Rapid onset severe thrombocytopenia following reexposure to piperacillin-tazobactam: report of two cases and review of the literature

Alzahrani, Musa; Alrumaih, Ibrahim; Alhamad, Fahad; Warith, Ahmed Abdel

doi:10.1080/09537104.2018.1468025

Cited by 15 publications

(8 citation statements)

References 21 publications

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“…Penicillin-like drugs, such as piperacillin, may trigger thrombocytopenia through this mechanism. Previous study has also shown that antibodies are recognised and bind to platelets in the presence of soluble piperacillin, thereby reducing platelet count 28. Elderly patients are more likely to have a rapid onset of immune thrombocytopenia due to repeated use of piperacillin-tazobactam 29.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a risk prediction model for linezolid-induced thrombocytopenia in elderly patients

et al. 2022

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ObjectivesLinezolid is the first oxazolidinone antimicrobial agent developed for treating multi-drug-resistant gram-positive bacterial infections. The study aimed to investigate the risk factors of linezolid (LI)-induced thrombocytopenia (LI-TP) and to develop and validate a risk prediction model to identify elderly patients at high risk of developing LI-TP during linezolid therapy.MethodsA retrospective cohort study was performed at Zhongshan Hospital, FuDan University, China. The study involved elderly Chinese patients aged ≥65 years administered with linezolid (600 mg) twice a day between January 2015 and April 2021. We collected the patients’ clinical characteristics and demographic data from electronic medical records, and compared the differences between LI-TP patients and those who had not developed thrombocytopenia (NO-TP) after linezolid treatment. The risk prediction model was developed based on the regression coefficient generated from logistic regression model.ResultsA total of 343 inpatients were enrolled from January 2015 to August 2020 and were used as the training set. Among them, 67 (19.5%) developed LI-TP. Multivariate logistic regression analysis revealed that baseline platelet counts <150×109·L-1 (odds ratio (OR)=3.576; p<0.001), age ≥75 years (OR=2.258; p=0.009), estimated glomerular filtration rate (eGFR <60 mL·(min·1.73 m2)-1 (OR=2.553; p=0.002), duration of linezolid therapy ≥10 d (OR=3.218; p<0.001), intensive care unit (ICU) admittance (OR=2.682; p=0.004), concomitant piperacillin-tazobactam (OR=3.863; p=0.006) were independent risk factors for LI-TP in elderly patients. The LI-TP risk prediction model was established using a scoring method based on the regression coefficient and exhibited a good discriminative power, with an area under the curve (AUC) of 0.795 (95% confidence interval (CI) 0.740 to 0.851) and 0.849 (95% CI 0.760 to 0.939) in the training set (n=343) and validation set (n=90) respectively.ConclusionsThese findings indicate that duration of linezolid therapy, age, eGFR, ICU admittance, baseline platelet counts, concomitant piperacillin-tazobactam were significantly associated with LI-TP in elderly patients. A risk prediction model based on these risk factors showed a good discriminative performance and may be useful for clinicians to identify patients at high risk of developing LI-TP.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a risk prediction model for linezolid-induced thrombocytopenia in elderly patients

et al. 2022

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“…In many cases, TMA, including cases of TTP, is detected at initial cancer diagnosis. 13,14 However, it may be seen at cancer recurrence and usually reflects the advanced stage of disease. 15 There were no signs of TTP with the initial diagnosis of malignancy in our patient.…”

Section: Discussionmentioning

confidence: 99%

Pembrolizumab-induced thrombotic thrombocytopenic purpura

Dickey

Raina

Gilbar

et al. 2019

J Oncol Pharm Pract

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Introduction Pembrolizumab is a humanised monoclonal antibody targeting the receptor programmed cell death protein-1 (PD-1), with anti-tumour activity demonstrated for many malignancies. Such immune checkpoint inhibitors are associated with many immune-related adverse events including rash, colitis, hepatitis, pneumonitis, endocrinopathy and, rarely, haematological adverse events, including immune-related thrombocytopenia. Case report We report a 60-year-old female with metastatic non-small cell lung cancer treated with pembrolizumab every three weeks. Following her fifth cycle, she presented to our hospital with community-acquired pneumonia. Thrombocytopenia developed the next day and, after detailed investigations, thrombotic thrombocytopenic purpura was diagnosed. Management and outcome Pembrolizumab was immediately ceased and plasma exchange commenced along with IV methylprednisolone 250 mg daily for three days followed by oral prednisolone. After five days of plasma exchange, platelet counts normalised and haemolytic anaemia resolved. Discussion Acquired thrombotic thrombocytopenic purpura is an autoimmune disorder caused by an inhibitory autoantibody against ADAMTS-13. While most cases of acquired thrombotic thrombocytopenic purpura are idiopathic, certain conditions (e.g. bacterial infection, autoimmune disorders, malignancies) and medications are associated with thrombotic thrombocytopenic purpura. Other potential causes were eliminated in our patient. As acquired thrombotic thrombocytopenic purpura is an autoimmune disorder, pembrolizumab, given its unique mechanism of action and association with immune-related adverse events, is believed to be implicated in the development of thrombotic thrombocytopenic purpura. This case is one of only two linking anti-PD-1 therapy to thrombotic thrombocytopenic purpura development (the other occurring in a patient on nivolumab plus ipilimumab). Thrombotic thrombocytopenic purpura is life-threatening and clinicians are advised to be aware of its possible occurrence in immune checkpoint inhibitor-treated patients.

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“…Alzahrani et al reported two cases of possible immune thrombocytopenia that developed rapidly and severely in association with re-exposure to piperacillin-tazobactam. 15 Also the platelet count in peripheral blood improved after the discontinuation of piperacillin-tazobactam and the initiation of corticosteroid therapy, suggesting the possibility of immune-mediated thrombocytopenia.…”

Section: Discussionmentioning

confidence: 94%

An unusual case of piperacillin-tazobactam-induced fever, eosinophilia, thrombocytopenia and liver damage

Zhang

et al. 2021

Eur J Hosp Pharm

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Piperacillin-tazobactam is a broad-spectrum antimicrobial agent that is commonly used in clinical practice. The development of delayed drug hypersensitivity reaction (DHR) has been reported in several cases previously. Here we describe an unusual case of non-immediate DHR due to a prolonged course of piperacillin-tazobactam. We report a 22-year-old man who developed fever, eosinophilia, thrombocytopenia and elevated hepatic enzymes following 17 days of piperacillin-tazobactam for methicillin-sensitive Staphylococcus aureus (MSSA) pneumonia. These adverse reactions were reversed immediately after antibiotic cessation. Our case highlights that clinicians should be aware of delayed adverse effects in patients receiving long-term piperacillin-tazobactam treatment.

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Rapid onset severe thrombocytopenia following reexposure to piperacillin-tazobactam: report of two cases and review of the literature

Cited by 15 publications

References 21 publications

Development and validation of a risk prediction model for linezolid-induced thrombocytopenia in elderly patients

Development and validation of a risk prediction model for linezolid-induced thrombocytopenia in elderly patients

Pembrolizumab-induced thrombotic thrombocytopenic purpura

An unusual case of piperacillin-tazobactam-induced fever, eosinophilia, thrombocytopenia and liver damage

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