Abdullayev Mirsaleh MİRYAGUBOGLU, Serdar GENCLER, Meral SEN, Hatice KİLİNC, Mehmet Tolga KAFADAR

Imipenem-associated seizure in a patient operated for left-sided colon tumor

İlaç ilişkili nöbetlerin patofizyolojisi birçok faktörü içermekle birlikte esas olarak kullanılan ilaç ve olgu faktörüne bağlıdır. Bu tip olgularda bilinen epilepsi öyküsü yoktur, kullanılan ilacın epileptik eşiği düşürmesine bağlı olarak epileptik nöbetler görülür. Sorumlu ajanın kesilmesiyle genelde nöbet tekrarı olmamaktadır. Beta-laktam antibiyotiklerin nadir görülen yan etkilerinden biri de konvülziyondur. Karbapenem grubu antibiyotiklerin nörotoksik yan etkilerinin, gamma amino bütirik asit reseptörleri ile etkileşim sonucu geliştiği sanılmaktadır. Meropenem ve imipenem de karbapenem grubu antibiyotiklerdir. Kliniğimizde sol kolon tümörü nedeniyle opere edilen ve postoperatif yara yeri enfeksiyonu gelişen 61 yaşındaki erkek hastada, kültür antibiogramda Klebsiella Pnömonia üredi. Tedavide imipenem/silastatin başlandı. Tedavinin 4. günü tonik-klonik kasılmalarla seyreden nöbet gelişti. Nöbet, imipenem/silastatin tedavisine bağlandı. Antiepileptik tedavi verilen hastada, yapılan tetkiklerde konvülziyonu açıklayacak başka bir patoloji bulunamadı. Antibiyotik tedavisi değiştirilen hasta, yatışının 11. günü şifa ile taburcu edildi

Sol kolon tümörü nedeniyle opere edilen hastada imipenem ilişkili nöbet

Although the pathophysiology of drug-associated seizures involves many factors, it mainly depends on the culprit drug and case-specific factors. There is usually no previous history of epilepsy in these patients, and epileptic seizures are due to lowering in epileptic threshold by the culprit drug. Epileptic seizures usually do not recur when the culprit agent is discontinued. Convulsion is a rare side effect of beta-lactam antibiotics. The neurotoxic side effects of carbapenem group antibiotics are thought to occur through an interaction with amino butyric acid receptors. Meropenem and imipenem are also a carbapenem group antibiotic. A 61-year-old man who developed a postoperative wound infection after being operated for left colon tumor had Klebsiella Pneumoniae proliferation in culture antibiogram and was put on imipenem/cilastatin treatment. He developed seizures with tonic-clonic convulsions on the fourth day of treatment, and the seizures were attributed to the imipenem/cilastatin treatment. No other pathology suggestive of seizure etiology could be found in his examinations. His antibiotic regimen was changed to a different one and he was discharged in good health on the 11th day of his hospital admission

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