The criterion-2 thrombocytopenia incidence was 42.5%, linezolid therapy duration and shock were independent risk factors. Linezolid and vancomycin are antibiotics that are commonly used in treating skin and soft-tissue infections, specifically those infections due to methicillin-resistant Staphylococcus aureus ( MRSA). Linezolid-induced pure red cell aplasia: a case report and literature review. Peyrani P, Wiemken T, Kelley R, Zervos M, Kett D, File T, Jr, et al. Greinacher A, Selleng K. Thrombocytopenia in the intensive care unit patient. This outcome has been noted previously: in a study by Nukui and others,15 one-half of the patients in whom thrombocytopenia occurred experienced this adverse effect within 11 days of starting linezolid. Tsuji Y, Hiraki Y, Matsumoto K, Mizoguchi A, Kobayashi T, Sadoh S, Morita K, Kamimura H, Karube Y. J Infect Chemother. Linezolid treatment days were consecutive, and each patient was included only once per admission, regardless of the number of discrete courses of linezolid therapy. Pak J Med Sci. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. XH wrote the manuscript, and all authors reviewed and edited it. The mechanisms of linezolid-induced thrombocytopenia may be related to myelosuppression and immune-mediated platelet destruction [19,20,21]. Further studies should stratify patients by onset of thrombocytopenia and expected mechanism of this adverse effect. Linezolid is a new antimicrobial agent that was recently approved by the US Food and Drug Administration for use in the treatment of infections due to drug-resistant pathogens, such as vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus [ 3, 4 ]. Reports from uncontrolled studies suggest that linezolid is associated with rates of thrombocytopenia higher than those reported in clinical studies. Since shock was a common risk factor for both thrombocytopenia definitions, the cumulative incidence of thrombocytopenia was compared in patients with and without shock using a log-rank test and presented as KaplanMeier curves. [29]. Chen C, Guo D-H, Cao X, Cai Y, Xu Y, Zhu M, et al. sharing sensitive information, make sure youre on a federal A total of 102 patients (38 women and 64 men; overall mean age 50 [SD 21] years) were included in the study. Laboratory data extracted included serum creatinine, platelet count, total protein concentration, albumin concentration, C-reactive protein (CRP) concentration, total bilirubin concentration, and international normalized ratio. Hanai Y, Matsuo K, Ogawa M, Higashi A, Kimura I, Hirayama S, et al. Linezolid is the first antibacterial drug in the class of oxazolidinones. Gerson et al. 2014;79:937. Fujii S, Takahashi S, Makino S, Kunimoto Y, Nakata H, Noda N, et al. Considering the global threat of antimicrobial resistance, linezolid has an important place among therapeutic antimicrobial options so that gaining further insights into its toxicities and identifying at-risk patients are crucial for optimizing therapy [2]. Brier ME, Stalker DJ, Aronoff GR, Batts DH, Ryan KK, OGrady M, et al. 8600 Rockville Pike The duration of hospitalization was 24.5715.58days and linezolid therapy duration was 7.405.75days. Of the patients in the linezolid group that developed thrombocytopenia, 30.3% had a platelet count<150,000/l, 13.7% had a platelet count<100,000/l and 4.6% had a platelet count<50,000/l. The non-significant variables are presented in Appendix 1. A retrospective study of the risk factors for linezolid-induced thrombocytopenia and anemia. Matsumoto K, Shigemi A, Takeshita A, Watanabe E, Yokoyama Y, Ikawa K, et al. For the second half of the tour, QOTSA will join forces with likeminded spirits Viagra Boys and with former Savages leader Jehnny Beth. The authors declare that they have no conflict of interest. Such differences may be at least partially attributable to the inclusion of patients from different racial groups, different clinical conditions and different definitions of thrombocytopenia. 2023 Mar;79(3):415-425. doi: 10.1007/s00228-023-03455-x. Earlyonset thrombocytopenia was defined as thrombocytopenia occurrence within 6days of linezolid treatment initiation. After controlling for other factors, only age and baseline platelet count were associated significantly with thrombocytopenia (OR 1.02; 95% CI 1.021.03; p<0.03) and (OR 0.99; 95% CI 0.930.98; p<0.0002), respectively (Table (Table44). Abdullah Althemery: conception or design of the work. La dure du traitement au linzolide tait de 14 jours (cart-type de 10). Nevertheless, the variation in thrombocytopenia definitions among these studies and their retrospective design might have influenced results [1416]. The mean time to the lowest thrombocytopenic platelet value was 21 (SD 15) days. The aims of this study are to determine potential risk factors for linezolid-induced thrombocytopenia, including early onset thrombocytopenia, and to analyze the influencing factors of different thrombocytopenia definitions. Health care professionals should remain vigilant in monitoring for thrombocytopenia for the entire duration of linezolid treatment. Firstly, we could not control for all confounding factors due to the retrospective design of the study. PubMed Table Table55 shows original and bootstrapped samples for different stages of thrombocytopenia. Introduction. Int J Clin Pharm-net. sharing sensitive information, make sure youre on a federal Soon after approval, reports surfaced of a higher incidence in clinical practice, reaching 48% [610]. 2002;46:27236. - 165.232.155.74. Binary logistic regression analysis indicated a significant correlation between shock and early-onset criterion-1 thrombocytopenia (adjusted OR=2.709, 95% CI=1.3595.398, p=0.005), and early-onset criterion-2 thrombocytopenia (adjusted OR=1.900, 95% CI=1.1133.243, p=0.019) after eliminating the confounding factors (Table 5). Data from repeat admissions of the same patient were included in the analysis. Conversely, this finding may be related to other factors. (Table 1). official website and that any information you provide is encrypted Proposed mechanisms include suppression of release of platelets from mature megakaryocytes [33], oxidative damage to circulating platelets [34] and immune-mediated platelet destruction [35, 36]. Ikuta S, Yasui C, Aihara T, Yoshie H, Iida H, Beppu N, Kurimoto A, Yanagi H, Mitsunobu M, Yamanaka N. Chronic liver disease increases the risk of linezolid-related thrombocytopenia in methicillin-resistant. Critical revision of the article. Higher plasma concentrations of linezolid have been identified as a risk factor for linezolid-induced thrombocytopenia.15,22 Furthermore, Brier and others24 showed that patients with renal impairment have higher concentrations of the 2 metabolites of linezolid. Risk factors associated with the development of thrombocytopenia in patients who received linezolid therapy. Linezolid therapy duration and shock were common causes of thrombocytopenia regardless of the definition. CAS Google Scholar. KaplanMeier analysis also indicated a higher cumulative thrombocytopenia incidence in shock patients than in those without shock (Fig. The weak association of risk factors to predict this adverse reaction and the wide use of linezolid are hurdles in implementing therapeutic drug monitoring (TDM). XN initiated the study and introduced the research question. Pharmacotherapy. 2022 Aug;11(4):1649-1660. doi: 10.1007/s40121-022-00663-3. Second, data were not available for all risk factors for all patients; for example, we were unable to analyze serum protein as a risk factor. The significant independent variables associated with thrombocytopenia are presented in Tables Tables22 and and33. Reduction of linezolid-associated thrombocytopenia by the dose adjustment based on the risk factors such as basal platelet count and body weight. The oxazolidinone linezolid inhibits initiation of protein synthesis in bacteria. The mean time to the first normal platelet value after discontinuation of linezolid was 6 (SD 5) days, based on data for 9 patients (data were unavailable for the other 9 patients). Diagn Micr Infec Dis. Epub 2015 Mar 2. Google Scholar. Ayshah Alshngeetee; Haya Aldabas; Layla AlBreacan; Renad Aljohani; Eid Hussein Alshahrani: Data collection. Recently, some cases of severe hyponatraemia occurring while receiving LZD have been reported. government site. The target was a convenience sample size of about 100 patients. Cross-resistance does not occur, since no other known antimicrobial agent inhibits this process. Patients known to have hematological malignancy such as leukemia or myelodysplastic syndrome, with confirmed heparin-induced thrombocytopenia, who received chemotherapy and with a baseline abnormal platelet count<150,000/l prior to therapy were excluded. The incidence rate of thrombocytopeina in the linezolid and vancomycin treatment groups was 37.7% and 22.3%, respectively, with a 0.05 alpha level and a power of 90%. Continuous data were expressed as meanSD values; and categorical data were expressed as frequencies. Data was de-identified prior to analysis so patient consent was not required. Linezolid has been associated with reversible myelosuppression. Accessibility In the vancomycin group the platelet count was <150,000/l in 8.5%, <100,000/l in 3.78% and<50,000/l in 1.89% of the patients. An official website of the United States government. 2005;365:6378. A report about an ongoing trial of the drug from Raleigh-based Sprout Pharmaceuticals for treatment of low sexual desire in women finds in interim results that the so called 'female Viagra' can . The safety concerns of this side effect and the potential need for discontinuation of effective drug therapy warrant further exploration of its frequency and associated risk factors. La thrombopnie a t dfinie comme un taux de plaquettes de moins de 100 109/L ou comme une rduction de 50 % de leur valeur initiale (cest--dire, avant lamorce du traitement au linzolide). The incidence and risk factors of LIT in neonatal patients were possibly different from other populations based on pathophysiological characteristics. Aim The aims of this study are to determine potential risk factors for linezolid-induced thrombocytopenia, and to analyze the influencing factors of different thrombocytopenia definitions. The higher frequency of thrombocytopenia among patients receiving concomitant UFH may relate to these patients having renal impairment, which would place them at higher risk of linezolid-induced thrombocytopenia. Google Scholar. Clinicians should monitor patients for linezolid-induced thrombocytopenia throughout therapy. [06.07.2007]. Characteristics of Patients with and without Thrombocytopenia. Risk factors for linezolid-induced thrombocytopenia included prolonged duration of therapy, renal impairment, and concomitant unfractionated heparin. We therefore defined thrombocytopenia as either a platelet count of<100109/L and a decrease in 25% or more from baseline of the platelet count, or a platelet count drop decrease of 25% or more from baseline. Interestingly, the first thrombocytopenic platelet value occurred within 14 days of initiation in 50% of the patients. Although vasopressor use might have served as a confounder to the higher rates of thrombocytopenia in the linezolid group, the difference was small at 31% vs. 24% for linezolid and vancomycin, respectively, and cannot be fully attributed to the higher rate of thrombocytopenia in the linezolid group. Background Previous reports about risk factors for linezolid-induced thrombocytopenia have been insufficient, often due to the variability in study design and population, and some factors have not yet been studied. High plasma linezolid concentration and impaired renal function affect development of linezolid-induced thrombocytopenia. It inhibits the activity of a broad range of gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), glycopeptide-intermediate S. aureus (GISA) and penicillin-resistant Streptococcus pneumoniae [1]. p<0.05 was considered to indicate a statistically significant difference. Before Analysis of thrombocytopenic effects and population pharmacokinetics of linezolid: a dosage strategy according to the trough concentration target and renal function in adult patients. This study was approved by the medical ethics committee of Xian Central Hospital (No. Drafting the article or revising it critically for important intellectual content. Similarly, via classification and regression tree analysis, the predictive factors of linezolid-induced thrombocytopenia at the beginning of treatment for early interventions have been identified as a platelet count reduction to less than 2.3% from baseline at 96 h after the initial dose and a linezolid concentration greater than or equal to 13 . However, there was no difference in thrombocytopenia incidence between ICU patients and non-ICU patients in our study, and shock was indicated as an independent risk factor. This was a retrospective, single-centre . government site. 1 Citations 4 Altmetric Metrics Abstract Introduction Linezolid and vancomycin have an important place among therapeutic antimicrobial options for multidrug-resistant gram-positive infections. Dix-huit patients (17,6 %) ont souffert de thrombopnie. Platelet count should be monitored during linezolid therapy especially during long-duration therapy and in shock patients. The sample size was estimated using the previous literature [1618]. Can J Hosp Pharm (2019 Mar-Apr) There are more references available in the full text version of this article. Nasraway et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Tajima M, Kato Y, Matsumoto J, Hirosawa I, Suzuki M, Takashio Y, et al. The site is secure. A significant number of studies reporting such a higher incidence involved Japanese patients, but whether this phenomenon reflects a higher rate of observation in this population or simply reflects research interest remains unclear [79, 1113]. The p values of log-rank tests for the different thrombocytopenia definitions (criterion 1, criterion 2, early-onset criterion-1 and early-onset criterion-2 thrombocytopenia) were 0.006, 0.021, 0.001 and 0.004, respectively (Fig. Adverse drug reactions spontaneously reported at a tertiary care hospital and preventable measures implemented. 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