Fatal Vitamin K-Dependent Coagulopathy Associated with Cefoperazone/Sulbactam: A Case Report

Hu, Huanrong

doi:10.1007/s40800-019-0100-0

Cited by 23 publications

(16 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While the practice guidelines for the use of antibiotics, prescribing patterns, patient population, and other factors related to the health care environment have changed in the last decades, findings from our study could not reflect these factors. In addition, the adverse events associated with the NMTT-cephalosporins related to coagulation have been continuously reported until recently [35,36]. Therefore, our findings should be interpreted while considering these factors, and future studies incorporating new updates are needed.…”

Section: Discussionmentioning

confidence: 91%

The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis

Park

Kim

et al. 2019

IJERPH

View full text Add to dashboard Cite

Cephalosporins that contain the N-methylthiotetrazole side chain (NMTT-cephalosporin) have been reported to be associated with coagulation-related adverse events; however, a comprehensive evaluation regarding the association is lacking. A systematic review and meta-analysis were conducted to assess the safety profile of NMTT-cephalosporins with respect to hypoprothrombinemia and bleeding. The MEDLINE, Embase, Cochrane, and RISS databases were systematically searched for clinical studies up to October 2018. The association between NMTT-cephalosporins and hypoprothrombinemia was estimated using an odds ratio (OR) with a 95% confidence interval (CI). A total of 15 studies on cefamandole, cefoperazone, cefotetan, cefmetazole, and moxalactam were identified and included in the meta-analysis. Hypoprothrombinemia (OR 1.676, 95% CI 1.275–2.203) and prothrombin time (PT) prolongation (OR 2.050, 95% CI 1.398–3.005) were significantly associated with NMTT-cephalosporins, whereas bleeding was not (OR 1.359, 95% CI 0.920–2.009). Subgroup analyses revealed that cefoperazone (OR 2.506, 95% CI 1.293–4.860), cefamandole (OR 3.247, 95% CI 1.083–9.733), and moxalactam (OR 3.367, 95% CI 1.725–6.572) were significantly associated with hypoprothrombinemia. An Antimicrobial Stewardship Program led by a multidisciplinary team could play a critical role in monitoring cephalosporin-related hypoprothrombinemia or PT prolongation in patients with underlying clinical conditions at risk for bleeding. The multidisciplinary team could also assist in communicating the potential safety concerns regarding NMTT-cephalosporin use with healthcare professionals to decrease the risk of adverse events.

show abstract

Section: Discussionmentioning

confidence: 91%

The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis

Park

Kim

et al. 2019

IJERPH

View full text Add to dashboard Cite

show abstract

“…It has low renal toxicity and high safety levels [19], but long-term high-dose use may lead to vitamin Kdependent coagulation dysfunction. Hu [20] reported a fatal vitamin K-dependent coagulopathy associated with cefoperazone/sulbactam in a 79-year-old man with normal coagulation function and no history of blood or liver disease. However, whether cefoperazone/sulbactam combined with tigecycline aggravates coagulopathy or hypofibrinogenaemia is unclear.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and risk factors of tigecycline-associated hypofibrinogenaemia in critically ill patients

Xiao

Zheng

et al. 2020

Eur J Clin Pharmacol

View full text Add to dashboard Cite

Purpose To analyze the clinical features and risk factors of tigecycline-associated hypofibrinogenaemia and study whether cefoperazone/sulbactam combined with tigecycline aggravates coagulopathy or hypofibrinogenaemia. Methods A retrospective case-control study of patients with severe infection who were treated with tigecycline was conducted. Patients were assigned to the hypofibrinogenaemia group (< 2.0 g/L) and normal fibrinogen (normal) group (≥ 2.0 g/L) to assess the clinical features of patients with tigecycline-associated hypofibrinogenaemia. The traits of patients treated with cefoperazone/ sulbactam in the hypofibrinogenaemia group were also analyzed. Results In total, 127 patients were enrolled in the study, including 71 patients with hypofibrinogenaemia and 56 patients with normal fibrinogen levels. Hypofibrinogenaemia developed at a median of 6 (4-8) days after tigecycline treatment, and the fibrinogen level returned to normal at a median of 3 (3-5) days after tigecycline discontinuation. In the multivariate analysis, intra-abdominal infection (p = 0.005), fibrinogen level at tigecycline initiation (p < 0.001), maintenance dose (p = 0.039), and treatment duration (p = 0.002) were found to be related to hypofibrinogenaemia. Treatment with cefoperazone/sulbactam was not associated with hypofibrinogenaemia (p = 0.681), but patients treated with cefoperazone/sulbactam had a higher incidence of coagulopathy (p = 0.009) and needed more blood products (p = 0.003) than those treated without cefoperazone/sulbactam. Conclusion Tigecycline-associated hypofibrinogenaemia often developed on the 6th (4th-8th) day of tigecycline use and was associated with intra-abdominal infection, fibrinogen level at tigecycline initiation, maintenance dose, and treatment duration of tigecycline but not cefoperazone/sulbactam.

show abstract

“…Safety, especially in the context of coagulopathy, is a serious concern for clinicians prescribing cefoperazonesulbactam. [24][25][26] No significant difference in pre-and post-treatment INR was observed in 30 patients receiving cefoperazone, but most of the patients did not have the assessment of coagulation disorder in this study. According to retrospective review of medical chart, no patients receiving cefoperazone-sulbactam had significant bleeding.…”

Section: Discussionmentioning

confidence: 53%

Clinical Efficacy of Cefoperazone-Sulbactam versus Piperacillin-Tazobactam in the Treatment of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Chen

et al. 2021

IDR

View full text Add to dashboard Cite

Objective The aim of this study was to compare the usefulness of cefoperazone-sulbactam and that of piperacillin-tazobactam in the treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Methods This retrospective study included the adult patients receiving cefoperazone-sulbactam or piperacillin-tazobactam against HAP/VAP in nine hospitals in Taiwan from March 1, 2018 to May 30, 2019. Primary outcome was clinical cure rate. Results A total of 410 patients were enrolled. Among them, 209 patients received cefoperazone-sulbactam and 201 patients received piperacillin-tazobactam. Overall, cefoperazone-sulbactam group had similar distribution of age, sex, or SOFA scores as piperacillin-tazobactam group. However, cefoperazone-sulbactam had higher comorbidity score and disease severity than piperacillin-tazobactam group (Charlson score: 6.5 ± 2.9 vs 5.7 ± 2.7, p < 0.001; APACHE II score: 21.4 ± 6.2 vs 19.3 ± 6.0, p = 0.002). Regarding clinical outcomes, no significant difference in clinical cure and failure rates was observed between cefoperazone-sulbactam and piperacillin-tazobactam group (clinical cure rate: 80.9% vs 80.1% and clinical failure rate: 17.2% vs 18.4%, p = 0.943). Moreover, no significant difference in clinical effectiveness and ineffectiveness rates was observed between cefoperazone-sulbactam and piperacillin-tazobactam group (clinical effective rate: 80.9% vs 80.6% and clinical ineffective rate: 17.7% vs 18.9%, p = 0.711). The all-cause mortality rates of the cefoperazone-sulbactam and piperacillin-tazobactam groups were similar (23.9% vs 20.9%, p = 0.48). After adjustment of Charlson score and APACHE II score, the similarities in these clinical outcomes did not change in overall patients and patients with HAP or VAP. Conclusion For treating adult patients with nosocomial pneumonia, cefoperazone-sulbactam was as effective as piperacillin-tazobactam.

show abstract

Fatal Vitamin K-Dependent Coagulopathy Associated with Cefoperazone/Sulbactam: A Case Report

Cited by 23 publications

References 12 publications

The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis

The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis

Clinical characteristics and risk factors of tigecycline-associated hypofibrinogenaemia in critically ill patients

Clinical Efficacy of Cefoperazone-Sulbactam versus Piperacillin-Tazobactam in the Treatment of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Contact Info

Product

Resources

About