Hematologic Adverse Effects of Prolonged Piperacillin-Tazobactam Use in Adults

Benli, Aysun; Şimşek-Yavuz, Serap; Başaran, Seniha; Çağatay, Atahan; Özsüt, Halit; Eraksoy, Haluk

doi:10.4274/tjh.2018.0127

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…The incidence of piperacillin-induced neutropenia varies from 10% to 34% in studies assessing a minimum duration of 10 days of therapy. 5,39 However, the exceptionally high incidence of 34% is limited by the retrospective nature of the corresponding study, which included a small cohort of patients treated for osteomyelitis and used a conservative threshold of <2.0 × 10 3 /µL for neutropenia. 5 Piperacillin-induced neutropenia in adults treated with shorter courses is rare.…”

Section: Resultsmentioning

confidence: 99%

“…1,3 Piperacillin, a member of the ureidopenicillin subclass, has been implicated in β-lactam-induced neutropenia more often than any other agent, with 246 cases. 2,3,5,29,31,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] Cases involving piperacillin or piperacillin-tazobactam were included in this count. Notably, a systematic review of piperacillin or piperacillin-tazobactam-induced neutropenia identified 183 cases using the Food and Drug Administration Adverse Event Reporting System.…”

Section: Incidence and Characteristicsmentioning

confidence: 99%

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A Review of β-Lactam–Associated Neutropenia and Implications for Cross-reactivity

2020

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Objective: To review the incidence, management, and current understanding of the pathophysiology of β-lactam–induced neutropenia and to critically evaluate the practicality and safety of direct substitution to an alternative β-lactam in the setting of this reaction. Data Sources: A literature analysis using the PubMed and Ovid search engines (July 1968 to October 2020) was performed using the search terms neutropenia, leukopenia, β-lactam, nonchemotherapy, agranulocytosis, and G-CSF (granulocyte colony-stimulating factor). Study Selection and Data Extraction: The included English-language studies evaluated the incidence, mechanism, and/or management of β-lactam–induced neutropenia in pediatric or adult patients. Data Synthesis: Drug-induced neutropenia is a well-documented adverse reaction of β-lactam antibiotics, with an incidence of approximately 10% following at least 2 weeks of intravenous therapy. However, multiple gaps in knowledge remain in the mechanism of pathophysiology and optimal management of this reaction. Both direct toxic and immune-mediated mechanisms have been implicated. Although the cornerstone of management includes cessation of the offending agent, controversy exists on the appropriateness of direct substitution or future use of an alternative β-lactam. Relevance to Patient Care and Clinical Practice: Given the frequency of use and superiority of β-lactams over alternative therapy for several infectious disease states, practical recommendations are needed on the management and safe use of β-lactams following β-lactam–induced neutropenia. Conclusion: Future use of β-lactams with differing R1 side chains, particularly those from a separate class, should not be deemed contraindicated following β-lactam–induced neutropenia and may be considered when indicated, with close laboratory monitoring.

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Section: Resultsmentioning

confidence: 99%

Section: Incidence and Characteristicsmentioning

confidence: 99%

A Review of β-Lactam–Associated Neutropenia and Implications for Cross-reactivity

2020

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“…Numerous studies have reported that the duration of treatment is directly associated with linezolid-associated thrombocytopenia 19,20 . Benli et al found that the incidence of leukopenia was 10% in patients treated with piperacillin-tazobactam for longer than 10 days 21 . In our study, it was found that as the days of antibiotic exposure increased, the frequency of observed side effects significantly increased, which aligns with the limited data available in the literature.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic-related adverse events and risk factors in hospitalized patients: a prospective cohort study

SOYSAL,

ŞENCAN,

KORKMAZ

2023

Cukurova Medical Journal

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Purpose: The objective of this study is to identify antibiotic-related adverse events and risk factors in hospitalized patients. Materials and Methods: This prospective cohort study included 776 inpatients who received antibiotic treatment between January 2019 and December 2020. Patients who experienced "definite" or "probable" adverse drug events (ADE) were examined using the World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria. The definition and severity criteria for antibiotic-related adverse events were determined according to the Common Terminology Criteria for Adverse Events (CTCAE). Results: The overall rate of antibiotic-associated ADE was 7.9 (95%CI, 6.8-9.1) per 1000 person-days. The study identified a total of 152 adverse events in 125 patients who experienced ADE. Among the 152 adverse events, 63 (41.4%) were severe, and 89 (58.6%) were non-severe. Independent risk factors for ADE included the number of comorbidities (up to 4 times higher increased risk), number of drugs used, and duration of antibiotic administration (up to 12.3 times higher and 8% increased risk for each additional day). The most common side effects were hematological, with 45 (29.6%) cases reported in the hematological system advers events. Conclusion: The management of antibiotic durations, which is a controllable factor in the development of antibiotic-related adverse events, is crucial. Rational use of antibiotics is essential, not only in terms of preventing the development of resistance but also in terms of reducing the frequency of adverse events that may become life-threatening.

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“…To date, the exact incidence of PTZ-induced haematological adverse effects varied between cohort studies due to the difficulty of definite diagnosis in clinical practice. Studies have merely indicated the risk factors for PTZ-induced haematological adverse effects as prolonged courses and increased cumulative doses 4 5…”

Section: Discussionmentioning

confidence: 99%

Piperacillin–tazobactam induced bicytopenia in low cumulative treatment doses

et al. 2019

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We present the case of infected wet gangrene of right foot in the setting of poorly controlled type 2 diabetes in a 71-year-old woman. This patient presented with improved infection condition after intravenous piperacillin–tazobactam (PTZ) 2.25 gm every 6 hours treatment and below knee amputation surgery on day 3. However, neutropenia and thrombocytopenia developed on day 13. We consulted a haematologist and performed a series of examinations. However, no significant findings were noted thereafter. PTZ was suspected to be the most likely cause of neutropenia and thrombocytopenia and was hence terminated on day 14 (cumulative dose of PTZ: 126 g) following stabilisation of the infection condition. A transfusion was performed with two units of single donor platelets on day 14 and treated with intravenous dexamethasone 5 mg every 8 hours from day 14 to 16. Her white blood cell and platelet counts increased on day 15 and continued to recover thereafter.

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Hematologic Adverse Effects of Prolonged Piperacillin-Tazobactam Use in Adults

Cited by 5 publications

References 11 publications

A Review of β-Lactam–Associated Neutropenia and Implications for Cross-reactivity

A Review of β-Lactam–Associated Neutropenia and Implications for Cross-reactivity

Antibiotic-related adverse events and risk factors in hospitalized patients: a prospective cohort study

Piperacillin–tazobactam induced bicytopenia in low cumulative treatment doses

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