Published online Oct 19, 2024. doi: 10.5498/wjp.v14.i10.1583
Revised: September 3, 2024
Accepted: September 20, 2024
Published online: October 19, 2024
Processing time: 72 Days and 0.2 Hours
Imipenem is a highly effective carbapenem antibiotic, which is widely used in the treatment of many serious bacterial infections. At the same time, it can also cause some adverse reactions, mental abnormalities are the most concerned central nervous system adverse reactions. Different patients respond differently to imipenem, and the effect of imipenem on psychiatric disorders is unclear. Therefore, meta-analysis summarizing the results of multiple previous studies can provide stronger evidence support for clinical guidelines to guide clinical rational use of imipenem to minimize risks.
To systematically review the effects of imipenem on mental-health disorders.
Method in Cochrane Library, Web of science, PubMed, ProQuest, and China’s biomedical literature databases Wanfang, Weipu and China HowNet, the related literatures about the controlled trials of imipenem-induced mental disorders from the establishment of the database to May 2024 were searched; the included literatures were analyzed using RevMan 5.4 software; and the heterogeneity among the studies was also discussed.
After reviewing the literature published between 2003 and 2017, seven controlled trials with a total of 550 patients were included, with 273 and 277 patients in the control and experimental groups, respectively. The sample size of the study ranged from a minimum of 30 cases to a maximum of 61 cases. Patients in the experimental group were treated with imipenem while the control group was treated with conventional drugs. Meta-analysis showed that the incidence of mental disorders in the experimental group was higher than that in the control group (odds ratio = 3.66, 95% confidence interval: 1.11-12.11, P = 0.030); however, there was no significant difference in the incidence of adverse reactions between the two groups (odds ratio = 0.05, 95% confidence interval: 0.00 to 0.10, P = 0.060). Funnel diagrams showed that the scattered points of each study were symmetrical and distributed in an inverted funnel shape; therefore, there was no publication bias.
Imipenem can cause mental disorders in patients. However, the low quality of the included literature may have affected the final results. Therefore, it is necessary to conduct a high-quality randomized controlled study with multiple samples to further confirm the mechanism of imipenem-induced mental disorders and provide effective guidance for clinical treatment.
Core Tip: Imipenem is widely used in clinical treatments because of its high efficiency, enzyme resistance, and broad-spectrum antibacterial properties. However, reports of its adverse reactions are increasing daily, among which nervous system adverse reactions are the most common, usually showing symptoms similar to those of nervous system diseases, mental disorders, and aggravating the original nervous system diseases. It has been reported that imipenem can cause insomnia, intermittent delirium and unconsciousness, and its nervous system adverse reactions are related to age, renal insufficiency, hypoxemia, and dosage. Although the adverse effects of imipenem on the nervous system have been recognized in reports both at home and abroad, there is still a lack of in-depth and systematic research on its specific mechanism of causing mental disorders. Owing to the differences in the intervention measures and evaluation methods of different studies, the effectiveness and comprehensiveness of existing research results are limited to some extent. Therefore, this study collected and analyzed relevant literature at home and abroad on imipenem-induced mental disorders and deeply explored its potential mechanism, providing a scientific and comprehensive reference for patients to use drugs safely.