Cefepime-associated thrombocytopenia in a critically ill patient

Lim, Phin Phin; Chong, Chee Ping; Aziz, Noorizan Abdul

doi:10.1007/s11096-011-9571-5

Cited by 14 publications

(18 citation statements)

References 8 publications

(22 reference statements)

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“…It is important to note that despite the pan-sensitivity of our patient's organism, we deemed it medically prudent to change antibiotics, and discontinue antifungal and antiviral therapy due to the patient's persistent thrombocytopenia and overall low risk for viral and fungal pathogens. Reports have found correlations between antibacterial, antifungal, and antiviral medications causing thrombocytopenia, including cefepime, fluconazole, and valaciclovir [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Blood cultures returned negative. Due to our patient's low risk for complication as determined by her Multinational Association for Supportive Care in Cancer (MASCC) score of 24, and Clinical Index of Stable Febrile Neutropenia (CISNE) score of 1, cefepime, valaciclovir, and fluconazole were discontinued due to their potential to decrease platelets, and ceftriaxone was started instead and continued for 4 more days [8][9][10]. WBCs dropped again between days 5 through 7, and platelets decreased between days 7 and 8.…”

Section: Case Presentationmentioning

confidence: 99%

See 1 more Smart Citation

Staphylococcus lugdunensis Urinary Tract Infection With Associated Neutropenic Fever

Bobde¹,

Berger²,

Jalil³

et al. 2022

Cureus

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We present a 62-year-old woman with a history of uterine cancer status post-total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) on paclitaxel, who presented to the emergency department febrile at 101.7 Fahrenheit and complaining of fatigue and urinary incontinence. Laboratory testing revealed neutropenia and urinalysis showed elevated bacteria with minimal white blood cells, and negative leukocyte and negative nitrites. Urine cultures ultimately showed Staphylococcus lugdunensis with negative blood cultures.S. lugdunensis is a less frequently speciated Staphylococcus and has been increasingly found due to advances in identification using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS). S. lugdunensis are Gram-positive cocci, nonsporulating, nonmotile, facultatively anaerobic, catalase-positive, coagulase-negative, oxidase-negative, delta-hemolytic organism. Traditionally, it is seen in skin and soft-tissue infections, as well as vascular infections, however, has minimal occurrences in urinary tract infections.The risk of infection is increased in immunocompromised states and empiric treatment is warranted while waiting for definitive results. Our patient was started on cefepime, valacyclovir, fluconazole, and a single dose of vancomycin while in the emergency department. Worsening thrombocytopenia during her antibiotic course necessitated the re-evaluation of antibiotic agents which can cause thrombocytopenia. Subsequently, due to the patient's improved clinical status, and low risk of severe outcome, fluconazole and valacyclovir were discontinued, and cefepime was changed to ceftriaxone.

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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Staphylococcus lugdunensis Urinary Tract Infection With Associated Neutropenic Fever

Bobde¹,

Berger²,

Jalil³

et al. 2022

Cureus

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“…A ceftazidime-induced thrombocytopenia case of an adult patient was reported for the first time in the Spanish pharmacovigilance system ( Domingo-Chiva et al, 2017 ). Similarly, there is limited post-marketing surveillance evidence on thrombocytopenia associated with cefepime and ceftizoxime sodium ( Lim et al, 2011 ). Because a delay in recognition can lead to significant morbidity and mortality, clinical criteria such as the Naranjo Adverse Drug Reaction Probability Scale were used to help determine the risk of DITP, which were less efficient.…”

Section: Discussionmentioning

confidence: 99%

Detection of Drug-Induced Thrombocytopenia Signals in Children Using Routine Electronic Medical Records

et al. 2021

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Background: Drug-induced thrombocytopenia (DITP) is a severe adverse reaction and a significantly under-recognized clinical problem in children. However, for post-marketing pharmacovigilance purposes, detection of DITP signals is crucial. This study aimed to develop a signal detection model for DITP using the pediatric electronic medical records (EMR) data.Methods: This study used the electronic medical records collected at Beijing Children’s Hospital between 2009 and 2020. A two-stage modeling method was developed to detect the signal of DITP. In the first stage, we calculated the crude incidence by mining cases of thrombocytopenia to select the potential suspected drugs. In the second stage, we constructed propensity score–matched retrospective cohorts of specific screened drugs from the first stage and estimated the odds ratio (OR) and 95% confidence interval (CI) using conditional logistic regression models. The novelty of the signal was assessed by current evidence.Results: In the study, from a total of 839 drugs, 21 drugs were initially screened as potentially inducing thrombocytopenia. In total, we identified 18 positive DITP associations. Of these, potential DITP risk of nystatin (OR: 1.75, 95% CI: 1.37–2.22) and latamoxef sodium (OR: 1.61, 95% CI: 1.38–1.88) were two new DITP signals in both children and adults. Six associations between thrombocytopenia and drugs including imipenem (OR: 1.69, 95% CI: 1.16–2.45), teicoplanin (OR: 4.75, 95% CI: 3.33–6.78), fusidic acid (OR: 2.81, 95% CI: 2.06–3.86), ceftizoxime sodium (OR: 1.83, 95% CI: 1.36–2.45), ceftazidime (OR: 2.16, 95% CI: 1.58–2.95), and cefepime (OR: 5.06, 95% CI: 3.77–6.78) were considered as new signals in children.Conclusion: This study developed a two-stage algorithm to detect safety signals of DITP and found eighteen positive signals of DITP, including six new signals in a pediatric population. This method is a promising tool for pharmacovigilance based on EMR data.

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“…Other adverse effects are found in a few case reports: acute renal failure [ 185 ] and electrolyte disorders [ 186 ]; severe intravascular haemolysis [ 187 , 188 ]; extreme thrombocytosis [ 189 ]; severe thrombocytopenia [ 190 – 193 ]; leukopenia [ 194 ]; delayed-type hypersensitivity [ 195 ]; anaphylactic shock [ 196 ]; and severe cutaneous reactions [ 197 ].…”

Section: Toxicitymentioning

confidence: 99%

Pharmacokinetics–pharmacodynamics issues relevant for the clinical use of beta-lactam antibiotics in critically ill patients

2018

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Antimicrobials are among the most important and commonly prescribed drugs in the management of critically ill patients and beta-lactams are the most common antibiotic class used. Critically ill patient’s pathophysiological factors lead to altered pharmacokinetics and pharmacodynamics of beta-lactams.A comprehensive bibliographic search in PubMed database of all English language articles published from January 2000 to December 2017 was performed, allowing the selection of articles addressing the pharmacokinetics or pharmacodynamics of beta-lactam antibiotics in critically ill patients.In critically ill patients, several factors may increase volume of distribution and enhance renal clearance, inducing high intra- and inter-patient variability in beta-lactam concentration and promoting the risk of antibiotic underdosing. The duration of infusion of beta-lactams has been shown to influence the fT > minimal inhibitory concentration and an improved beta-lactam pharmacodynamics profile may be obtained by longer exposure with more frequent dosing, extended infusions, or continuous infusions.The use of extracorporeal support techniques in the critically ill may further contribute to this problem and we recommend not reducing standard antibiotic dosage since no drug accumulation was found in the available literature and to maintain continuous or prolonged infusion, especially for the treatment of infections caused by multidrug-resistant bacteria.Prediction of outcome based on concentrations in plasma results in overestimation of antimicrobial activity at the site of infection, namely in cerebrospinal fluid and the lung. Therefore, although no studies have assessed clinical outcome, we recommend using higher than standard dosing, preferably with continuous or prolonged infusions, especially when treating less susceptible bacterial strains at these sites, as the pharmacodynamics profile may improve with no apparent increase in toxicity.A therapeutic drug monitoring-guided approach could be particularly useful in critically ill patients in whom achieving target concentrations is more difficult, such as obese patients, immunocompromised patients, those infected by highly resistant bacterial strains, patients with augmented renal clearance, and those undergoing extracorporeal support techniques.

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Cefepime-associated thrombocytopenia in a critically ill patient

Abstract: Although cefepime-induced thrombocytopenia is rare, clinicians should be alert to this potential adverse effect among critically ill patients.

Cited by 14 publications

References 8 publications

Staphylococcus lugdunensis Urinary Tract Infection With Associated Neutropenic Fever

Staphylococcus lugdunensis Urinary Tract Infection With Associated Neutropenic Fever

Detection of Drug-Induced Thrombocytopenia Signals in Children Using Routine Electronic Medical Records

Pharmacokinetics–pharmacodynamics issues relevant for the clinical use of beta-lactam antibiotics in critically ill patients

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