Ertapenem-Induced Encephalopathy: A Case Report Highlighting Carbapenem-associated Neurotoxicity
Imran Khan *
Hôpital Montfort, Institut du Savoir Montfort, University of Ottawa School of Pharmaceutical Sciences, Ottawa, K1K 0T2, Canada.
Kadir Abdi, Abdillahi
Hôpital Montfort, Ottawa, K1K 0T2, Canada.
Vanessa Lasalle
Hôpital Montfort, Ottawa, K1K 0T2, Canada.
Marlene Mansour
Faculty of Medicine, Hôpital Montfort, University of Ottawa, Ottawa, K1K 0T2, Canada.
Arif Ismail
Hôpital Montfort, Ottawa, K1K 0T2, Canada.
Bernadett Kovacs
Faculty of Medicine, Hôpital Montfort, University of Ottawa, Ottawa, K1K 0T2, Canada.
Kaouther Derouiche
Hôpital Montfort, Ottawa, K1K 0T2, Canada.
Caitlin Richler
Hôpital Montfort, University of Ottawa School of Pharmaceutical Science, Ottawa, K1K 0T2, Canada.
Christine Landry
Hôpital Montfort, University of Ottawa School of Pharmaceutical Science, Ottawa, K1K 0T2, Canada.
Sydney Morin
Hôpital Montfort, University of Ottawa School of Pharmaceutical Science, Ottawa, K1K 0T2, Canada.
Kimberley Do
Hôpital Montfort, Institut du Savoir Montfort, University of Ottawa School of Pharmaceutical Sciences, Ottawa, K1K 0T2, Canada.
Laurent Montpetit
Hôpital Montfort, University of Ottawa School of Pharmaceutical Science, Ottawa, K1K 0T2, Canada.
Marian Shafik
Hôpital Montfort, University of Ottawa School of Pharmaceutical Science, Ottawa, K1K 0T2, Canada.
Pierre Thabet
Hôpital Montfort, Institut du Savoir Montfort, University of Ottawa School of Pharmaceutical Sciences, Ottawa, K1K 0T2, Canada.
*Author to whom correspondence should be addressed.
Abstract
Background: Ertapenem is a once-daily carbapenem antibiotic commonly used in the treatment of complicated infections. Although traditionally associated with a lower risk of central nervous system (CNS) toxicity compared to imipenem, emerging reports highlight the potential for ertapenem-induced neurotoxicity, especially in patients with renal impairment and hypoalbuminemia. Early recognition is crucial, as symptoms are often reversible with drug discontinuation
Case Presentations: We report a case of a 46-year-old woman with type 2 diabetes, advanced chronic kidney disease, developmental delay, and hypoalbuminemia who developed acute encephalopathy with visual hallucinations approximately three weeks into outpatient ertapenem therapy for suspected diabetic foot osteomyelitis. Despite stable vitals and supportive care for acute kidney injury, she exhibited a sudden decline in mental status. Extensive investigations excluded metabolic, structural, and infectious causes. Ertapenem was discontinued, and the patient was treated with intravenous albumin and supportive measures, resulting in rapid and complete neurologic recovery within 48 hours. A Naranjo score of 7 supported a probable adverse drug reaction.
Conclusions: This case highlights ertapenem-induced encephalopathy as a reversible yet under recognized complication in vulnerable populations. Risk factors such as renal dysfunction and hypoalbuminemia should prompt close monitoring and dose adjustment. Albumin infusion may represent a promising adjunctive therapy in select cases.
Keywords: Ertapenem, neurotoxicity, encephalopathy, carbapenem, hypoalbuminemia, chronic kidney disease, adverse drug reaction