Analysis of the clinical characteristic of adverse drug reactions in central nervous system induced by meropenem
10.3760/cma.j.cn114015-20220418-00330
- VernacularTitle:美罗培南相关中枢神经系统不良反应临床病例分析
- Author:
Meiyu DENG
1
;
Xuhong YU
;
Linghui ZHANG
;
Ling CHEN
Author Information
1. 解放军第三〇五医院呼吸内科，北京 100017
- Publication Type:Journal Article
- Keywords:
Meropenem;
Central nervous system diseases;
Drug-related side effects and adverse reactions;
Aged;
Renal insufficiency
- From:
Adverse Drug Reactions Journal
2022;24(12):641-646
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the occurrence and the clinical characteristics of meropenem-related central nervous system (CNS) adverse reactions.Methods:Using the hospital information system, the electronic medical records of patients who were hospitalized in the Department of Respiratory, the 305 Hospital of the People′s Liberation Army from January 2016 to December 2021 and received meropenem were collected. Medical records of patients who developed CNS symptoms after meropenem administration were screened and analyzed retrospectively. The data extracted from the medical records mainly included gender, age, infectious diseases, underlying diseases, renal function at admission [serum creatinine, endogenous creatinine clearance (Ccr)] in the patient, the application of meropenem (dose, whether dose was adjusted according to Ccr), and the occurrence (occurrence time, main clinical manifestations, etc.), treatment, and outcome of meropenem-related CNS adverse reaction. The incidence of meropenem-related CNS adverse reactions was calculated, and their clinical characteristics was descriptively analyzed.Results:A total of 636 patients used meropenem during the set period and 17 of them developed meropenem-related CNS adverse reactions, with an incidence of 2.7%. Among 17 patients, 10 were male and 7 were female, aged from 74 to 94 years with a median age of 86 years. Thirteen patients had pulmonary infection (one with urinary system infection) and 4 had acute exacerbation of chronic obstructive pulmonary disease (2 with type Ⅱ respiratory failure); 14 patients had combined renal insufficiency (10 of them had a Cc r <50 ml/min) and 5 had sequelae of cerebral infarction. Ten patients were with Cc r <50 ml/min and 3 of them did not adjust the dose of meropenem according to Ccr, resulting in excessive dosage. The time to onset of CNS symptoms in 17 patients ranged from 1 to 7 days after starting meropenem, with a median time of 3 days. Twelve patients presented mainly with psychiatric disorders (including delirium, agitation, hyperarousal, hallucinations, confusion and sleep reversal, etc.), and 5 with limb or orolingual convulsions. Meropenem was discontinued in all 17 patients after the onset of CNS symptoms and 5 of them were given symptomatic treatments. Symptoms were relieved after 1-7 days in all the patients, with a median time of 3 days. Conclusions:Meropenem-related CNS adverse reactions are more common in elderly patients and patients with renal insufficiency, respiratory failure, and a history of CNS diseases. The main manifestations are mental disorders and convulsions, which mostly occur within one week of drug use. Stopping meropenem in time and receiving appropriate symptomatic treatments contribute a good prognosis in patients.
