Comparative evaluation of thrombocytopenia in adult patients receiving linezolid or glycopeptides in a respiratory intensive care unit

Zhang,Zhaorui; Liang,Zhixin; Li,Huaidong; Chen,Liang'an; She,Danyang

doi:10.3892/etm.2013.1437

Comparative evaluation of thrombocytopenia in adult patients receiving linezolid or glycopeptides in a respiratory intensive care unit

Authors:
- Zhaorui Zhang
- Zhixin Liang
- Huaidong Li
- Liang'an Chen
- Danyang She
View Affiliations

Affiliations: Department of Respiratory Medicine, Chinese PLA General Hospital, Haidian, Beijing, P.R. China, Department of Respiratory Disease, The 88th Hospital of Chinese PLA, Tai'an, Shandong, P.R. China
Published online on: December 4, 2013 https://doi.org/10.3892/etm.2013.1437
Pages: 501-507

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Linezolid is an oxazolidinone antibiotic agent, active against gram‑positive bacteria that are resistant to traditional antibiotics, including glycopeptides. Linezolid is generally well tolerated, but has been associated with hematologic adverse effects such as thrombocytopenia. The primary objective of this study was to compare the incidence of thrombocytopenia between patients receiving linezolid or glycopeptides in different age groups. The secondary objective was to assess the association between the time‑to‑event and occurrence of thrombocytopenia. This retrospective study reviewed the medical records of patients who were treated with linezolid or glycopeptides (vancomycin or teicoplanin) between January 2010 and June 2013 in a respiratory intensive care unit. Data were extracted from the patients' electronic medical records, which were obtained from a central database in the hospital, and multivariate analyses were performed. In total, the study included 225 patients who received linezolid or glycopeptides. The cumulative probability of thrombocytopenia was higher in the patients receiving linezolid than in those receiving glycopeptides (P<0.05), however the cumulative probability of thrombocytopenia did not differ significantly between patients receiving linezolid or glycopeptides in the subgroup whose age was <65 years (P>0.05). With a treatment duration of ≥7 days, the incidence of thrombocytopenia and the mean platelet count reduction in the patients receiving linezolid was significantly higher than in those receiving glycopeptides (P<0.05). No significant difference was identified in the mean platelet counts between the patients receiving linezolid and those receiving glycopeptides. In conclusion, it was identified that patients in a respiratory intensive care unit, aged ≥65 years or with a treatment duration of ≥7 days who were treated with linezolid were more likely to develop thrombocytopenia than patients of the same subgroup who were treated with glycopeptides.

View Figures

View References

1	Liu YN, Cao B, Wang H, et al: Adult hospital acquired pneumonia: a multicenter study on microbiology and clinical characteristics of patients from 9 Chinese cities. Zhonghua Jie He He Hu Xi Za Zhi. 35:739–746. 2012.(In Chinese).
2	Diekema DJ, Pfaller MA, Schmitz FJ, et al; SENTRY Partcipants Group. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis. 32(Suppl 2): S114–S132. 2001.PubMed/NCBI
3	Kim HB, Park WB, Lee KD, et al: Nationwide surveillance for Staphylococcus aureus with reduced susceptibility to vancomycin in Korea. J Clin Microbiol. 41:2279–2281. 2003.
4	Riska EB, Böstman O, von Bonsdorff H, et al: Outcome of closed injuries exceeding 20-unit blood transfusion need. Injury. 19:273–276. 1988. View Article : Google Scholar : PubMed/NCBI
5	Stéphan F, Hollande J, Richard O, Cheffi A, Maier-Redelsperger M and Flahault A: Thrombocytopenia in a surgical ICU. Chest. 115:1363–1370. 1999.
6	Baughman RP, Lower EE, Flessa HC and Tollerud DJ: Thrombocytopenia in the intensive care unit. Chest. 104:1243–1247. 1993. View Article : Google Scholar : PubMed/NCBI
7	Shalansky SJ, Verma AK, Levine M, Spinelli JJ and Dodek PM: Risk markers for thrombocytopenia in critically ill patients: a prospective analysis. Pharmacotherapy. 22:803–813. 2002. View Article : Google Scholar : PubMed/NCBI
8	Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C and Hahn EG: Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med. 30:1765–1771. 2002. View Article : Google Scholar : PubMed/NCBI
9	Vanderschueren S, De Weerdt A, Malbrain M, et al: Thrombocytopenia and prognosis in intensive care. Crit Care Med. 28:1871–1876. 2000. View Article : Google Scholar : PubMed/NCBI
10	Cawley MJ, Wittbrodt ET, Boyce EG and Skaar DJ: Potential risk factors associated with thrombocytopenia in a surgical intensive care unit. Pharmacotherapy. 19:108–113. 1999. View Article : Google Scholar : PubMed/NCBI
11	Akca S, Haji-Michael P, de Mendonça A, Suter P, Levi M and Vincent JL: Time course of platelet counts in critically ill patients. Crit Care Med. 30:753–756. 2002. View Article : Google Scholar : PubMed/NCBI
12	Wang HL, Aguilera C, Knopf KB, Chen TM, Maslove DM and Kuschner WG: Thrombocytopenia in the Intensive Care Unit. J Intensive Care Med. 28:268–280. 2013. View Article : Google Scholar : PubMed/NCBI
13	Patnode NM and Gandhi PJ: Drug-induced thrombocytopenia in the coronary care unit. J Thromb Thrombolysis. 10:155–167. 2000. View Article : Google Scholar : PubMed/NCBI
14	Soriano A, Ortega M, García S, et al: Comparative study of the effects of pyridoxine, rifampin, and renal function on hematological adverse events induced by linezolid. Antimicrob Agents Chemother. 51:2559–2563. 2007. View Article : Google Scholar : PubMed/NCBI
15	Gerson SL, Kaplan SL, Bruss JB, et al: Hematologic effects of linezolid: summary of clinical experience. Antimicrob Agents Chemother. 46:2723–2726. 2002. View Article : Google Scholar : PubMed/NCBI
16	Kohno S, Yamaguchi K, Aikawa N, et al: Linezolid versus vancomycin for the treatment of infections caused by methicillin-resistant Staphylococcus aureus in Japan. J Antimicrob Chemother. 60:1361–1369. 2007. View Article : Google Scholar : PubMed/NCBI
17	Stevens DL, Herr D, Lampiris H, Hunt JL, Batts DH and Hafkin B: Linezolid versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. 34:1481–1490. 2002. View Article : Google Scholar : PubMed/NCBI
18	Rubinstein E, Isturiz R, Standiford HC, et al: Worldwide assessment of linezolid’s clinical safety and tolerability: comparator-controlled phase III studies. Antimicrob Agents Chemother. 47:1824–1831. 2003.
19	Nasraway SA, Shorr AF, Kuter DJ, O’Grady N, Le VH and Cammarata SK: Linezolid does not increase the risk of thrombocytopenia in patients with nosocomial pneumonia: comparative analysis of linezolid and vancomycin use. Clin Infect Dis. 37:1609–1616. 2003. View Article : Google Scholar : PubMed/NCBI
20	Xu HB, Jiang RH, Li L and Xiao HP: Linezolid in the treatment of MDR-TB: a retrospective clinical study. Int J Tuberc Lung Dis. 16:358–363. 2012. View Article : Google Scholar : PubMed/NCBI
21	Attassi K, Hershberger E, Alam R and Zervos MJ: Thrombocytopenia associated with linezolid therapy. Clin Infect Dis. 34:695–698. 2002. View Article : Google Scholar : PubMed/NCBI
22	Niwa T, Suzuki A, Sakakibara S, et al: Retrospective cohort chart review study of factors associated with the development of thrombocytopenia in adult Japanese patients who received intravenous linezolid therapy. Clin Ther. 31:2126–2133. 2009. View Article : Google Scholar
23	Takahashi Y, Takesue Y, Nakajima K, et al: Risk factors associated with the development of thrombocytopenia in patients who received linezolid therapy. J Infect Chemother. 17:382–387. 2011. View Article : Google Scholar : PubMed/NCBI
24	Le Moyec L, Racine S, Le Toumelin P, et al: Aminoglycoside and glycopeptide renal toxicity in intensive care patients studied by proton magnetic resonance spectroscopy of urine. Crit Care Med. 30:1242–1245. 2002.PubMed/NCBI
25	Xie L, He S, Fu L, et al: The prevalence and risk factors of thrombocytopenia after living-related renal transplantation in Chinese adult recipients. Transplant Proc. 45:197–199. 2013. View Article : Google Scholar : PubMed/NCBI
26	Falagas ME, Siempos II and Vardakas KZ: Linezolid versus glycopeptide or beta-lactam for treatment of Gram-positive bacterial infections: meta-analysis of randomised controlled trials. Lancet Infect Dis. 8:53–66. 2008. View Article : Google Scholar : PubMed/NCBI
27	Kalil AC, Murthy MH, Hermsen ED, Neto FK, Sun J and Rupp ME: Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Crit Care Med. 38:1802–1808. 2010. View Article : Google Scholar : PubMed/NCBI
28	Patel N, VanDeWall H, Tristani L, et al: A comparative evaluation of adverse platelet outcomes among Veterans’ Affairs patients receiving linezolid or vancomycin. J Antimicrob Chemother. 67:727–735. 2012.PubMed/NCBI
29	An MM, Shen H, Zhang JD, Xu GT and Jiang YY: Linezolid versus vancomycin for meticillin-resistant Staphylococcus aureus infection: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents. 41:426–433. 2013. View Article : Google Scholar : PubMed/NCBI
30	Hiraki Y, Tsuji Y, Hiraike M, et al: Correlation between serum linezolid concentration and the development of thrombocytopenia. Scand J Infect Dis. 44:60–64. 2012. View Article : Google Scholar : PubMed/NCBI
31	Orrick JJ, Johns T, Janelle J and Ramphal R: Thrombocytopenia secondary to linezolid administration: what is the risk? Clin Infect Dis. 35:348–349. 2002. View Article : Google Scholar : PubMed/NCBI
32	Chen C, Guo D, Cao X, et al: Risk factors for thrombocytopenia in adult chinese patients receiving linezolid therapy. Curr Ther Res Clin Exp. 73:195–206. 2012. View Article : Google Scholar : PubMed/NCBI