DI-056 Linezolid induced thrombocytopenia in a patient with renal insufficiency: A case report and a retrospective case study

Abstract

BackgroundLinezolid is a new antimicrobial agent with a broad spectrum of activity against all clinically important gram positive bacteria, including methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE). The incidence of linezolid induced thrombocytopenia was reported to be 2.4% in phase III trials. Clearance of linezolid is not altered in patents with renal insufficiency and no dose adjustment is necessary. Therefore, linezolid is a suitable and reasonable drug of choice for patients with renal insufficiency who have MRSA or VRE infection. Moreover, renal insufficiency is also known to cause thrombocytopenia.PurposeThis study investigated if the incidence of linezolid induced thrombocytopenia in a patient with renal insufficiency was higher than that of others with normal renal function.Material and methodsThe case report was in relation to severe thrombocytopenia (platelet count <100 × 109 platelets/L) in a patient with haemodialysis who was treated with linezolid for VRE infection. Then, a retrospective study was performed in patients treated with linezolid and to evaluate the incidence of linezolid induced thrombocytopenia.Results16 patients (10 females), with mean age of 64.8 years, were studied between August 2014 and August 2015. The samples size was small because of the limitations of using linezolid imposed by the national healthy insurance of Taiwan. 6 patients had decreased platelet count of >25% from baseline during treatment with linezolid and 4 (67%) had renal insufficiency (creatinine clearance <50 mL/min). Two patients with renal insufficiency had severe thrombocytopenia.ConclusionThe results showed that the incidence of linezolid induced thrombocytopenia was higher in patients with renal insufficiency. Clinicians should consider the potential risks of linezolid treatment and monitor closely platelet count in during linezolid treatment. Further studies should be encouraged to determine if dose adjustment of linezolid in renal insufficiency is necessary to reduce the incidence of linezolid related thrombocytopenia.References and/or AcknowledgementsClin Infect Dis 2006;42:66-72Int J Antimicrob Agents 2008;28:345-51Int J Antimicrob Agents 2014;44:242-7Eur J Clin Pharmacol 2014;70:23-8J Infect Chemother 2011;17:382-7This study was financially supported by the Department of Pharmacy, Kaohsiung Municipal Hsiao-Kang Hospital.No conflict of interest.

Occurrence of linezolid induced thrombocytopenia and its association with the risk factors: a review article

“…Thrombocytopenia definition used varied among the studies; thrombocytopenia is considered, if there was >25% reduction from the baseline platelet count with final platelet count <1 lakh/mm 3 , >25% reduction from the baseline platelet count only; >30% from the baseline platelet count; 7 >50% from the baseline platelet count (Table 1). 1,6,11,[13][14][15] Two studies which defined thrombocytopenia as >25% reduction from the baseline platelet count and final platelet count <1 lakh/mm 3 has shown the occurrence ranging from 18 -48% with mean age range of 66 to 83 years with mean dose of 24mg/kg in one study and 600 mg BD in other study and mean duration of 12 to 14 days. 1,13 Another two studies with thrombocytopenia definition >25% reduction from the baseline platelet count showed the occurrence of about 16.6-50% with mean age of 50-61 years with a mean dose of 17-20mg/kg in one study and 600mg BD in another study for mean duration of 8 days -12 weeks.…”

“…6 In one study where the thrombocytopenia occurrence has been analysed based on presence or absence of renal insufficiency showed 57% and 33% with and without renal insufficiency with mean age of 68 years with dose of 600mg BD and mean duration of 10 days. 14 (Table 2), in one study by Natsumoto et al, serum creatinine and Dose Per Kg bodyweight per Day (DPKD, mg/kg/day) has been identified as risk factor. 1,6,7,11 The adjusted odds ratio with 95% confidence interval for serum creatinine (mg/dl) and DPKD, were 1.51 (1.01-2.50) and 1.14 (1.05-1.26) respectively by Bi and multivariate logistic regression.…”