SHM Converge Scientific Abstract ePoster Gallery-Too Much Vitamin Z? Piperacillin/Tazobactam Mediated Encephalopathy

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This case describes a 64-year-old man with quadriplegia and neurogenic bladder who presented with an obstructed suprapubic catheter, severe suprapubic pain, and hypotension. He was treated for a complicated catheter-associated urinary tract infection with extended-infusion piperacillin/tazobactam because prior urine cultures had grown ESBL organisms. The initial culture confirmed ESBL Proteus mirabilis, sensitive only to piperacillin/tazobactam and carbapenems.<br /><br />After four days of therapy, he developed recurrent visual hallucinations. By day seven, his mental status worsened to disorientation to place, time, and situation. Extensive evaluation for other causes of encephalopathy was unrevealing, including repeat infectious workup, electrolytes, CT head, pain control, and bowel regimen.<br /><br />Piperacillin/tazobactam was stopped after completing a seven-day course, and his mentation returned to baseline within 36 hours, with complete resolution of hallucinations. He also reported having similar hallucinations during prior piperacillin/tazobactam exposure, strengthening the association.<br /><br />The report emphasizes that medication-induced encephalopathy should be considered when common causes are excluded. While cefepime neurotoxicity is well recognized, piperacillin/tazobactam-induced encephalopathy is rarer but documented. Symptoms typically begin 1.5 to 7 days after starting therapy, with a median onset of four days, and usually improve within 48 hours after discontinuation. Risk factors include higher daily doses and renal insufficiency, which can lead to drug accumulation; clinicians should be cautious about overestimating renal function in patients with low muscle mass. A proposed mechanism is beta-lactam-related disruption of GABA signaling.

Asset Subtitle

Tony Vu

Meta Tag

Author List Fernando Hernandez, Saleem Ali, Tony Vu

Category Clinical Vignettes

Concept Piperacillin/Tazobactam

Concept Encephalopathy

Concept Altered Mental Status

Concept Beta-Lactam Neurotoxicity

Concept Renal Disease

Distinguished Non-Finalist

Presenter Organization University of Texas Health San Antonio, University Hospital

Presenting Author Tony Vu

Track Adult

Keywords

piperacillin/tazobactam

encephalopathy

visual hallucinations

ESBL Proteus mirabilis

catheter-associated urinary tract infection

quadriplegia

neurogenic bladder

beta-lactam neurotoxicity

renal insufficiency

suprapubic catheter

Piperacillin/Tazobactam

Encephalopathy

Altered Mental Status

Beta-Lactam Neurotoxicity

Renal Disease