A systematic review and meta-analysis of myelosuppression in pediatric patients treated with linezolid for Gram-positive bacterial infections

Kato, Hideo; Hagihara, Mao; Asai, Nobuhiro; Koizumi, Yusuke; Yamagishi, Yuka

doi:10.1016/j.jiac.2021.03.003

Cited by 8 publications

(10 citation statements)

References 29 publications

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“…A recent meta-analysis showed that the incidence of thrombocytopenia increased by 5 times in pediatric patients receiving linezolid treatment for more than 14 days. [ 17 ] In the present study, we could not identify long-term treatment as a risk factor for linezolid-associated severe thrombocytopenia. However, most cases of severe thrombocytopenia occurred within the first 10 days of linezolid treatment.…”

Section: Discussioncontrasting

confidence: 75%

Prevalence and risk factors for severe linezolid-associated thrombocytopenia in pediatric patients: An analysis of a public database

et al. 2023

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Linezolid is widely used in various clinical settings. Studies have revealed that it may cause thrombocytopenia in adults. However, the correlation between the use of linezolid and thrombocytopenia in pediatric patients is still unclear. This study aimed to identify the impact of Linezolid on the occurrence of thrombocytopenia in children. A retrospective observational study was conducted using data on patients treated with linezolid from the Pediatric Intensive Care clinical database. Univariate and multiple logistic regression analyses were performed to identify the risk factors of linezolid-related severe thrombocytopenia. A total of 134 patients were included. The prevalence of severe thrombocytopenia was 8.96% (12/134). Univariate analysis indicated that the severe thrombocytopenia group showed significantly higher proportion of concomitant carbapenem (75% vs 44.3%; P < .05) and piperacillin/tazobactam (25% vs 6.6%; P < .05) than that of the non-severe thrombocytopenia group. Multivariate analysis also revealed that the occurrence of severe thrombocytopenia was significantly associated with concurrent use of carbapenem (odd ratio = 4.058; 95% confidence interval: 1.012-16.274; P = .048) and piperacillin/tazobactam (odd ratio = 5.335; 95% confidence interval: 1.117-25.478; P = .036). 75% of patients (9/12) developed severe thrombocytopenia within the first 7 days of linezolid use. The concomitant use of carbapenem and piperacillin/tazobactam was associated with an increased probability of severe thrombocytopenia in pediatric patients undergoing linezolid treatment. Further prospective clinical studies are required, and more detailed mechanisms of blood toxicity in pediatric patients must be investigated.

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Section: Discussioncontrasting

confidence: 75%

Prevalence and risk factors for severe linezolid-associated thrombocytopenia in pediatric patients: An analysis of a public database

et al. 2023

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“…Treatment duration of more than 14 days was also reported to be one of the risk factors associated with linezolid-induced myelosuppression. Therefore, careful follow-up is necessary in these patients [25]. There are many studies that affirm the hematological effects of Linezolid, as well as warn of the possible risks and precautions to take into account when implementing this drug, so it is necessary to establish a follow-up in all patients who use this drug.…”

Section: Discussionmentioning

confidence: 99%

"Myelosuppression and Other Adverse Reactions Caused by Linezolid"

Sanchez

2023

OAJBS

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Background: Linezolid is a synthetic oxazolidinone antimicrobial drug. It is indicated for gram-positive infections and approved for the treatment of other conditions. Myelosuppression is a condition in which bone marrow activity decreases, resulting in fewer red blood cells, white blood cells, and platelets. Pancytopenia is not a disease but a manifestation of other underlying conditions.Methodology: A systematic review was carried out through various databases, such as PubMed, Scielo and ScienceDirect; The search and selection of articles was carried out in indexed journals in English.Results: Linezolid is used as an effective antibiotic against bacteria belonging to the gram-positive group. At high doses up to 1,000 mg/kg/day, reversible myelosuppression occurred. This antibiotic also presents other adverse reactions to take into account such as serotonin syndrome, hypoglycemia, among others. Conclusion:This review offers up-to-date and detailed information on the adverse effects and hematological effects of Linezolid in order to identify its correct use as well as its prognosis.

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“…However, several factors may interfere with use of linezolid for the treatment of SIAI: 1) The product’s guidelines recommend using it only for treatment of infection by MRSA but not as a first-line anti-gram positive bacteria option. [ 4 ] 2) The linezolid instructions highlight its bone marrow suppression (such as thrombocytopenia), and a study in Japan pointed out that thrombocytopenia developed in 48.4% of patients during linezolid therapy, [ 5 ] the pooled incidences of thrombocytopenia and anemia were 9% (95% confidence interval (CI), 3–18%) and 4% (95% CI, 0–12%), [ 6 ] which may make clinicians wary of using the drug for treating SIAI patients who have thrombocytopenia and is a common manifestation of sepsis. To further understand the clinical application of linezolid in SIAI, we conducted this retrospective analysis to evaluate the effectiveness, safety, and prognosis of linezolid in the treatment of SIAI.…”

Section: Introductionmentioning

confidence: 99%

Linezolid in the treatment of severe intraabdominal infection: A STROBE-compliant retrospective study

You

Su²,

Sun

et al. 2022

Medicine

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Safety concerns over bone marrow suppression and thrombocytopenia may inhibit the use of linezolid to treat intraabdominal infection (IAI). To evaluate the effectiveness, safety, and prognosis of linezolid in the treatment of severe IAI (SIAI). Patients were divided into a linezolid group and nonlinezolid group according to whether linezolid was prescribed. Subgroup analysis (thrombocytopenia treated with linezolid group (I), and thrombocytopenia treated with nonlinezolid group (II) also was performed. We evaluated the effectiveness of linezolid by analyzing the changes in white blood cells (WBC) and procalcitonin, evaluated safety by analyzing the changes in platelet counts, and evaluated patient outcomes by analyzing the length of hospital stay, the length of ICU stay, and the rates of clinical improvement. Sixty-six adult SIAI patients were treated with anti-gram-positive (G+) bacteria drugs for more than 7 days from January 1, 2014, to December 31, 2020. The length of hospital stay, the length of ICU stay, and the rates of clinical improvement were not significantly different between the linezolid group and nonlinezolid group. On the 15th day after anti-G + bacteria treatment, the WBC of the linezolid group was significantly lower than in the nonlinezolid group (9.00 ± 4.30 vs 13.1 ± 6.19, P < .05). The time for a statistical difference in the decrease of procalcitonin in the linezolid group was earlier than in the nonlinezolid group (day 6 vs day 7, P < .05). There was no statistically significant difference in the changes of platelet counts in the subgroup I (P > .05), but compared with the baseline data (day 0), the time for the statistical difference in the increase of platelets in thrombocytopenia treated with linezolid group was earlier (day 5 vs day 6, P < .05). There was no statistical difference in the changes of platelets in subgroup II (P > .05). In the treatment of severe intraabdominal infection in a single-center, retrospective study, linezolid was not inferior to other antibiotics in patient clinical outcomes or seral WBC and procalcitonin values. Linezolid also induced no evident bone marrow suppression or thrombocytopenia. Linezolid is a good choice for treatment of SIAI.

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A systematic review and meta-analysis of myelosuppression in pediatric patients treated with linezolid for Gram-positive bacterial infections

Cited by 8 publications

References 29 publications

Prevalence and risk factors for severe linezolid-associated thrombocytopenia in pediatric patients: An analysis of a public database

Prevalence and risk factors for severe linezolid-associated thrombocytopenia in pediatric patients: An analysis of a public database

"Myelosuppression and Other Adverse Reactions Caused by Linezolid"

Linezolid in the treatment of severe intraabdominal infection: A STROBE-compliant retrospective study

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