Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children

Abstract

OBJECTIVES We studied the frequency and characteristics of antibiotic-induced neutropenia in otherwise healthy children receiving antibiotic therapy for hematogenous osteoarticular infections (OAIs). METHODS We retrospectively enrolled otherwise healthy children between 1 month and 18 years of age discharged with an OAI from our institution over an 11-year period. An absolute neutrophil count (ANC) ≤1500 cells/μL was defined as neutropenia. We recorded demographic and clinical information, as well as the value and timing of each ANC in relation to changes in antibiotic therapy. A multivariable regression model assessed the contributions of various risk factors. RESULTS A total of 186 children were enrolled (mean age, 7.6 years; 67.2% boys). β-Lactams represented 61.2% of all prescriptions. During treatment, 61 subjects (32.8%) developed neutropenia (median time to onset, 24 days). An ANC < 500 cells/μL occurred in 7 subjects (3.8%). Neutropenic subjects (mean age, 6.0 years) were significantly younger than those without neutropenia (mean age, 8.5 years) (OR = 0.86; 95% CI: 0.79–0.93; p < 0.001) and received significantly longer courses of total (89.3 vs. 55.8 days) and parenteral (24.6 vs. 19.9 days) antibiotic therapy (OR = 1.01; 95% CI: 1.01–1.02; p = 0.004 and OR = 1.02; 95% CI: 1.01–1.04; p = 0.041, respectively). Recurrent neutropenia occurred in 23.0% of all neutropenic subjects and was significantly more common in those with a longer mean duration of parenteral therapy (OR = 1.05; 95% CI: 1.02–1.09; p = 0.004.). No complications from neutropenia occurred. CONCLUSIONS Neutropenia was common in our cohort of children receiving prolonged antibiotic therapy for OAIs. Younger age and longer courses of therapy were associated with an increased risk of neutropenia.

Acute antibiotically induced neutropenia: A systematic review of case reports

“…Our results show a median duration of therapy until onset of neutropenia of 21 days. Similar studies show that neutropenia occurs late in the course of antibiotic treatment, 5,6 thus possibly substantiating the claim that an increased duration of administration might put patients at higher risk for developing neutropenia. A small prospective study concludes that administration of high-dosage beta-lactam antibiotics for extended periods of time puts patients at a higher risk for developing neutropenia.…”

Antibiotic-associated neutropenia is marked by depletion of intestinalLachnospiraceaein pediatric patients

“…We identified associations between neutropenia and the total length of antibiotic therapy, length of intravenous antibiotic therapy, length of admission to the hospital and admission to the intensive care unit (Table 2) . Previous reports concur with the increased risk of neutropenia with longer treatment courses, as we saw in our cohort 33,34 . While standard intravenous and oral dosing for many common antibiotics (e.g.…”

"Case Series of Ceftriaxone-Induced Neutropenia and Leukopenia: Experience in Outpatient Parenteral Antimicrobial Therapy (OPAT) Setting"

“…The incidence of non-chemotherapy idiosyncratic drug-induced neutropenia is reported to range from 2.4 to 15.4 cases per million people [4]. Among the reported cases of antibiot-ic-induced neutropenia, beta-lactams and glycopeptides are the most common reported causative agents [5][6][7]. The mechanism of antibiotic-induced neutropenia remains uncertain and potentially multifactorial.…”