya S, Seah, Jonathan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810748/
http://dx.doi.org/10.1093/ofid/ofz360.1961
_version_ 1783462319822471168
author Fong, Raymond K C
Donoghue, Stephen G
Shafi, Humaira
Yen Tan, Seow
Boon Lee, Wee
Chiu Kit Wong, Edmund
Alalageri, Vijaya S
Seah, Jonathan
author_facet Fong, Raymond K C
Donoghue, Stephen G
Shafi, Humaira
Yen Tan, Seow
Boon Lee, Wee
Chiu Kit Wong, Edmund
Alalageri, Vijaya S
Seah, Jonathan
author_sort Fong, Raymond K C
collection PubMed
description BACKGROUND: Numerous reports have emerged about the neurotoxic effects of ertapenem. A recent study supports carbapenem use for the treatment of extended spectrum β-lactamase (ESBL)- producing Gram-negative bacteremia. This will likely bolster the use of ertapenem as it is a convenient choice to complete antibiotic treatment in an outpatient setting. This study aims to review the incidence of neurotoxicity with ertapenem and the risk factors associated with it. METHODS: A retrospective nested cohort study was conducted in Changi General Hospital in Singapore from January 2015 to Decemeber 2016. All patients who received at least 24 hours of ertapenem were identified. Those who exhibited ertapenem-associated neurotoxic effects were selected as cases while those who did not were included in the pool of controls and randomly selected at a 1:3 ratio. RESULTS: A total of 544 patients were treated with ertapenem in our hospital during this 2-year period. Twenty-five patients (incidence 4.6%) developed neurotoxic manifestations and 75 patients were included as controls. Acute confusion was the commonest reaction (n = 19, 76%) followed by hallucinations (n = 8, 32%) and seizures (n = 5, 20%). Baseline characteristics were similar in both groups; the median age of the cases was 79 years (IQR 71–83 years) and 14 (56%) were males. The median duration of ertapenem use before neurotoxicity occurred was 7 days (IQR 5–11days). The median Naranjo ADR probability score for cases was 7 (range 5 to 7) which suggests a probable relationship. Univariate analysis showed that renal impairment (with CrCl< 60 mL/minute) (OR 3.31, 95% CI 1.03–10.64), a history of a vulnerable brain (including stroke and epilepsy etc)(OR 2.61 95% CI 1.03–6.61) increased the risk of neurotoxicity. Neurotoxicity was also significantly associated with longer hospitalization (median 21 days, p = 0.03). CONCLUSION: Our study suggests that renal impairment or a history of vulnerable brain may increase the risk for ertapenem-associated neurotoxicity. Hence, caution should be exercised when ertapenem is used to treat these individuals. Future prospective studies to further evaluate risk and to derive a prediction scoring system may help to reduce the incidence of neurotoxic adverse events with ertapenem use. DISCLOSURES: All authors: No reported disclosures.
format Online
Article
Text
id pubmed-6810748
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-68107482019-10-28 2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study Fong, Raymond K C Donoghue, Stephen G Shafi, Humaira Yen Tan, Seow Boon Lee, Wee Chiu Kit Wong, Edmund Alalageri, Vijaya S Seah, Jonathan Open Forum Infect Dis Abstracts BACKGROUND: Numerous reports have emerged about the neurotoxic effects of ertapenem. A recent study supports carbapenem use for the treatment of extended spectrum β-lactamase (ESBL)- producing Gram-negative bacteremia. This will likely bolster the use of ertapenem as it is a convenient choice to complete antibiotic treatment in an outpatient setting. This study aims to review the incidence of neurotoxicity with ertapenem and the risk factors associated with it. METHODS: A retrospective nested cohort study was conducted in Changi General Hospital in Singapore from January 2015 to Decemeber 2016. All patients who received at least 24 hours of ertapenem were identified. Those who exhibited ertapenem-associated neurotoxic effects were selected as cases while those who did not were included in the pool of controls and randomly selected at a 1:3 ratio. RESULTS: A total of 544 patients were treated with ertapenem in our hospital during this 2-year period. Twenty-five patients (incidence 4.6%) developed neurotoxic manifestations and 75 patients were included as controls. Acute confusion was the commonest reaction (n = 19, 76%) followed by hallucinations (n = 8, 32%) and seizures (n = 5, 20%). Baseline characteristics were similar in both groups; the median age of the cases was 79 years (IQR 71–83 years) and 14 (56%) were males. The median duration of ertapenem use before neurotoxicity occurred was 7 days (IQR 5–11days). The median Naranjo ADR probability score for cases was 7 (range 5 to 7) which suggests a probable relationship. Univariate analysis showed that renal impairment (with CrCl< 60 mL/minute) (OR 3.31, 95% CI 1.03–10.64), a history of a vulnerable brain (including stroke and epilepsy etc)(OR 2.61 95% CI 1.03–6.61) increased the risk of neurotoxicity. Neurotoxicity was also significantly associated with longer hospitalization (median 21 days, p = 0.03). CONCLUSION: Our study suggests that renal impairment or a history of vulnerable brain may increase the risk for ertapenem-associated neurotoxicity. Hence, caution should be exercised when ertapenem is used to treat these individuals. Future prospective studies to further evaluate risk and to derive a prediction scoring system may help to reduce the incidence of neurotoxic adverse events with ertapenem use. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2019-10-23 /pmc/articles/PMC6810748/ http://dx.doi.org/10.1093/ofid/ofz360.1961 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Fong, Raymond K C
Donoghue, Stephen G
Shafi, Humaira
Yen Tan, Seow
Boon Lee, Wee
Chiu Kit Wong, Edmund
Alalageri, Vijaya S
Seah, Jonathan
2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study
title 2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study
title_full 2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study
title_fullStr 2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study
title_full_unstemmed 2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study
title_short 2283. The Incidence and Risk Factors for Neurotoxicity in Patients on Ertapenem Therapy: a Retrospective Case- Control Study
title_sort 2283. the incidence and risk factors for neurotoxicity in patients on ertapenem therapy: a retrospective case- control study
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810748/
http://dx.doi.org/10.1093/ofid/ofz360.1961
work_keys_str_mv AT fongraymondkc 2283theincidenceandriskfactorsforneurotoxicityinpatientsonertapenemtherapyaretrospectivecasecontrolstudy
AT donoghuestepheng 2283theincidenceandriskfactorsforneurotoxicityinpatientsonertapenemtherapyaretrospectivecasecontrolstudy
AT shafihumaira 2283theincidenceandriskfactorsforneurotoxicityinpatientsonertapenemtherapyaretrospectivecasecontrolstudy
AT yentanseow 2283theincidenceandriskfactorsforneurotoxicityinpatientsonertapenemtherapyaretrospectivecasecontrolstudy
AT boonleewee 2283theincidenceandriskfactorsforneurotoxicityinpatientsonertapenemtherapyaretrospectivecasecontrolstudy
AT chiukitwongedmund 2283theincidenceandriskfactorsforneurotoxicityinpatientsonertapenemtherapyaretrospectivecasecontrolstudy
AT alalagerivijayas 2283theincidenceandriskfactorsforneurotoxicityinpatientsonertapenemtherapyaretrospectivecasecontrolstudy
AT seahjonathan 2283theincidenceandriskfactorsforneurotoxicityinpatientsonertapenemtherapyaretrospectivecasecontrolstudy