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AL Qamariat Z, Aljaffar AA, Alabdulaal ZS, Alnezir F, Al-Zawad WM, Alqattan M, Almahdi A. Rapid Onset and Recovery Linezolid-Induced Thrombocytopenia: A Large-Sample, Single-Center Retrospective Cohort Study. Drug Healthc Patient Saf 2024; 16:43-49. [PMID: 38800628 PMCID: PMC11127688 DOI: 10.2147/dhps.s458284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Thrombocytopenia is a common and potentially severe adverse effect of linezolid, but the time to onset during treatment has varied substantially across studies. Moreover, the time to recovery after linezolid withdrawal has not been examined in a larger patient sample. Objective The first objective of this study was to measure the mean time to linezolid-induced thrombocytopenia (LIT) and the second was to measure the mean time to recovery after linezolid discontinuation. Methods A retrospective observational cohort study was conducted between January 2017 and December 2022 at Dammam Medical Complex using the medical records of hospitalized adults with normal baseline platelet counts receiving intravenous linezolid for a minimum of 48 hours. All patients included in the analyses received daily platelet count monitoring for up to 14 days after linezolid initiation and 14 days after discontinuation. Thrombocytopenia was defined as a drop in platelet count to <150 × 109/L or <50% of baseline within 14 days. The dose duration-risk relationship and recovery rate were analyzed by constructing Kaplan-Meier survival curves. Results In total, 334 patients met study inclusion criteria. The mean time to develop thrombocytopenia after starting linezolid was five days, and the mean time of recovery was also 5 days. The cumulative risk of thrombocytopenia reached 100% by day six of therapy, and cumulative recovery reached 100% by day six after linezolid withdrawal, with half of the study population recovering by day four. Conclusion Thrombocytopenia can develop rapidly during linezolid treatment, but recovery after discontinuation is also rapid. Rapid thrombocytopenia is a common adverse effect of linezolid that must be considered prior to prescription, and routine monitoring of platelet count is recommended so that linezolid treatment can be discontinued, if thrombocytopenia occurs.
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Affiliation(s)
- Zahra AL Qamariat
- Pharmaceutical Affairs, Dammam Health Network, Dammam, Eastern Province, Saudi Arabia
| | - Amnah A Aljaffar
- Pharmaceutical Affairs, Dammam Health Network, Dammam, Eastern Province, Saudi Arabia
| | | | - Fatima Alnezir
- Pharmaceutical Affairs, Dammam Health Network, Dammam, Eastern Province, Saudi Arabia
| | - Weaam M Al-Zawad
- Pharmaceutical Affairs, Dammam Health Network, Dammam, Eastern Province, Saudi Arabia
| | - Mohammed Alqattan
- Pharmacy Department, Saudi German Hospital, Dammam, Eastern Province, Saudi Arabia
| | - Abdulmohsen Almahdi
- Pharmacy Department, Saudi German Hospital, Dammam, Eastern Province, Saudi Arabia
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Kovacevic P, Milakovic D, Kovacevic T, Barisic V, Dragic S, Zlojutro B, Miljkovic B, Vucicevic K, Rizwan Z. Thrombocytopenia risks in ARDS COVID-19 patients treated with high-dose linezolid during vvECMO therapy: an observational study. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03136-1. [PMID: 38713258 DOI: 10.1007/s00210-024-03136-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
Patients treated with ECMO are at great risk of nosocomial infections, and around 10% of isolates are gram-positive pathogens. Linezolid (LZD) is effective in the treatment of these infections but appropriate dosing is challenging. The aim was to evaluate the occurrence of thrombocytopenia during ECMO when treated with LZD. An LZD trough concentration of 8 mg/L was set as the cutoff value for thrombocytopenia occurrence among critically ill patients who received parenteral LZD therapy at a dose of 600 mg every 8 h during ECMO. Eleven patients were included in this prospective observational study. Median LZD trough concentrations were 7.85 (interquartile range (IQR), 1.95-11) mg/L. Thrombocytopenia was found in 81.8% of patients. Based on the median LZD trough concentrations cutoff value, patients were divided into two groups, 1.95 (IQR, 0.91-3.6) and 10.3 (IQR, 9.7-11.7) mg/L, respectively. Median platelet values differed significantly between groups on admission, ECMO day 0, ECMO day 1, and LZD sampling day [194 and 152.5, (p < 0.05)], [113 and 214, (p < 0.05)], [76 and 147.5, (p < 0.01)], and [26 and 96.5, (p < 0.01)], respectively. Duration of LZD therapy was similar between the groups. Significant platelet reduction was observed in both groups, emphasizing the need for closer monitoring to prevent LZD-associated thrombocytopenia.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina.
| | - Dragana Milakovic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Vedrana Barisic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Branislava Miljkovic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade Faculty of Pharmacy, Vojvode Stepe 40, 11221, Belgrade, Republic of Serbia
| | - Katarina Vucicevic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade Faculty of Pharmacy, Vojvode Stepe 40, 11221, Belgrade, Republic of Serbia
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Wang W, Li Z, Gordeev MF, Yuan H. Preclinical toxicity evaluation of novel antibacterial contezolid acefosamil in rats and dogs. J Appl Toxicol 2024; 44:770-783. [PMID: 38237604 DOI: 10.1002/jat.4579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 04/16/2024]
Abstract
Contezolid acefosamil (CZA) is an intravenous prodrug of oxazolidinone antibiotic contezolid (CZD). It is being developed to treat infections due to Gram-positive bacteria including multidrug-resistant pathogens, while addressing myelosuppression and neurotoxicity limitations associated with long-term use of this class of antibiotics. In vivo, CZA is rapidly deacylated into its first metabolite MRX-1352, which is then dephosphorylated to release active drug CZD. Four-week repeat-dose toxicity studies of intravenous CZA were conducted in Sprague-Dawley rats (40, 80, and 160/120 mg/kg/dose twice a day [BID]) and beagle dogs (25, 50, and 100/75 mg/kg/dose BID). The high doses administered to both rats and dogs were adjusted due to adverse effects including decreased body weight and food consumption. Additionally, a dose-dependent transient reduction in erythrocyte levels was recorded at the end of dosing phase. Importantly, no myelosuppressive reduction in platelet counts was observed, in contrast to the myelosuppression documented for standard-of-care oxazolidinone linezolid. The no-observed-adverse-effect level (NOAEL) of CZA was 80 and 25 mg/kg/dose BID in rats and dogs, respectively. Separately, 3-month neuropathological evaluation in Long-Evans rats (25, 37.5, and 50 mg/kg/dose, oral CZA, BID) demonstrated no neurotoxicity in the central, peripheral, and optical neurological systems. Toxicokinetic data from these studies revealed that CZD exposures at NOAELs were higher than or comparable with that for the intended clinical dose. These results confirm the favorable safety profile for CZA and support its clinical evaluation for long-term therapy of persistent Gram-positive infections, beyond the application for earlier oxazolidinones.
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Affiliation(s)
- Wen Wang
- MicuRx Pharmaceuticals, Inc., Foster City, California, USA
| | - Zhengyao Li
- Shanghai MicuRx Pharmaceutical, Co., Ltd., Shanghai, China
| | | | - Hong Yuan
- Shanghai MicuRx Pharmaceutical, Co., Ltd., Shanghai, China
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Thabit AK, Alghamdi AA, Alsaeed AK, Magbool NM, Alsowaida YS, Mahrous AJ, Alruwaili A, Albakistani ZK, Albangali BO, Alghumuy AM, Youssef SA, Alodayli RM, Almutairi MS. Linezolid-Associated Thrombocytopenia: Assessment of Risk Factors in Patients without Hemato-Oncologic Diseases. J Clin Med 2024; 13:2380. [PMID: 38673653 PMCID: PMC11050941 DOI: 10.3390/jcm13082380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Linezolid is used for Gram-positive bacterial infections. Thrombocytopenia is one of its main adverse effects resulting from myelosuppression. Several studies have assessed risk factors that may increase the risk of this adverse effect. However, most studies included patients with hemato-oncologic diseases, which may confound such assessments. This study aimed to investigate risk factors for linezolid-associated thrombocytopenia in patients without hemato-oncologic diseases. Methods: This was a multicenter retrospective case-control study of adult patients treated with linezolid twice daily for ≥3 days. Patients with hemato-oncologic diseases, active dengue fever, active COVID-19, baseline platelet count <100 × 103/mm3, concurrent therapy with trimethoprim/sulfamethoxazole or valproic acid, and a recent platelet transfusion within 7 days were excluded. Thrombocytopenia was defined as a drop in platelet count below 100 × 103/mm3. Results: Out of 158 evaluated patients, 33 developed thrombocytopenia, indicating an incidence rate of 20.9%. Of all the risk factors assessed, creatinine clearance of <60 mL/min and bacteremia/infective endocarditis were significantly associated with linezolid-associated thrombocytopenia (adjusted odds ratios, 3.25 and 5.95; 95% CI 1.12-9.45 and 1.23-28.66; p = 0.031 and 0.026, respectively). End of therapy platelet counts were significantly lower in the cases than in the controls (79 vs. 243 × 103/mm3; p < 0.001). Similarly, the percentage of platelet count change was significantly different (-55.1% vs. -10.2%; p < 0.001). Conclusions: In our study, the incidence rate of linezolid-associated thrombocytopenia was 20.9%, and we found that patients with renal impairment and bacteremia may need close monitoring of platelet counts. Prospective studies are warranted to evaluate the potential need for renal dose adjustment.
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Affiliation(s)
- Abrar K. Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Arwa A. Alghamdi
- Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Afnan K. Alsaeed
- Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Nesereen M. Magbool
- Faculty of Pharmacy, King Abdulaziz University, Jeddah 22254-2265, Saudi Arabia
| | - Yazed S. Alsowaida
- Department of Clinical Pharmacy, College of Pharmacy, University of Ha’il, Hail 55473, Saudi Arabia
| | - Ahmad J. Mahrous
- Clinical Pharmacy Department, College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Alya Alruwaili
- Department of Pharmaceutical Care, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | | | | | - Anas M. Alghumuy
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Sara A. Youssef
- Department of Pharmaceutical Care, Saudi German Hospital, Hail 55481, Saudi Arabia
| | - Reem M. Alodayli
- Department of Pharmaceutical Care, Saudi German Hospital, Hail 55481, Saudi Arabia
| | - Masaad Saeed Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia;
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Patel A, Doernberg SB, Zack T, Butte AJ, Radtke KK. Predictive Modeling of Drug-Related Adverse Events with Real-World Data: A Case Study of Linezolid Hematologic Outcomes. Clin Pharmacol Ther 2024; 115:847-859. [PMID: 38345264 DOI: 10.1002/cpt.3201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
Electronic health records (EHRs) provide meaningful knowledge of drug-related adverse events (AEs) that are not captured in standard drug development and postmarketing surveillance. Using variables obtained from EHR data in the University of California San Francisco de-identified Clinical Data Warehouse, we aimed to evaluate the potential of machine learning to predict two hematological AEs, thrombocytopenia and anemia, in a cohort of patients treated with linezolid for 3 or more days. Features for model input were extracted at linezolid initiation (index), and outcomes were characterized from index to 14 days post-treatment. Random forest classification (RFC) was used for AE prediction, and reduced feature models were evaluated using cumulative importance (cImp) for feature selection. Grade 3+ thrombocytopenia and anemia occurred in 31% of 2,171 and 56% of 2,170 evaluable patients, respectively. Of the total 53 features, as few as 7 contributed at least 50% cImp, resulting in prediction accuracies of 70% or higher and area under the receiver operating characteristic curves of 0.886 for grade 3+ thrombocytopenia and 0.759 for grade 3+ anemia. Sensitivity analyses in strictly defined patient subgroups revealed similarly high predictive performance in full and reduced feature models. A logistic regression model with the same 50% cImp features showed similar predictive performance as RFC and good concordance with RFC probability predictions after isotonic calibration, adding interpretability. Collectively, this work demonstrates potential for machine learning prediction of AE risk in real-world patients using few variables regularly available in EHRs, which may aid in clinical decision making and/or monitoring.
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Affiliation(s)
- Anu Patel
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Travis Zack
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Atul J Butte
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
- University of California Health, University of California, Office of the President, Oakland, California, USA
| | - Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
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Qin Y, Chen Z, Gao S, Shen Y, Ye Y. Development and validation of a risk prediction model for linezolid-induced thrombocytopenia in elderly patients. Eur J Hosp Pharm 2024; 31:94-100. [PMID: 35477677 PMCID: PMC10895188 DOI: 10.1136/ejhpharm-2022-003258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Linezolid 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. METHODS A 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. RESULTS A 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. CONCLUSIONS These 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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Affiliation(s)
- Yan Qin
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Zhe Chen
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Shuai Gao
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yun Shen
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Yanrong Ye
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
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Zhao X, Peng Q, Hu D, Li W, Ji Q, Dong Q, Huang L, Piao M, Ding Y, Wang J. Prediction of risk factors for linezolid-induced thrombocytopenia based on neural network model. Front Pharmacol 2024; 15:1292828. [PMID: 38449807 PMCID: PMC10915059 DOI: 10.3389/fphar.2024.1292828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
Background: Based on real-world medical data, the artificial neural network model was used to predict the risk factors of linezolid-induced thrombocytopenia to provide a reference for better clinical use of this drug and achieve the timely prevention of adverse reactions. Methods: The artificial neural network algorithm was used to construct the prediction model of the risk factors of linezolid-induced thrombocytopenia and further evaluate the effectiveness of the artificial neural network model compared with the traditional Logistic regression model. Results: A total of 1,837 patients receiving linezolid treatment in a hospital in Xi 'an, Shaanxi Province from 1 January 2011 to 1 January 2021 were recruited. According to the exclusion criteria, 1,273 cases that did not meet the requirements of the study were excluded. A total of 564 valid cases were included in the study, with 89 (15.78%) having thrombocytopenia. The prediction accuracy of the artificial neural network model was 96.32%, and the AUROC was 0.944, which was significantly higher than that of the Logistic regression model, which was 86.14%, and the AUROC was 0.796. In the artificial neural network model, urea, platelet baseline value and serum albumin were among the top three important risk factors. Conclusion: The predictive performance of the artificial neural network model is better than that of the traditional Logistic regression model, and it can well predict the risk factors of linezolid-induced thrombocytopenia.
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Affiliation(s)
- Xian Zhao
- Department of Pharmacy, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Qin Peng
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Dongmei Hu
- Department of Pharmacy, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Weiwei Li
- Department of Pharmacy, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Qing Ji
- Department of Pharmacy, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Qianqian Dong
- Department of Pharmacy, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Luguang Huang
- Department of Information, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Miyang Piao
- Department of Pharmacy, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Yi Ding
- Department of Pharmacy, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Jingwen Wang
- Department of Pharmacy, First Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
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Zou F, Cui Z, Lou S, Ou Y, Zhu C, Shu C, Chen J, Zhao R, Wu Z, Wang L, Chen Z, Chen H, Lan Y. Adverse drug events associated with linezolid administration: a real-world pharmacovigilance study from 2004 to 2023 using the FAERS database. Front Pharmacol 2024; 15:1338902. [PMID: 38434706 PMCID: PMC10904462 DOI: 10.3389/fphar.2024.1338902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction: Linezolid is an oxazolidinone antibiotic that is active against drug-resistant Gram-positive bacteria and multidrug-resistant Mycobacterium tuberculosis. Real-world studies on the safety of linezolid in large populations are lacking. This study aimed to determine the adverse events associated with linezolid in real-world settings by analyzing data from the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). Methods: We retrospectively extracted reports on adverse drug events (ADEs) from the FAERS database from the first quarter of 2004 to that of 2023. By using disproportionality analysis including reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian Confidence Propagation Neural Network (BCPNN), along with the multi-item gamma Poisson shrinker (MGPS), we evaluated whether there was a significant association between linezolid and ADE. The time to onset of ADE was further analyzed in the general population and within each age, weight, reporting population, and weight subgroups. Results: A total of 11,176 reports of linezolid as the "primary suspected" drug and 263 significant adverse events of linezolid were identified, including some common adverse events such as thrombocytopenia (n = 1,139, ROR 21.98), anaemia (n = 704, ROR 7.39), and unexpected signals that were not listed on the drug label such as rhabdomyolysis (n = 90, ROR 4.33), and electrocardiogram QT prolonged (n = 73, ROR 4.07). Linezolid-induced adverse reactions involved 27 System Organ Class (SOC). Gender differences existed in ADE signals related to linezolid. The median onset time of all ADEs was 6 days, and most ADEs (n = 3,778) occurred within the first month of linezolid use but some may continue to occur even after a year of treatment (n = 46). Conclusion: This study reports the time to onset of adverse effects in detail at the levels of SOC and specific preferred term (PT). The results of our study provide valuable insights for optimizing the use of linezolid and reducing potential side effects, expected to facilitate the safe use of linezolid in clinical settings.
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Affiliation(s)
- Fan Zou
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhiwei Cui
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Siyu Lou
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yingyong Ou
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Chengyu Zhu
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Chengjie Shu
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Junyou Chen
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Ruizhen Zhao
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhu Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Li Wang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhenyong Chen
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Huayu Chen
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yuanbo Lan
- Department of Tuberculosis, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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9
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Zhang D, Xu Y, Wang X, Hou L, Xing M, Xu S, Guo R, Luo Y. Risk factors for thrombocytopenia in patients receiving linezolid therapy: a systematic review and meta-analysis. Eur J Clin Pharmacol 2023; 79:1303-1314. [PMID: 37578552 DOI: 10.1007/s00228-023-03542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The incidence of linezolid-induced thrombocytopenia (LIT) has been reported to vary widely across studies. We performed a meta-analysis to identify the risk factors for thrombocytopenia among patients who received linezolid treatment. METHODS The PubMed, Embase and Cochrane Library databases were searched from inception to November 2022 to identify eligible studies. Data on the potential predictors of incidence in LIT were pooled using a random effects model. Sensitivity analyses were performed to determine the robustness of the results when significant heterogeneity was observed. RESULTS Forty observational studies involving 6454 patients treated with linezolid were included in the analysis. LIT was estimated to occur in 37% of patients. The following important factors were associated with the incidence of LIT: advanced age, body mass index, concurrent renal impairment or liver disease, abnormal laboratory parameters (including white blood cell count, serum creatinine, baseline platelet count, albumin, creatinine clearance rate, and estimated glomerular filtration rate), treatment duration and renal replacement therapy. CONCLUSIONS A variety of risk factors related to the occurrence of LIT were revealed in our analysis. Early identification of these factors could help patients improve clinical outcomes.
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Affiliation(s)
- Dan Zhang
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yasi Xu
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Wang
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Leping Hou
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengyu Xing
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Xu
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Guo
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Luo
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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10
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Zhang L, Yan Y, Liao R, Dong H. Effect of Platelet Parameters on Linezolid-Related Thrombocytopenia in Hospitalized Patients. Infect Drug Resist 2023; 16:6145-6154. [PMID: 37719650 PMCID: PMC10505032 DOI: 10.2147/idr.s408102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
Background Linezolid-induced thrombocytopenia incidence varies considerably. Linezolid-related thrombocytopenia in patients has received few studies which have investigated risk factors including platelet parameters except for platelet counts. The study aims to analyze the effect of platelet parameters, including mean platelet volume and platelet large cell ratio, on linezolid-related thrombocytopenia in patients. Methods The effect of platelet parameters on linezolid-related thrombocytopenia was identified by univariate and multivariate logistic regressions. A Kaplan-Meier survival analysis was carried out to compare the survival of patients who developed linezolid-related thrombocytopenia with patients who did not. Results Thrombocytopenia occurred at a rate of 41.5% (66/159) after linezolid therapy in hospitalized patients. Platelet parameters, including the difference in mean platelet volume (MPV/fL=0.08 (-1.2-0.9)vs-0.5 (-1.5-0.3), (OR, 0.459; P = 0.001), the difference in platelet large cell ratio (PLCR/fL=0.9 (-5.1-6.2)vs-3.8 (-8.6-2.4), (OR, 1.156; P = 0.001), baseline platelet counts (OR, 0.995; P = 0.006) and duration of linezolid therapy≥10d (OR, 1.346; P = 0.007), were significantly associated with linezolid-related thrombocytopenia in hospitalized patients. In addition, other risk factors which also are associated with linezolid-related thrombocytopenia include baseline red blood cells, co-medication with parecoxib and co-medication with caspofungin. Accumulated in-hospital mortality of patients with thrombocytopenia was significantly higher than that of patients without thrombocytopenia during linezolid treatment (19.7% vs 8.6%, P = 0.003). Conclusion The difference in mean platelet volume, the difference in large platelet ratio, baseline platelet counts and duration of linezolid therapy≥10d significantly affected the development of linezolid-related thrombocytopenia in hospitalized patients.
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Affiliation(s)
- Lu Zhang
- Department of Pharmacy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
| | - Yan Yan
- Department of Pharmacy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
| | - Ru Liao
- Department of Pharmacy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
| | - Haiyan Dong
- Department of Pharmacy, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, People’s Republic of China
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11
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Tatsumi H, Akatsuka M, Kuroda H, Kazuma S, Suzuki S, Masuda Y. Effect of linezolid on platelet count in critically ill patients with thrombocytopenia. PLoS One 2023; 18:e0286088. [PMID: 37384758 PMCID: PMC10310034 DOI: 10.1371/journal.pone.0286088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Linezolid (LZD) is one of the antibiotics used to treat methicillin-resistant Staphylococcus aureus. In Japan, the dose of LZD is not generally adjusted by renal function or therapeutic drug monitoring and is readily available for critically ill patients. The adverse effects of LZD include pancytopenia, especially thrombocytopenia. We investigated the effect of LZD on platelet counts in critically ill patients with thrombocytopenia during admission to the intensive care unit (ICU). METHODS Fifty-five critically ill patients with existing thrombocytopenia (platelet count < 100 ×103 /μL) who received LZD for five days or more during the period from January 2011 to October 2018 were included. Changes in platelet count and frequency of platelet concentrate (PC) transfusion were evaluated retrospectively. RESULTS Mean (± standard error) platelet count prior to initiation of LZD was 47 ± 4 ×103 /uL, which increased significantly to 86 ± 13 ×103 /uL on day 15 (p<0.01). Median [interquartile range] duration of LZD therapy was 9 [8-12] days. Thirty-two patients (58.2%) required PC transfusion in the 15-day study period. The daily rate of PC transfusion decreased from 30.2% on days 1-5 to 18.2% on days 11-15. Similar tendencies were observed in patients with non-hematological and hematological disease. CONCLUSION Thrombocytopenia in critically ill patients in the ICU did not worsen after initiation of LZD therapy, and may be considered for the treatment of MRSA in this setting.
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Affiliation(s)
- Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Masayuki Akatsuka
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiromitsu Kuroda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Satoshi Kazuma
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shintaro Suzuki
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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12
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Applications of Artificial Intelligence in Thrombocytopenia. Diagnostics (Basel) 2023; 13:diagnostics13061060. [PMID: 36980370 PMCID: PMC10047875 DOI: 10.3390/diagnostics13061060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/26/2023] [Accepted: 03/04/2023] [Indexed: 03/15/2023] Open
Abstract
Thrombocytopenia is a medical condition where blood platelet count drops very low. This drop in platelet count can be attributed to many causes including medication, sepsis, viral infections, and autoimmunity. Clinically, the presence of thrombocytopenia might be very dangerous and is associated with poor outcomes of patients due to excessive bleeding if not addressed quickly enough. Hence, early detection and evaluation of thrombocytopenia is essential for rapid and appropriate intervention for these patients. Since artificial intelligence is able to combine and evaluate many linear and nonlinear variables simultaneously, it has shown great potential in its application in the early diagnosis, assessing the prognosis and predicting the distribution of patients with thrombocytopenia. In this review, we conducted a search across four databases and identified a total of 13 original articles that looked at the use of many machine learning algorithms in the diagnosis, prognosis, and distribution of various types of thrombocytopenia. We summarized the methods and findings of each article in this review. The included studies showed that artificial intelligence can potentially enhance the clinical approaches used in the diagnosis, prognosis, and treatment of thrombocytopenia.
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13
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Inoue Y, Takekuma Y, Miyai T, Kashiwagi H, Sato Y, Sugawara M, Imai S. Use of Japanese big data from electronic medical records to investigate risk factors and identify their high-risk combinations for linezolid-induced thrombocytopenia. Eur J Clin Pharmacol 2023; 79:415-425. [PMID: 36715711 DOI: 10.1007/s00228-023-03455-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE Thrombocytopenia is a major event associated with linezolid (LZD) therapy. Factors affecting LZD-induced thrombocytopenia (LIT) have been reported in previous studies. However, several issues pertaining to LIT have not yet been clarified. In the present study, we used Japanese big data to investigate associated factors and their high-risk combinations that influence LIT. METHODS Patients administered LZD between May 2006 and October 2020 were included in this study. LIT was defined as either a 30% or more reduction from the baseline platelets or platelet values of < 100,000/µL. We evaluated factors affecting LIT and combinations of factors that alter LIT risk according to a decision tree (DT) analysis, a typical machine learning method. RESULTS We successfully enrolled 1399 patients and LIT occurred in 44.7% of the patients (n = 626). We classified the laboratory data on renal function, LZD duration, age, and body weight (BW) into smaller categories. The results of multivariate analysis showed that prolonged LZD therapy, BW < 45 kg, estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2, and dialysis were risk factors for LIT. The DT analysis revealed that the highest risk was a combination of LZD duration ≥ 14 days and eGFR < 30 mL/min/1.73 m2. CONCLUSIONS The present study extracted four risk factors and identified high-risk combinations for LIT. Patients with these risk factors should be closely monitored.
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Affiliation(s)
- Yuki Inoue
- Graduate School of Life Science, Hokkaido University, Kita 10-Jo, Nishi 8-Chome, Kita-Ku, Sapporo, 060-0810, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan
| | - Takayuki Miyai
- Graduate School of Life Science, Hokkaido University, Kita 10-Jo, Nishi 8-Chome, Kita-Ku, Sapporo, 060-0810, Japan
| | - Hitoshi Kashiwagi
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-Jo, Nishi 6-Chome, Kita-Ku, Sapporo, 060-0812, Japan
| | - Yuki Sato
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-Jo, Nishi 6-Chome, Kita-Ku, Sapporo, 060-0812, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita 14-Jo, Nishi 5-Chome, Kita-Ku, Sapporo, 060-8648, Japan.,Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-Jo, Nishi 6-Chome, Kita-Ku, Sapporo, 060-0812, Japan.,Global Station for Biosurfaces and Drug Discovery, Hokkaido University, Kita 12-Jo, Nishi 6-Chome, Kita-Ku, Sapporo, 060-0812, Japan
| | - Shungo Imai
- Faculty of Pharmaceutical Sciences, Hokkaido University, Kita 12-Jo, Nishi 6-Chome, Kita-Ku, Sapporo, 060-0812, Japan. .,Faculty of Pharmacy, Keio University, 1-5-30 Shibakouen, Minato-Ku, Tokyo, 105-8512, Japan.
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14
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Li T, Chen YX, Lin JJ, Lin WX, Zhang WZ, Dong HM, Cai SX, Meng Y. Successful treatment of disseminated nocardiosis diagnosed by metagenomic next-generation sequencing: A case report and review of literature. World J Clin Cases 2022; 10:10120-10129. [PMID: 36246801 PMCID: PMC9561593 DOI: 10.12998/wjcc.v10.i28.10120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/25/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nocardia paucivorans is an infrequently found bacterium with the potential to cause severe infection, with a predilection for the central nervous system, both in immunocompromised and immunocompetent individuals. Rapid etiological diagnosis of nocardiosis can facilitate timely and rational antimicrobial treatment. Metagenomic next-generation sequencing (mNGS) can improve the rate and reduce the turnaround time for the detection of Nocardia.
CASE SUMMARY A 49-year-old man was admitted to hospital with cough and hemoptysis. Imaging revealed pulmonary consolidation as well as multiple brain lesions. Nocardia asiatica and Nocardia beijingensis were rapidly detected by mNGS of bronchoalveolar lavage fluid (BALF) while bacterial culture of BALF and pathological biopsy of lung tissue were negative. In early stages, he was treated with trimethoprim-sulfamethoxazole (TMP-SMZ) and linezolid by individual dose adjustment based on serum concentrations and the adverse effects of thrombocytopenia and leukopenia. The treatment was then replaced by TMP-SMZ and ceftriaxone or minocycline. He was treated with 8 mo of parenteral and/or oral antibiotics, and obvious clinical improvement was achieved with resolution of pulmonary and brain lesions on repeat imaging.
CONCLUSION mNGS provided fast and precise pathogen detection of Nocardia. In disseminated nocardiosis, linezolid is an important alternative that can give a better outcome with the monitoring of linezolid serum concentrations and platelet count.
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Affiliation(s)
- Ting Li
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yi-Xin Chen
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Jia-Jia Lin
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wei-Xian Lin
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wei-Zhen Zhang
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Hang-Ming Dong
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Shao-Xi Cai
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Ying Meng
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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15
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Huo BN, Wu YE, Shu L, Zhang RQ, Xiao JW, Li QB, Zhao W, Jia YT, Song L. Relationship Between Linezolid Exposure and the Typical Clinical Laboratory Safety and Bacterial Clearance in Chinese Pediatric Patients. Front Pharmacol 2022; 13:926711. [PMID: 35979237 PMCID: PMC9377148 DOI: 10.3389/fphar.2022.926711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: There have been limited studies concerning the safety and efficacy of linezolid (LZD) in children. This study aimed to evaluate the association between LZD exposure and clinical safety and efficacy in Chinese pediatric patients. Methods: This retrospective cross-sectional study included patients ≤18 years of age who received ≥3 days of LZD treatment between 31 January 2015, and 31 December 2020. Demographic characteristics, medication information, laboratory test information, and bacterial culture results were collected from the Hospital Information System (HIS). Exposure was defined as AUC24 and calculated by the non-linear mixed-effects modeling program (NONMEM), version 7.2, based on two validated population pharmacokinetic models. Binary logistic regression analyses were performed to analyze the associations between AUC24 and laboratory adverse events, and receiver operating characteristic curves were used to calculate the cut-off values. Efficacy was evaluated by bacterial clearance. Results: A total of 413 paediatric patients were included, with an LZD median (interquartile range) dose, duration, clearance and AUC24 of 30.0 (28.1-31.6) mg/kg/day, 8 (4‒15) days,1.31 (1.29-1.32) L/h and 81.1 (60.6-108.7) mg/L·h, respectively. Adverse events associated with TBil, AST, ALT, PLT, hemoglobin, WBC, and neutrophil count increased during and after LZD treatment when compared with before medication (p < 0.05), and the most common adverse events were thrombocytopaenia (71/399, 17.8%) and low hemoglobin (61/401, 15.2%) during the LZD treatment. Patients with AUC24 higher than 120.69 mg/L h might be associated with low hemoglobin 1–7 days after the end of the LZD treatment, and those with an AUC24 higher than 92.88 mg/L∙h might be associated with thrombocytopaenia 8–15 days after the end of the LZD treatment. A total of 136 patients underwent bacterial culture both before and after LZD treatment, and the infection was cleared in 92.6% (126/136) of the patients, of whom 69.8% (88/126) had AUC24/MIC values greater than 80. Conclusion: Hematological indicators should be carefully monitored during LZD treatment, especially thrombocytopaenia and low hemoglobin, and a continuous period of monitoring after LZD withdrawal is also necessary. Since the AUC24 cut-off values for laboratory adverse events were relatively low, a trade-off is necessary between the level of drug exposure required for treatment and safety, and the exposure target (AUC24/MIC) in pediatric patients should be further studied, especially for patients with complications and concomitant medications.
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Affiliation(s)
- Ben-Nian Huo
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yue-E. Wu
- Key Laboratory of Chemical Biology (Ministry of Education), Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ling Shu
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Ruo-Qi Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Key Laboratory of Standardization for Chinese Herbal Medicine, School of Pharmacy, Ministry of Education, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jian-Wen Xiao
- Department of Hematology, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Qian-Bo Li
- Department of Information Center, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhao
- Key Laboratory of Chemical Biology (Ministry of Education), Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Yun-Tao Jia
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yun-Tao Jia, ; Lin Song,
| | - Lin Song
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yun-Tao Jia, ; Lin Song,
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16
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Al-Harbi D, Alturaiki A, Alshngeetee A, Aldabas H, AlBreacan L, Aljohani R, Alshahrani EH, Althemery A, Esba LCA. Linezolid vs Vancomycin in Induced Thrombocytopenia. Infect Dis Ther 2022; 11:1649-1660. [PMID: 35727490 PMCID: PMC9334466 DOI: 10.1007/s40121-022-00663-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Linezolid and vancomycin have an important place among therapeutic antimicrobial options for multidrug-resistant gram-positive infections. Thrombocytopenia is an adverse effect reported with both and can lead to treatment interruption. Our objective was to compare the incidence of thrombocytopenia in patients receiving linezolid or vancomycin and to identify risk factors associated with thrombocytopenia. METHODS This was a retrospective observational cohort study that involved patients who received linezolid (intravenously or orally) or vancomycin (intravenously) at a tertiary care hospital, between January 2016 and October 2019, for a minimum of 5 days and in whom platelet values were measured during treatment. Data on platelet count were collected during therapy in each group to identify the incidence of thrombocytopenia. RESULTS A total of 453 patients fulfilled the study criteria; 241 patients received linezolid and 212 patients vancomycin. The main logistic regression analysis revealed that patients in the linezolid group had approximately a four times higher incidence of thrombocytopenia (OR 4.39; 95% CI 2.38-8.08) compared to vancomycin. An increased incidence of thrombocytopenia was associated with advanced age, baseline platelet count and vasopressor use. CONCLUSION Clinicians considering vancomycin or linezolid for a susceptible infection should weigh the higher risk of thrombocytopenia that may be observed with linezolid vs. vancomycin in their decision.
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Affiliation(s)
- Dimah Al-Harbi
- King Abdulaziz Medical City, Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulrahman Alturaiki
- King Abdulaziz Medical City, Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ayshah Alshngeetee
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Haya Aldabas
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Layla AlBreacan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Renad Aljohani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Abdullah Althemery
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Laila Carolina Abu Esba
- King Abdulaziz Medical City, Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. .,College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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17
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Hsu YC, Chen SY, Hung YJ, Huang YW. Renal replacement therapy and concurrent fluconazole therapy increase linezolid-related thrombocytopenia among adult patients. Sci Rep 2022; 12:9894. [PMID: 35701469 PMCID: PMC9198091 DOI: 10.1038/s41598-022-13874-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
Linezolid has been reported to be associated with thrombocytopenia. However, limited information is available on susceptibility to thrombocytopenia after linezolid usage. We aimed to investigate the risk factors for linezolid-associated thrombocytopenia (LAT). We conducted a retrospective cohort study of patients aged ≥ 18 years who received linezolid for ≥ 5 d during hospitalization in 2019. Information was extracted from electronic medical records. Thrombocytopenia was defined as a platelet count of < 100 × 109/L or a reduction from baseline ≥ 25%. Binary logistic regression and survival analyses were used to evaluate the risk factors for LAT. A total of 98 patients were enrolled. Thrombocytopenia occurred in 53.1% patients, with a median of 9 d after initiation of linezolid. There was no significant difference in the mortality or proportion of platelet transfusions between patients with and without thrombocytopenia. A higher risk of LAT was found in patients who received renal replacement therapy (RRT) (OR 4.8 [1.4–16.4]), or concurrent fluconazole (OR 3.5 [1.2–9.8]). Patients who received RRT (8 vs. 15 d) or concurrent fluconazole (11 vs. 15 d) had a shorter median time to develop thrombocytopenia. Those who simultaneously received RRT and fluconazole had the shortest median of time (6.5 d) and the highest risk of developing thrombocytopenia (87.5%).
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Affiliation(s)
- Yueh-Chun Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan
| | - Szu-Ying Chen
- Department of Nursing, Fooyin University, Kaohsiung, 831, Taiwan.,Division of Occupational Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan.,Division of Surgical Intensive Care, Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan
| | - Yung-Jun Hung
- Department of Pharmacy, E-Da hospital, Kaohsiung, 824, Taiwan
| | - Yu-Wei Huang
- Department of Anesthesiology, Emergency and Critical Care Center, E-Da hospital, I-Shou University, Kaohsiung, 824, Taiwan. .,Department of Nursing, Fooyin University, Kaohsiung, 831, Taiwan.
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18
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Oehadian A, Santoso P, Menzies D, Ruslami R. Hematologic Toxicity of Linezolid in Multidrug Resistant and Extensively Drug Resistant Tuberculosis (MDR/XDR-TB): the role of mitochondria. Tuberc Respir Dis (Seoul) 2022; 85:111-121. [PMID: 35045688 PMCID: PMC8987663 DOI: 10.4046/trd.2021.0122] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/16/2022] [Indexed: 12/02/2022] Open
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is caused by an organism that is resistant to both rifampicin and isoniazid. Extensively drug-resistant TB, a rare type of MDR-TB, is caused by an organism that is resistant to quinolone and one of group A TB drugs (i.e., linezolid and bedaquiline). In 2018, the World Health Organization revised the groupings of TB medicines and reclassified linezolid as a group A drug for the treatment of MDR-TB. Linezolid is a synthetic antimicrobial agent in the oxazolidinone class. Although linezolid has a good efficacy, it can cause substantial adverse events, especially hematologic toxicity. In both TB infection and linezolid mechanism of action, mitochondrial dysfunction plays an important role. In this concise review, characteristics of linezolid as an anti-TB drug are summarized, including its efficacy, pathogenesis of hematologic toxicity highlighting mitochondrial dysfunction, and the monitoring and management of hematologic toxicity.
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Affiliation(s)
- Amaylia Oehadian
- Department of Internal Medicine, Hasan Sadikin Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Prayudi Santoso
- Department of Internal Medicine, Hasan Sadikin Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
| | - Dick Menzies
- McGill International TB Centre Respiratory Epidemiology and Clinical Research Unit, Montreal Canada, Director of the WHO McGill Collaborative Centre for TB Research
| | - Rovina Ruslami
- Department of Biomedical Science, Division of Pharmacology, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia
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19
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Melo N, Correia C, Gonçalves J, Dias M, Garcia RM, Palma P, Duro R. Corynebacterium striatum cardiac device-related endocarditis: A case report. IDCases 2022; 27:e01371. [PMID: 35004177 PMCID: PMC8718561 DOI: 10.1016/j.idcr.2021.e01371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 01/22/2023] Open
Abstract
Diagnosis of cardiac device-related endocarditis may be complex. Corynebacterium striatum has been increasingly associated with severe infections. Antimicrobial treatment is difficult, especially in the presence of resistance.
Corynebacterium striatum is an emerging Gram-positive bacillus associated with invasive infection in both immunocompetent and immunocompromised patients, especially associated with medical devices. Its ability to form biofilms has been demonstrated and it has been occasionally associated with cardiac device-related infective endocarditis with few cases described in literature. We report a case of C. striatum cardiac device-related infective endocarditis of complex management.
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Affiliation(s)
- Nuno Melo
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Cristina Correia
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Juliana Gonçalves
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Manuela Dias
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Raquel Mota Garcia
- Cardiology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Pedro Palma
- Infectious Diseases Unit, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Raquel Duro
- Unit for the Prevention and Control of Infection and Antimicrobial Resistance, Centro Hospitalar e Universitário de São João, Porto, Portugal
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20
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Han X, Wang J, Zan X, Peng L, Nie X. Risk factors for linezolid-induced thrombocytopenia in adult inpatients. Int J Clin Pharm 2021; 44:330-338. [PMID: 34731363 PMCID: PMC8564787 DOI: 10.1007/s11096-021-01342-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
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. 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. Method This retrospective study involved patients who were administered intravenous linezolid for ≥ 1 day between January 1, 2015 and January 1, 2021. Their demographic and clinical data were extracted from electronic medical records. Thrombocytopenia was defined as: ①thrombocytopenia with platelet count < 100 × 109/L and a decrease in 25% or more from baseline of the platelet count (criterion 1); ②thrombocytopenia due to a platelet count drop decrease of 25% or more from baseline (criterion 2). Risk factors were determined via binary logistic regression analysis. Results This study included 320 patients. Binary logistic regression analysis indicated that baseline platelet count (p < 0.001), linezolid therapy duration (p = 0.001) and shock (patients require vasoactive medications) (p = 0.019) were independent risk factors for criterion-1thrombocytopenia, while linezolid therapy duration (p < 0.001) and shock (p = 0.015) were independent risk factors for criterion-2 thrombocytopenia. There was also a significant correlation between shock and early-onset thrombocytopenia (p = 0.005 and 0.019 for criterion 1 and criterion 2, respectively). Conclusion Linezolid therapy duration and shock were common causes of different thrombocytopenia definitions; shock was correlated with early-onset thrombocytopenia. Platelet count should be monitored during linezolid therapy especially during long-duration therapy and in shock patients.
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Affiliation(s)
- Xiaonian Han
- Department of Pharmacy, Xi'an Central Hospital, Houzaimen No.185, North Street, Xian, Shaanxi, 710003, China
| | - Jinping Wang
- Department of Pharmacy, Xi'an Central Hospital, Houzaimen No.185, North Street, Xian, Shaanxi, 710003, China
| | - Xin Zan
- Department of Pharmacy, Xi'an Central Hospital, Houzaimen No.185, North Street, Xian, Shaanxi, 710003, China
| | - Lirong Peng
- Department of Pharmacy, Xi'an Central Hospital, Houzaimen No.185, North Street, Xian, Shaanxi, 710003, China
| | - Xiaojing Nie
- Department of Pharmacy, Xi'an Central Hospital, Houzaimen No.185, North Street, Xian, Shaanxi, 710003, China.
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21
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Tsuji Y. Hospital Pharmacometrics for Optimal Individual Administration of Antimicrobial Agents for Anti-methicillin-resistant Staphylococcus aureus Infected Patients. Biol Pharm Bull 2021; 44:1174-1183. [PMID: 34471044 DOI: 10.1248/bpb.b21-00002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Therapeutic drug monitoring and target concentration intervention based on population pharmacokinetic and pharmacodynamic models has been strongly recommended for anti-methicillin-resistant Staphylococcus aureus (MRSA) agents in order to provide appropriate antimicrobial chemotherapy to each individual patient, and pharmacokinetic and pharmacodynamic analyses in hospitalized patients have been actively conducted, as evidenced with vancomycin. Teicoplanin, daptomycin, and linezolid have been the most studied antibiotics, using population pharmacokinetics of patients with MRSA. Infections caused by MRSA have higher severity and fatality rates than other antimicrobial-susceptible infections. Therefore, many medical facilities have been implementing infection control programs based on antimicrobial stewardship to prevent nosocomial infections and drug-resistant strains. Studies detailing pharmacometrics for these antibiotics have been reported to elucidate the pharmacokinetic and pharmacodynamic properties, to determine significant factors influencing variabilities between individuals, and to develop target concentration interventions and dosing regimens for adults, the elderly, patients with renal insufficiency including those on continuous renal replacement therapies, patients with low body weight, obese patients, and pediatric patients. This review presents the details of our recent research on the optimal dosing design of antimicrobial agents for the treatment of MRSA infection based on hospital pharmacometrics. In addition, the prospect of using modeling and simulation has shown major advantages in supporting dosing regimen selection.
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Affiliation(s)
- Yasuhiro Tsuji
- Center for Pharmacist Education, School of Pharmacy, Nihon University
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22
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Pratama NYI, Zulkarnain BS, Fatmawati U. Hematological side effect analysis of linezolid in MDR-TB patients with individual therapy. J Basic Clin Physiol Pharmacol 2021; 32:777-781. [PMID: 34214355 DOI: 10.1515/jbcpp-2020-0468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/07/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to estimate the prevalence and analyze the risk factors for linezolid-induced hematological side effects in multidrug-resistant tuberculosis (MDR-TB) patients. METHODS Data were collected from medical records of MDR-TB patients who received linezolid between January 2018 and May 2020. Statistical significance analysis and multivariate analysis were performed with SPSS version 24 software. RESULTS Hematological side effects were identified in 27 out of 93 patients (29.0%). The most prevalent effect was anemia (29.0%), while the less prevalent effects were thrombocytopenia (3.2%) and leukopenia (2.2%). These side effects were reported after 2 weeks of linezolid treatment. The drug dose was more than 11 mg/kgBW/day or patient weighing less than 54 kg was identified as an independent risk factor for anemia in multivariate analysis. CONCLUSIONS Anemia was the most prevalent of linezolid-induced hematological side effects in MDR-TB patients. Therefore, hemoglobin monitoring might be recommended in patients weighing less than 54 kg and after receiving linezolid therapy for at least 2 weeks.
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Affiliation(s)
| | | | - Umi Fatmawati
- Department of Pharmacy, Dr Soetomo General Hospital, Surabaya, Indonesia
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23
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Broyles AD, Banerji A, Barmettler S, Biggs CM, Blumenthal K, Brennan PJ, Breslow RG, Brockow K, Buchheit KM, Cahill KN, Cernadas J, Chiriac AM, Crestani E, Demoly P, Dewachter P, Dilley M, Farmer JR, Foer D, Fried AJ, Garon SL, Giannetti MP, Hepner DL, Hong DI, Hsu JT, Kothari PH, Kyin T, Lax T, Lee MJ, Lee-Sarwar K, Liu A, Logsdon S, Louisias M, MacGinnitie A, Maciag M, Minnicozzi S, Norton AE, Otani IM, Park M, Patil S, Phillips EJ, Picard M, Platt CD, Rachid R, Rodriguez T, Romano A, Stone CA, Torres MJ, Verdú M, Wang AL, Wickner P, Wolfson AR, Wong JT, Yee C, Zhou J, Castells M. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:S16-S116. [PMID: 33039007 DOI: 10.1016/j.jaip.2020.08.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ana Dioun Broyles
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Sara Barmettler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Catherine M Biggs
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Rebecca G Breslow
- Division of Sports Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Katherine N Cahill
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Josefina Cernadas
- Allergology and Immunology Service, Centro Hospitalar Universitário de S.João Hospital, Porto, Portugal
| | - Anca Mirela Chiriac
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Elena Crestani
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Pascale Dewachter
- Department of Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Meredith Dilley
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Ari J Fried
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarah L Garon
- Associated Allergists and Asthma Specialists, Chicago, Ill
| | - Matthew P Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David I Hong
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Joyce T Hsu
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Parul H Kothari
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Timothy Kyin
- Division of Asthma, Allergy & Immunology, University of Virginia, Charlottesville, Va
| | - Timothy Lax
- Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Min Jung Lee
- Allergy and Immunology at Hoag Medical Group, Newport Beach, Calif
| | - Kathleen Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Anne Liu
- Division of Allergy / Immunology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stephanie Logsdon
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Andrew MacGinnitie
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Maciag
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Samantha Minnicozzi
- Division of Allergy and Clinical Immunology, Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Allison E Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, University of California, San Francisco Medical Center, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Sarita Patil
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Department of Medicine & Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Division of Allergy and Clinical Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Tito Rodriguez
- Drug Allergy Department, Al-Rashed Allergy Center, Sulaibikhat, Al-Kuwait, Kuwait
| | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Maria Jose Torres
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
| | - Miriam Verdú
- Allergy Unit, Hospital Universitario de Ceuta, Ceuta, Spain
| | - Alberta L Wang
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Paige Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Anna R Wolfson
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Johnson T Wong
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Christina Yee
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Joseph Zhou
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Mariana Castells
- Drug hypersensitivity and Desensitization Center, Brigham and Women's Hospital, Boston, Mass
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Clinical Use and Adverse Drug Reactions of Linezolid: A Retrospective Study in Four Belgian Hospital Centers. Antibiotics (Basel) 2021; 10:antibiotics10050530. [PMID: 34064418 PMCID: PMC8147790 DOI: 10.3390/antibiotics10050530] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 12/30/2022] Open
Abstract
In Belgium, linezolid is indicated for pneumonia and skin and soft tissue infections, but is more broadly used, due to its oral bioavailability and activity against multiresistant organisms. This could increase the risk of adverse drug reactions (ADR), notably hematological disorders (anemia, thrombocytopenia), neuropathy, or lactic acidosis. We analyzed linezolid clinical use in relationship with occurrence of ADR in Belgian hospitals and highlighted risk factors associated with the development of thrombocytopenia. A retrospective analysis of electronic medical records and laboratory tests of adult patients treated with linezolid in four Belgian hospitals in 2016 allowed the collection of ADR for 248 linezolid treatments. Only 19.7% of indications were in-label. ADR included 43 thrombocytopenia, 17 anemia, 4 neuropathies, and 4 increases in lactatemia. In a multi-variate analysis, risk factors of thrombocytopenia were a treatment duration > 10 days, a glomerular filtration rate < 60 mL/min, and a Charlson index ≥ 4. Off-label use of linezolid is frequent in Belgium, and ADR more frequent than reported in the summary of product characteristics, but not statistically associated with any indication. This high prevalence of ADR could be related to a high proportion of patients presenting risk factors in our population, highlighting the importance of detecting them prospectively.
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25
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Ogami C, Tsuji Y, Nishi Y, Kawasuji H, To H, Yamamoto Y. External Evaluation of Population Pharmacokinetics and Pharmacodynamics in Linezolid-Induced Thrombocytopenia: The Transferability of Published Models to Different Hospitalized Patients. Ther Drug Monit 2021; 43:271-278. [PMID: 33009290 DOI: 10.1097/ftd.0000000000000816] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/30/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of this study was to perform an external evaluation of published linezolid population pharmacokinetic and pharmacodynamic models, to evaluate the predictive performance using an independent data set. Another aim was to offer an elegant environment for display and simulation of both the concentration and platelet count after linezolid administration. METHODS We performed a systematic literature search in PubMed for all studies evaluating the population pharmacokinetic and pharmacodynamic parameters of linezolid in patients and selected the models to be used for the external validation. The bias of predictions was visually evaluated by plotting prediction errors (PEs) and relative PEs. The precision of prediction was evaluated by calculating the mean absolute error (MAE), root mean squared error (RMSE), and mean relative error (MRE). RESULTS Three articles (models A, B, and C) provided linezolid-induced platelet dynamic models using population pharmacokinetic and pharmacodynamic modeling approaches. The PE and relative PE of both linezolid concentrations and platelet counts for models A and C showed similar predictive distributions. With respect to the prediction accuracy of total linezolid concentration, the MAE, RMSE, and MRE of population prediction values for model C was the smallest. The comparison of the MAE, RMSE, and MRE of patient-individual prediction values for the 3 pharmacodynamic models revealed no large differences. CONCLUSIONS We confirmed the transferability of published population pharmacokinetic and pharmacodynamic models and showed that they were suitable for extrapolation to other hospitals and/or patients. This study also introduced application software based on model C for the therapeutic drug monitoring of linezolid.
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Affiliation(s)
- Chika Ogami
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama
| | - Yasuhiro Tsuji
- Center for Pharmacist Education, School of Pharmacy, Nihon University, Funabashi, Chiba
| | - Yoshifumi Nishi
- Division of Hospital Safety Management, Kyorin University Hospital, Mitaka
- Department of Pharmaceutical Sciences, International University of Health and Welfare, Otawara; and
| | - Hitoshi Kawasuji
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Hideto To
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
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26
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Pattanaik S, Jain A, Ahluwalia J. Evolving Role of Pharmacogenetic Biomarkers to Predict Drug-Induced Hematological Disorders. Ther Drug Monit 2021; 43:201-220. [PMID: 33235023 DOI: 10.1097/ftd.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Drug-induced hematological disorders constitute up to 30% of all blood dyscrasias seen in the clinic. Hematologic toxicity from drugs may range from life-threatening marrow aplasia, agranulocytosis, hemolysis, thrombosis to mild leukopenia, and thrombocytopenia. Pathophysiologic mechanisms underlying these disorders vary from an extension of the pharmacological effect of the drug to idiosyncratic and immune-mediated reactions. Predicting these reactions is often difficult, and this makes clinical decision-making challenging. Evidence supporting the role of pharmacogenomics in the management of these disorders in clinical practice is rapidly evolving. Despite the Clinical Pharmacology Implementation Consortium and Pharmacogenomics Knowledge Base recommendations, few tests have been incorporated into routine practice. This review aims to provide a comprehensive summary of the various drugs which are implicated for the hematological adverse events, their underlying mechanisms, and the current evidence and practical recommendations to incorporate pharmacogenomic testing in clinical care for predicting these disorders.
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Affiliation(s)
| | - Arihant Jain
- Internal Medicine, Hematology and Bone Marrow Transplantation, and
| | - Jasmina Ahluwalia
- Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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27
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Dai Y, Jiang S, Chen X, Han L, Zhang C, Yu X, Zhang X. Analysis of the risk factors of linezolid-related haematological toxicity in Chinese patients. J Clin Pharm Ther 2021; 46:807-813. [PMID: 33555057 DOI: 10.1111/jcpt.13359] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Haematological toxicity including thrombocytopenia, anaemia and leucopenia is the main adverse events of linezolid (LZD) therapy. This study aimed to investigate the risk factors for LZD-induced haematological toxicity and define the threshold of plasma trough concentration to minimize the haematological toxicity. METHODS 145 patients who received LZD for more than 10 days were retrospectively reviewed to determine the incidence of LZD-induced haematological toxicity. Meanwhile, the risk factors of haematological toxicity were confirmed by univariate and multivariate logistic regression analysis. RESULTS AND DISCUSSION 9 (6.2%) patients developed leucopenia, while 52 (35.9%) and 26 (17.9%) patients developed thrombocytopenia and anaemia, respectively. The estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m2 (OR, 2.744; 95% CI, 1.117-6.734; p = 0.028) and baseline platelet count <200 × 109 /L (OR, 6.817; 95% CI, 2.870-16.193; p < 0.0001) were found to be significant risk factors for LZD-related thrombocytopenia. Aspartate aminotransferase (AST) >80 U/L (OR, 4.844; 95% CI, 1.207-19.451; p = 0.026) and eGFR <90 ml/min/1.73 m2 (OR, 7.132; 95% CI, 2.088-24.357; p = 0.002) were the risk factors for LZD-related anaemia. However, no significant risk factors were identified for LZD-related leucopenia. Moreover, LZD plasma trough concentration >8 mg/L [OR, 3.047; 95% CI, 1.233-7.539; p = 0.016] could be a predictor for the development of thrombocytopenia and anaemia. WHAT IS NEW AND CONCLUSION Hepatic and/or renal dysfunction are the risk factors for LZD-related haematological toxicity, while the target plasma trough concentration within 8 mg/L via dose reduction could minimize the haematological toxicity induced by LZD.
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Affiliation(s)
- Ying Dai
- Department of Pharmacy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of National Drug Cinical Trial Institute, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuying Jiang
- Department of Pharmacy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Pharmacy, Taizhou Municipal Central Hospital, Taizhou, Zhejiang, China
| | - Xiaoou Chen
- Department of Pharmacy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lu Han
- Department of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chunhong Zhang
- Department of Pharmacy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xuben Yu
- Department of Pharmacy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of National Drug Cinical Trial Institute, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiuhua Zhang
- Department of National Drug Cinical Trial Institute, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Pharmacy, Wenzhou Medical University, Wenzhou, Zhejiang, China
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28
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Liu T, Luo J, Bi G, Du Z, Kong J, Chen Y. Antibacterial synergy between linezolid and baicalein against methicillin-resistant Staphylococcus aureus biofilm in vivo. Microb Pathog 2020; 147:104411. [PMID: 32745664 DOI: 10.1016/j.micpath.2020.104411] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/09/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) can form biofilms, which prevents the penetration of antibiotics, decreasing their efficacy. This study investigated whether baicalein has synergistic antibacterial effects with linezolid in vivo. We cultivated MRSA 17546 biofilms on silicone implants and inserted them into the air pouches of rat models. The rats were treated with linezolid, baicalein, or a combination therapy for three consecutive days. All treatments reduced the number of colony-forming units (CFU) in the biofilms compared to the control (p < 0.05). However, by day two, the CFU counts were significantly lower in the combination group than in the individual treatment groups (p < 0.05). Histological analysis of the air pouches showed that the severity of the inflammatory cell infiltration was severe in the combination therapy group. In the combination group, the biofilm structure on the implant's surface was sparse and more free colonies could be seen by scanning electron microscopy (SEM); by day three, no obvious biofilm was observed. The serum levels of Staphylococcus enterotoxin A (SEA), C-reactive protein (CRP), and procalcitonin (PCT) were the lowest in the group where rats were treated with the combination of baicalein and linezolid (p < 0.05) compared to other groups. The results suggest that baicalein may inhibit the accessory gene regulator system, reducing the expression of SEA, thus lowering CRP and PCT levels. Furthermore, the inhibitory effect was more pronounced when baicalein was combined with linezolid. These results provide an important basis for the development of a new combination regimen to treat patients with biofilm-associated MRSA infections.
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Affiliation(s)
- Tangjuan Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Jing Luo
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Guan Bi
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Zhongye Du
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Jinliang Kong
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China.
| | - Yiqiang Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China.
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29
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Soraluce A, Barrasa H, Asín-Prieto E, Sánchez-Izquierdo JÁ, Maynar J, Isla A, Rodríguez-Gascón A. Novel Population Pharmacokinetic Model for Linezolid in Critically Ill Patients and Evaluation of the Adequacy of the Current Dosing Recommendation. Pharmaceutics 2020; 12:pharmaceutics12010054. [PMID: 31936614 PMCID: PMC7023070 DOI: 10.3390/pharmaceutics12010054] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/13/2019] [Accepted: 12/30/2019] [Indexed: 12/30/2022] Open
Abstract
Antimicrobial treatment in critically ill patients remains challenging. The aim of this study was to develop a population pharmacokinetic model for linezolid in critically ill patients and to evaluate the adequacy of current dosing recommendation (600 mg/12 h). Forty inpatients were included, 23 of whom were subjected to continuous renal replacement therapies (CRRT). Blood and effluent samples were drawn after linezolid administration at defined time points, and linezolid levels were measured. A population pharmacokinetic model was developed, using NONMEM 7.3. The percentage of patients that achieved the pharmacokinetic/pharmacodynamic (PK/PD) targets was calculated (AUC24/MIC > 80 and 100% T>MIC). A two-compartment model best described the pharmacokinetics of linezolid. Elimination was conditioned by the creatinine clearance and by the extra-corporeal clearance if the patient was subjected to CRRT. For most patients, the standard dose of linezolid did not cover infections caused by pathogens with MIC ≥ 2 mg/L. Continuous infusion may be an alternative, especially when renal function is preserved.
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Affiliation(s)
- Amaia Soraluce
- Pharmacokinetics, Nanotechnology and Gene Therapy Group, Faculty of Pharmacy, Centro de Investigación Lascaray-ikergunea, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (A.S.); (A.I.)
| | - Helena Barrasa
- Intensive Care Unit, Araba University Hospital, 01004 Vitoria-Gasteiz, Spain; (H.B.); (J.M.)
| | - Eduardo Asín-Prieto
- Pharmacometrics & Systems Pharmacology Research Unit, Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy and Nutrition, University of Navarra, 31008 Pamplona, Spain;
| | | | - Javier Maynar
- Intensive Care Unit, Araba University Hospital, 01004 Vitoria-Gasteiz, Spain; (H.B.); (J.M.)
| | - Arantxazu Isla
- Pharmacokinetics, Nanotechnology and Gene Therapy Group, Faculty of Pharmacy, Centro de Investigación Lascaray-ikergunea, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (A.S.); (A.I.)
| | - Alicia Rodríguez-Gascón
- Pharmacokinetics, Nanotechnology and Gene Therapy Group, Faculty of Pharmacy, Centro de Investigación Lascaray-ikergunea, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain; (A.S.); (A.I.)
- Correspondence: ; Tel.: +34-945-01-3094
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Role of linezolid combination therapy for serious infections: review of the current evidence. Eur J Clin Microbiol Infect Dis 2020; 39:1043-1052. [PMID: 31898798 DOI: 10.1007/s10096-019-03801-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/17/2019] [Indexed: 01/24/2023]
Abstract
As long-standing clinical problems, a series of complicated infections are more difficult to treat due to the development of antibiotic resistance, especially caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), and multidrug-resistant Mycobacterium tuberculosis (M. tuberculosis). Moreover, the treatment options available to against these infections are also becoming increasingly limited. Linezolid is the first synthetic oxazolidinone antibiotic with a unique mechanism of action, and its efficacy against Gram-positive bacteria has been clearly demonstrated. However, the limitations of linezolid alone for the treatment of these complicated infections have been reported in the recent years. Combination therapy may be a good approach to enhance efficacy and prevent the development of resistance. In this review, the results of multiple linezolid combination therapies from in vitro, animal studies, and clinical cases for the treatment of MRSA, VRE, and multidrug-resistant M. tuberculosis strains will be discussed, and thus provide more relevant information for clinician in clinical practice.
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Cazavet J, Bounes FV, Ruiz S, Seguin T, Crognier L, Rouget A, Fourcade O, Minville V, Conil JM, Georges B. Risk factor analysis for linezolid-associated thrombocytopenia in critically ill patients. Eur J Clin Microbiol Infect Dis 2019; 39:527-538. [PMID: 31853741 DOI: 10.1007/s10096-019-03754-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/27/2019] [Indexed: 11/30/2022]
Abstract
Linezolid is an antibiotic used against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus. Its primary adverse effect is haematotoxicity. The objective of this study was to analyse the risk factors for onset of thrombocytopenia in critically ill patients treated with linezolid. This was a retrospective, single-centre study of 72 patients. Platelets were measured from D0 to D20 after the start of treatment. The risk factors for thrombocytopenia were identified using a multivariate logistic regression analysis following a Monte Carlo simulation. Following ROC curve analysis, a baseline platelet count lower than 108 × 109/L and a Cmin higher than 4 mg/L, with respective odds ratios of 117 (95% CI [97-206]) and 3 (95% CI [1.5-6.2]) in the simulated population, were identified as risk factors. Among the source population patients combining these 2 factors, a significantly higher number developed thrombocytopenia (66.7% vs. 33.3%, p = 0.0042). A baseline platelet count lower than 108 × 109/L and a Cmin higher than 4 mg/L are risk factors for the onset of thrombocytopenia in critically ill patients treated with linezolid.
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Affiliation(s)
- Julien Cazavet
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Fanny Vardon Bounes
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Stéphanie Ruiz
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Thierry Seguin
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Laure Crognier
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Antoine Rouget
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Olivier Fourcade
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Vincent Minville
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Jean-Marie Conil
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France.,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Bernard Georges
- Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France. .,Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France.
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Lima LS, Brito EDCA, Mattos K, Parisotto EB, Perdomo RT, Weber SS. A retrospective cohort study to screen linezolid-induced thrombocytopenia in adult patients hospitalized in the Midwestern Region of Brazil. Hematol Transfus Cell Ther 2019; 42:230-237. [PMID: 31519529 PMCID: PMC7417447 DOI: 10.1016/j.htct.2019.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/12/2019] [Accepted: 07/02/2019] [Indexed: 11/04/2022] Open
Abstract
Background Thrombocytopenia (TP) is the major event associated with linezolid (LZD) therapy. We investigated the incidence and risk factors for thrombocytopenia in hospitalized adults who received LZD (1200 mg/day) between 2015 and 2017. HIV-positive, death during follow-up and those with a baseline platelet count ≤100 × 103/mm3 were excluded. Method TP was defined as a decrease in platelet count of ≥20% from the baseline level at the initiation of linezolid therapy and a final count of <100 × 103/mm3. The odds ratios (OR) for thrombocytopenia were obtained using multivariate stepwise logistic regression analysis. Main results A total of 66 patients were included (mean age [SD] 62 [18], male gender [%], 37 [56]). LZD-associated TP was identified in 12 patients (18.2%). For TP, the adjusted OR [95% CI] of the platelet count ≤200 × 103/mm3, serum creatinine and renal impairment at baseline were 5.66 [1.15–27.9], 4.57 [1.26–16.5] and 9.41 [1.09–80.54], respectively. Male gender and dosage per weight per day (DPWD) >20 mg/kg/day were not risk factors. Conclusion The results showed that the incidence of linezolid-induced thrombocytopenia was lower in patients with normal renal function and higher in those with platelet counts ≤200 × 103/mm3 or serum creatinine >1.5 mg/dL at the start of the treatment.
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Affiliation(s)
- Letícia Souza Lima
- Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | | | - Karine Mattos
- Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | | | | | - Simone Schneider Weber
- Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil; Universidade Federal do Amazonas (UFAM), Itacoatiara, AM, Brazil.
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Milosevic TV, Vertenoeil G, Payen VL, Sonveaux P, Tulkens PM, Constantinescu SN, Van Bambeke F. Prolonged inhibition and incomplete recovery of mitochondrial function in oxazolidinone-treated megakaryoblastic cell lines. Int J Antimicrob Agents 2019; 54:661-667. [PMID: 31374333 DOI: 10.1016/j.ijantimicag.2019.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/21/2019] [Indexed: 12/01/2022]
Abstract
Thrombocytopenia is commonly seen in patients receiving linezolid for >14 days. Linezolid is a reversible inhibitor of mitochondrial function in various cell types. This study investigated the inhibitory effects of linezolid and tedizolid, and their potential recovery on (i) CYTox I expression (subunit I of cytochrome c-oxidase; encoded by the mitochondrial genome), (ii) cytochrome c-oxidase activity and (iii) mitochondrial respiration (Seahorse bioanalysis) in two megakaryocytic cell lines [UT-7 WT (human acute megakaryoblastic leukaemia cells) and UT-7 MPL (transduced to express the thrombopoietin receptor)]. Cells were exposed to linezolid (0.5-25 mg/L) or tedizolid (0.1-5 mg/L) for up to 5 days and recovery followed after drug removal. Both oxazolidinones caused concentration- and time-dependent inhibition of CYTox I expression, cytochrome c-oxidase activity and mitochondrial spare capacity. On electron microscopy, mitochondria appeared dilated with a loss of cristae. Globally, tedizolid exerted stronger effects than linezolid. While CYTox I expression recovered completely after 6 days of drug washout, only partial (linezolid) or no (tedizolid) recovery of cytochrome c-oxidase activity, and no rescue of mitochondrial spare capacity (after 3 days) was observed. Thus, and in contrast to previous studies using a variety of cell lines unrelated to megakaryocytic lineages, the inhibitory effects exerted by oxazolidinones on the mitochondrial function of megakaryoblastic cells appear to be particularly protracted. Given the dynamics of platelet production and destruction, these results may explain why oxazolidinone-induced thrombocytopenia is one of the most common side effects in patients exposed to these antibiotics.
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Affiliation(s)
- Tamara V Milosevic
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Gaëlle Vertenoeil
- Signal Transduction and Molecular Haematology, Ludwig Institute for Cancer Research, Brussels Branch, Brussels, Belgium; de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Valéry L Payen
- Pole of Pharmacology and Therapeutics, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Sonveaux
- Pole of Pharmacology and Therapeutics, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Paul M Tulkens
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
| | - Stefan N Constantinescu
- Signal Transduction and Molecular Haematology, Ludwig Institute for Cancer Research, Brussels Branch, Brussels, Belgium; de Duve Institute, Université catholique de Louvain, Brussels, Belgium; Walloon Excellence in Life Science and Biotechnology, Brussels, Belgium
| | - Françoise Van Bambeke
- Pharmacologie cellulaire et moléculaire, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
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Reappraisal of Linezolid Dosing in Renal Impairment To Improve Safety. Antimicrob Agents Chemother 2019; 63:AAC.00605-19. [PMID: 31109977 DOI: 10.1128/aac.00605-19] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/12/2019] [Indexed: 11/20/2022] Open
Abstract
Linezolid is administered as a fixed dose to all patients despite evidence of increased exposure and myelosuppression in renal impairment. The objectives of these studies were to assess the risk of thrombocytopenia with standard-dose linezolid in renal impairment and to identify an alternate dosing strategy. In study 1, data from adult patients receiving linezolid for ≥10 days were retrospectively reviewed to determine the frequency of thrombocytopenia in patients with and without renal impairment. Time-to-event analyses were performed using Cox proportional-hazards models. In study 2, population pharmacokinetic modeling was employed to build covariate-structured models using an independent data set of linezolid concentrations obtained during routine therapeutic drug monitoring (TDM). Monte Carlo simulations were performed to identify linezolid dosing regimens that maximized attainment of therapeutic trough concentrations (2 to 8 mg/liter) across various renal-function groups. Toxicity analysis (study 1) included 341 patients, 133 (39.0%) with renal impairment. Thrombocytopenia occurred more frequently among patients with renal impairment (42.9% versus 16.8%; P < 0.001), and renal impairment was independently associated with this toxicity in multivariable analysis (adjusted hazard ratio [aHR], 2.37; 95% confidence interval [CI], 1.52 to 3.68). Pharmacokinetic analyses (study 2) included 1,309 linezolid concentrations from 603 adult patients. Age, body surface area, and estimated glomerular filtration rate (eGFR) were identified as covariates of linezolid clearance. Linezolid dose reductions improved the probability of achieving optimal exposures in simulated patients with eGFR values of <60 ml/min. Thrombocytopenia occurs more frequently in patients with renal impairment receiving standard linezolid doses. Linezolid dose reduction and trough-based TDM are predicted to mitigate this treatment-limiting toxicity.
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Tsutsumi T, Imai S, Yamada K, Yamada T, Kasashi K, Kobayashi M, Iseki K. [Verification of Relationship between Administration of Linezolid and Vomiting]. YAKUGAKU ZASSHI 2019; 139:1055-1061. [PMID: 31257252 DOI: 10.1248/yakushi.19-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Linezolid (LZD), an antimicrobial agent against methicillin-resistant Staphylococcus aureus, demonstrates good bone and joint penetration, and is used for prosthetic bone and joint infections. Recently, we observed vomiting in several patients administered LZD. However, there are few reports on the incidence rate of, and risk factors for, LZD-induced nausea and vomiting. In this study, we aimed to verify the relationship between LZD administration and vomiting. Patients administered LZD at the Department of Orthopedic Surgery of Hokkaido University Hospital between November 2008 and December 2017 were enrolled in the study. The primary endpoint was the comparison of the vomiting rate between patients administered LZD (LZD group) and those administered other antibiotics (non-LZD group). For the secondary endpoint, to verify the risk factors of vomiting, a univariate logistic regression analysis was performed. In total, 130 patients were included in this study; 77 patients in the LZD group, and 53 in the non-LZD group. Vomiting occurred in 18 patients in the LZD group and 4 patients in the non-LZD group (23.4% and 7.5%, respectively); this was significantly higher in the LZD group. In the univariate logistic regression analysis, LZD administration, gender (female), age ≥65 years, renal impairment (creatinine clearance <60 mL/min) and concomitant use of rifampicin were extracted as potential risk factors of vomiting. The results of this study reveal a possible relationship between LZD administration and vomiting.
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Affiliation(s)
| | - Shungo Imai
- Department of Pharmacy, Hokkaido University Hospital
| | - Katsuhisa Yamada
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | | | | | | | - Ken Iseki
- Department of Pharmacy, Hokkaido University Hospital.,Laboratory of Clinical Pharmaceutics and Therapeutics, Division of Pharmasciences, Faculty of Pharmaceutical Sciences, Hokkaido University
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36
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Ansari S, Jha RK, Mishra SK, Tiwari BR, Asaad AM. Recent advances in Staphylococcus aureus infection: focus on vaccine development. Infect Drug Resist 2019; 12:1243-1255. [PMID: 31190912 PMCID: PMC6526327 DOI: 10.2147/idr.s175014] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/19/2019] [Indexed: 12/17/2022] Open
Abstract
Staphylococcus aureus normally colonizes the nasal cavity and pharynx. After breaching the normal habitat, the organism is able to cause a number of infections at any site of the body. The development of antibiotic resistance has created a global challenge for treating infections. Therefore, protection by vaccines may provide valuable measures. Currently, several vaccine candidates have been prepared which are either in preclinical phase or in early clinical phase, whereas several candidates have failed to show a protective efficacy in human subjects. Approaches have also been made in the development of monoclonal or polyclonal antibodies for passive immunization to protect from S. aureus infections. Therefore, in this review we have summarized the findings of recently published scientific literature to make a concise report.
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Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Chitwan Medical College and Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Rajesh Kumar Jha
- Department of Systems and Diseases (Pharmacology), Saba University School of Medicine, Saba, Dutch Caribbean
| | - Shyam Kumar Mishra
- Department of Microbiology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | | | - Ahmed Morad Asaad
- Department of Microbiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Giunio-Zorkin N, Brown G. Real-Life Frequency of New-Onset Thrombocytopenia during Linezolid Treatment. Can J Hosp Pharm 2019; 72:133-138. [PMID: 31036974 PMCID: PMC6476580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Thrombocytopenia is a well-recognized adverse effect of linezolid; however, the frequency of this adverse effect during therapy has been variable across previous studies, and the associated risk factors are unclear. OBJECTIVES To identify the real-life frequency of new-onset thrombocytopenia due to linezolid and to determine the associated risk factors. METHODS A retrospective observational cohort study was conducted among consecutive inpatients at a tertiary care hospital who received linezolid for a minimum of 5 days between January 2013 and August 2017. Data were extracted from electronic medical records obtained from a hospital database. Thrombocytopenia was defined as platelet count less than 100 × 109/L or a 50% reduction from baseline (i.e., before linezolid initiation). Risk factors were identified by comparing the characteristics of patients who experienced the adverse effect during linezolid therapy with those of patients who did not experience the adverse effect. Continuous data were analyzed with the t test and categorical data with the χ2 test. RESULTS A total of 102 patients were included (38 women, 64 men; overall mean age 50 years, standard deviation [SD] 21). The mean duration of linezolid therapy was 14 (SD 10) days. Thrombocytopenia occurred in 18 patients (17.6%). Risk factors for the development of thrombocytopenia included mean duration of therapy (22 [SD 18] days versus 12 [SD 7] days; p = 0.023), renal replacement therapy (17% versus 4%; p = 0.032), renal impairment (61% versus 32%; p = 0.021), and concomitant administration of unfractionated heparin (50% versus 21%; p = 0.013). CONCLUSIONS The real-life frequency of new-onset of thrombocytopenia in patients receiving linezolid for a minimum of 5 days was 17.6%. Risk factors for linezolid-induced thrombocytopenia included prolonged duration of therapy, renal impairment, and concomitant unfractionated heparin.
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Affiliation(s)
- Nicole Giunio-Zorkin
- , BSc, PharmD, ACPR is a Clinical Pharmacist with St Paul's Hospital, Vancouver, British Columbia
| | - Glen Brown
- , BSc(Pharm), PharmD, FCSHP, BCPS, BCCCP, is a Clinical Pharmacy Specialist in Critical Care with St Paul's Hospital, Vancouver, British Columbia. He is also an Associate Editor with the Canadian Journal of Hospital Pharmacy
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Chen H, Li L, Liu Y, Wu M, Xu S, Zhang G, Qi C, Du Y, Wang M, Li J, Huang X. In vitro activity and post-antibiotic effects of linezolid in combination with fosfomycin against clinical isolates of Staphylococcus aureus. Infect Drug Resist 2018; 11:2107-2115. [PMID: 30464553 PMCID: PMC6219420 DOI: 10.2147/idr.s175978] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objectives Linezolid combination therapy is recommended for the treatment of Staphylococcus aureus (S. aureus) infections. However, the optimal regimen of the combination therapy for S. aureus is unknown. The objective of this study was to investigate the antibacterial activity, post-antibiotic effect (PAE), and post-antibiotic subminimum inhibitory concentration (MIC) effect (PA-SME) of linezolid alone and in combination with fosfomycin against eleven clinical isolates of S. aureus. Methods The synergistic effects and antibacterial activity of linezolid and fosfomycin were assessed by checkerboard and time-kill assays. To determine the PAE and PA-SME, S. aureus strains in the logarithmic phase of growth were exposed for 1, 2, and 3 hours to the antibiotics, alone and in combination. Recovery periods of test strains were evaluated using viable counting after dilution. Results Synergistic effects were observed for eight strains and no antagonism was found with any combination. Moreover, linezolid combined with fosfomycin at 4x MIC showed the best synergistic antibacterial effect, and this effect was retained after 24 hours. In addition, both the antibiotics alone and in combination showed increased PAE and PA-SME values in a concentration- and time-dependent manner. Conclusion Linezolid combined with fosfomycin exerted a good antibacterial effect against S. aureus, and the combinations have significant PAE and PA-SME.
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Affiliation(s)
- Hao Chen
- Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.,Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China, .,Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China,
| | - Lan Li
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China, .,Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China,
| | - Yanyan Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,
| | - Maomao Wu
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China, .,Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China,
| | - Shuangli Xu
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China, .,Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China,
| | - Guijun Zhang
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China, .,Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China,
| | - Caifen Qi
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China, .,Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China,
| | - Yan Du
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China, .,Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China,
| | - Mingli Wang
- Department of Microbiology, Anhui Medical University, Hefei, Anhui, China
| | - Jiabin Li
- Department of Infectious Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,
| | - Xiaohui Huang
- Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China, .,Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei, Anhui, China,
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Nie X, Zhang Y, Wu Z, Jia L, Wang X, Langan SM, Benchimol EI, Peng X. Evaluation of reporting quality for observational studies using routinely collected health data in pharmacovigilance. Expert Opin Drug Saf 2018; 17:661-668. [PMID: 29857774 DOI: 10.1080/14740338.2018.1484106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To appraise the reporting quality of studies which concerned linezolid-related thrombocytopenia referring to REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement. METHODS Medline, Embase, Cochrane library and clinicaltrial.gov were searched for observational studies concerning linezolid-related thrombocytopenia using routinely collected health data from 2000 to 2017. Two reviewers screened potential eligible articles and extracted data independently. Finally, reporting quality assessment was performed by two senior researchers using RECORD statement. RESULTS Of 25 included studies, 11 (44.0%) mentioned the type of data in the title and/or abstract. In 38 items derived from RECORD statement, the median number of items reported in the included studies was 22 (inter-quartile range 18-27). Inadequate reporting issues were discovered in the following aspects: validation studies of the codes or algorithms, study size estimation, quantitative variables, subgroup statistical methods, missing data, follow-up/matching or sampling strategy, sensitivity analysis and cleaning methods, funding and role of funders and accessibility of protocol, raw data. CONCLUSION This study provides the evidence that the reporting quality of post-marketing safety evaluation studies conducted using routinely collected health data was often insufficient. Future stakeholders are encouraged to endorse the RECORD guidelines in pharmacovigilance.
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Affiliation(s)
- Xiaolu Nie
- a Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Ying Zhang
- b Department of Epidemiology and Biostatistics , School of Public Health, Capital Medical University , Beijing , China
| | - Zehao Wu
- b Department of Epidemiology and Biostatistics , School of Public Health, Capital Medical University , Beijing , China
| | - Lulu Jia
- c Clinical Research Unit, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Xiaoling Wang
- c Clinical Research Unit, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Sinéad M Langan
- d Department of Epidemiology and Population Health , London School of Hygiene and Tropical Medicine , London , United Kingdom
| | - Eric I Benchimol
- e Children's Hospital of Eastern Ontario Research Institute,Department of Pediatrics and School of Epidemiology and Public Health , University of Ottawa , Ottawa , Canada.,f Institute for Clinical Evaluative Sciences , Toronto , Canada
| | - Xiaoxia Peng
- a Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China.,g Key Laboratory of Major Diseases in Children , Ministry of Education , Beijing , China
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González-Del Castillo J, Candel FJ, Manzano-Lorenzo R, Arias L, García-Lamberechts EJ, Martín-Sánchez FJ. Predictive score of haematological toxicity in patients treated with linezolid. Eur J Clin Microbiol Infect Dis 2017; 36:1511-1517. [PMID: 28343274 DOI: 10.1007/s10096-017-2960-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aims of our study were to determine the factors associated with developing haematological toxicity (HT) in patients taking linezolid (LZD), to develop a predictive model of HT in these patients, and to evaluate factors associated with 30-day mortality. METHODS This was an observational retrospective cohort study of patients treated for at least 5 days with LDZ in 2015. Demographic, clinical and analytical data were collected. Development of HT was defined as a 25% platelet count decrease between the basal count and the 1-week lab test. RESULTS Five hundred forty-nine patients were finally included, mean age was 73.3 (SD 15.4) years, and 303 (55.2%) were men. One hundred seventy-five (30.1%) patients achieved HT criteria during treatment with LZD and 41 (7.5%) died. The final model included the presence of cerebrovascular disease (2 points), moderate or severe liver disease (2 points), renal failure (2 points) and basal platelet count less than 90,000/mm3 (8 points). This new model showed an AUC of 0.711 (IC 95% 0.664-0.757; p < 0.001) to predict the development of HT. The probability of HT based on this classification was 6.2, 29.9 and 76.5% for low (0-4 points), intermediate (5-10 points) and high risk (>10 points), respectively. The independent variables associated with 30-day mortality were metastatic solid tumor, lymphoma, age >75 years and HT. CONCLUSION This score could help in the identification of patients with high risk for HT and assess the use of an antibiotic other than LZD, an important issue considering its relation with 30-day mortality observed in our study.
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Affiliation(s)
- J González-Del Castillo
- Emergency Department, Hospital Universitario Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain. .,Health Research Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - F J Candel
- Health Research Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain.,Department of Clinical Microbiology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - R Manzano-Lorenzo
- Pharmacy Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - L Arias
- Pharmacy Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - E J García-Lamberechts
- Emergency Department, Hospital Universitario Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain.,Health Research Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - F J Martín-Sánchez
- Emergency Department, Hospital Universitario Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain.,Health Research Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
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Nishijo N, Tsuji Y, Matsunaga K, Kutsukake M, Okazaki F, Fukumori S, Kasai H, Hiraki Y, Sakamaki I, Yamamoto Y, Karube Y, To H. Mechanism Underlying Linezolid-induced Thrombocytopenia in a Chronic Kidney Failure Mouse Model. J Pharmacol Pharmacother 2017; 8:8-13. [PMID: 28405130 PMCID: PMC5370331 DOI: 10.4103/jpp.jpp_167_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective: To investigate the relationship between renal function and linezolid (LZD)-induced thrombocytopenia and elucidate the underlying mechanism using a chronic renal disease (CRD) mouse model. Materials and Methods: CRD was induced in 5-week-old male Institute of Cancer Research (ICR) mice by 5/6 nephrectomy. After this procedure, LZD (25 and 100 mg/kg) was administered intraperitoneally once every day for 28 days. Platelet counts, white blood cell (WBC) counts, and hematocrit (HCT) levels were measured every 7 days. 2-14C-thymidine (0.185 MBq) was administrated intravenously to LZD-administered mice to evaluate the thymidine uptake ability of bone marrow. Results: Platelet counts were significantly lower in the LZD-administered CRD group than in the LZD-nonadministered groups at 14, 21, and 28 days (P < 0.05); however, these changes were not observed in LZD-administered mice with normal renal function, regardless of the duration of LZD administration. No significant changes were observed in WBC counts or HCT levels in any LZD-administered CRD mouse. Moreover, radioactive levels in bone marrow were not significantly different in each group. Conclusions: These results indicate that LZD-induced decreases in platelet counts were enhanced by renal impairment in vivo, suggesting that LZD-induced thrombocytopenia is not caused by nonimmune-mediated bone marrow suppression.
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Affiliation(s)
- Nao Nishijo
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Yasuhiro Tsuji
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Kazuhisa Matsunaga
- Laboratory of Drug Design and Drug Delivery, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan
| | - Masahiko Kutsukake
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Fumiyasu Okazaki
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Shiro Fukumori
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
| | - Hidefumi Kasai
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; Certara G.K., Minato-Ku, Tokyo 105-0001, Japan
| | - Yoichi Hiraki
- Department of Pharmacy, National Hospital Organization Beppu Medical Center, Beppu, Oita, 874-0011, Japan
| | - Ippei Sakamaki
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, India
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, India
| | - Yoshiharu Karube
- Laboratory of Drug Design and Drug Delivery, Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan
| | - Hideto To
- Department of Medical Pharmaceutics, Faculty of Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan
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Oh DH, Motorna O, Kong JB, Brown S, Gilbertson M. Linezolid-associated reticulocytopenia. Ann Hematol 2016; 95:2095-2097. [PMID: 27659049 DOI: 10.1007/s00277-016-2824-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Danielle H Oh
- Department of Haematology, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.
| | - Olga Motorna
- Department of Haematology, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
| | - Jun Beng Kong
- Department of Haematology, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
| | - Susan Brown
- Department of Haematology, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Michael Gilbertson
- Department of Haematology, Monash Medical Centre, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Melbourne, Australia
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Nedved AN, DeFrates SR, Hladnik LM, Stockerl-Goldstein KE. Effect of Linezolid on Hematologic Recovery in Newly Diagnosed Acute Myeloid Leukemia Patients Following Induction Chemotherapy. Pharmacotherapy 2016; 36:1087-1094. [DOI: 10.1002/phar.1824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Sean R. DeFrates
- Department of Pharmacy; Northwestern Memorial Hospital; Chicago Illinois
| | - Lindsay M. Hladnik
- Division of Oncology; Washington University School of Medicine in St. Louis; St. Louis Missouri
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Efficacy of Linezolid and Fosfomycin in Catheter-Related Biofilm Infection Caused by Methicillin-Resistant Staphylococcus aureus. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6413982. [PMID: 27366751 PMCID: PMC4913002 DOI: 10.1155/2016/6413982] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/04/2016] [Accepted: 05/10/2016] [Indexed: 01/24/2023]
Abstract
As long-standing clinical problems, catheter-related infections and other chronic biofilm infections are more difficult to treat due to the high antibiotic resistance of biofilm. Therefore, new treatments are needed for more effective bacteria clearance. In this study, we evaluated the antibacterial activities of several common antibiotics alone and their combinations against biofilm-embedded methicillin-resistant staphylococcus aureus (MRSA) infections, both in vitro and in vivo. In brief, fosfomycin, levofloxacin, and rifampin alone or in combination with linezolid were tested in vitro against planktonic and biofilm-embedded MRSA infection in three MRSA stains. The synergistic effects between linezolid and the other three antibiotics were assessed by fractional inhibitory concentration index (FICI) and time-kill curves, where the combination of linezolid plus fosfomycin showed the best synergistic effect in all strains. For further evaluation in vivo, we applied the combination of linezolid and fosfomycin in a catheter-related biofilm rat model and found that viable bacteria counts in biofilm were significantly reduced after treatment (P < 0.05). In summary, we have shown here that the combination of linezolid and fosfomycin treatment had improved therapeutic effects on biofilm-embedded MRSA infection both in vitro and in vivo, which provided important basis for new clinical therapy development.
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Bassetti M, Righi E. Safety profiles of old and new antimicrobials for the treatment of MRSA infections. Expert Opin Drug Saf 2016; 15:467-81. [PMID: 26764972 DOI: 10.1517/14740338.2016.1142528] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of severe nosocomial and community-acquired infections. Various adverse effects have been associated with compounds that are commonly used in the treatment of MRSA. AREAS COVERED Prolonged use of high-dose vancomycin has been linked with nephrotoxicity. Linezolid use has been associated with lactic acidosis in regimens longer than 14 days and occurrence of thrombocytopenia in patients with renal impairment. Daptomycin use correlates with reversible and often asymptomatic myopathy. Among new compounds, telavancin has shown increased toxicity compared to vancomycin, especially in patients with severe renal impairment, while a low rate of adverse effects was reported others glycolipopeptides such as dalbavancin and oritavancin and for new cephalosporins. Recently studied oxazolidinones (tedizolid and radezolid) also showed mild adverse effects in Phase 2 and 3 clinical trials. EXPERT OPINION Due to the constant increase in antimicrobial resistance, the use of higher doses and prolonged regimens of antibiotics employed in the treatment of Gram-positive infections has become more common and linked to increased toxicity. Furthermore, new compounds with MRSA activity have been recently approved and will be regularly employed in clinical practice. The knowledge of the adverse effects and risk factors for the development of toxicity associated with anti-MRSA antimicrobials is paramount for the correct use of old and new compounds, especially in the treatment of severe infections.
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Affiliation(s)
- Matteo Bassetti
- a Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy
| | - Elda Righi
- a Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy
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Wang TL, Guo DH, Bai Y, Wen K, Han WY, Wang R. Thrombocytopenia in Patients Receiving Prolonged Linezolid May be Caused by Oxidative Stress. Clin Drug Investig 2015; 36:67-75. [DOI: 10.1007/s40261-015-0352-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nawar T, Kanafani ZA. Telavancin (VIBATIV) for the treatment of complicated skin and skin structure infections. Expert Rev Anti Infect Ther 2015; 13:825-33. [PMID: 26059192 DOI: 10.1586/14787210.2015.1043889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Methicillin-resistant Staphylococcus aureus has emerged as a major causative pathogen in complicated skin and skin structure infections (cSSSIs). Unfortunately, treatment failure with vancomycin has been increasingly reported. Over the past decade, several alternative antimicrobial agents have been studied and approved for the treatment of cSSSIs. One such agent is the lipoglycopeptide telavancin, which was approved by the US FDA 2009. Given its dual mechanism of action, telavancin is characterized by a highly bactericidal activity and low potential for resistance selection. In addition, in clinical trials, it was efficacious and safe in the treatment of cSSSI. The purpose of this review is to give a background overview of telavancin, highlighting its microbiological, pharmacokinetic and pharmacodynamics characteristics, to summarize the available evidence for its use in the treatment of cSSSIs, and to provide an updated evaluation of its safety profile.
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Affiliation(s)
- Tamara Nawar
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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