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Is Piperacillin-Tazobactam an Appropriate Empirical Agent for Hospital-Acquired Sepsis and Community-Acquired Septic Shock of Unknown Origin in Australia? Healthcare (Basel) 2022; 10:healthcare10050851. [PMID: 35627988 PMCID: PMC9142067 DOI: 10.3390/healthcare10050851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/30/2022] [Accepted: 05/01/2022] [Indexed: 11/17/2022] Open
Abstract
Early appropriate empirical antibiotics are critical for reducing mortality in sepsis. For hospital-acquired sepsis of unknown origin in Australia, piperacillin-tazobactam (TZP) is recommended as an empirical therapy. Anecdotally, some institutions also use TZP for community-acquired septic shock. This narrative review aimed to scrutinise the appropriateness of TZP as an empirical agent for undifferentiated hospital-acquired sepsis and community-acquired septic shock. An online database (Medline) was searched for relevant studies in adults published in the last 10 years. Studies were included if they addressed separately reported clinical outcomes related to a relevant aspect of TZP therapy in sepsis. Of 290 search results, no studies directly addressed the study aim. This review therefore explores several themes that emerged from the contemporary literature, all of which must be considered to fully interrogate the appropriateness of TZP use in this context. This review reveals the paucity and low quality of evidence available for TZP use in sepsis of unclear origin, while demonstrating the urgent need and equipoise for an Australian audit of TZP use in patients with sepsis of unknown origin.
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Iwazawa H, Tanaka H, Tatsumichi T, Yamaguchi K, Takahashi K, Suzuki K, Motoki T, Kanenishi K, Kosaka S. A puerperal patient with agranulocytosis during tazobactam / piperacillin administration : A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:368-371. [PMID: 34759160 DOI: 10.2152/jmi.68.368] [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: 11/14/2022]
Abstract
Tazobactam / piperacillin (TAZ / PIPC) is an injectable combination drug consisting of a broad-spectrum penicillin and a β-lactamase inhibitor. This antimicrobial has a wide spectrum of efficacy against both Gram-positive bacteria and anaerobes. Adverse events usually present as diarrhea or liver dysfunction ; agranulocytosis has not been reported in Japanese patients with puerperal disorders. However, we report a 32-year-old Japanese woman who received TAZ / PIPC to treat an intraperitoneal infection that developed after complications related to transvaginal delivery. Within 14 days of beginning TAZ / PIPC therapy, the patient developed agranulocytosis, indicated by a white blood cell count of 1900 cells / µL and a neutrophil count of 475 cells / µL. We discontinued TAZ / PIPC at this point and changed the antimicrobial to meropenem. Seven days later, her white blood cell count increased to 3700 cells / µL (neutrophil count : 1684 cells / µL), and the intraperitoneal infection resolved. Patients receiving TAZ / PIPC should be monitored periodically for agranulocytosis as well as for diarrhea and liver dysfunction. J. Med. Invest. 68 : 368-371, August, 2021.
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Affiliation(s)
- Haruna Iwazawa
- Department of Pharmacy, Kagawa University Hospital, Ikenobe, Miki, Kagawa, Japan
| | - Hiroaki Tanaka
- Department of Pharmacy, Kagawa University Hospital, Ikenobe, Miki, Kagawa, Japan
| | - Takakiyo Tatsumichi
- Department of Pharmacy, Kagawa University Hospital, Ikenobe, Miki, Kagawa, Japan
| | - Kazunori Yamaguchi
- Department of Pharmacy, Kagawa University Hospital, Ikenobe, Miki, Kagawa, Japan
| | - Koichi Takahashi
- Department of Pharmacy, Kagawa University Hospital, Ikenobe, Miki, Kagawa, Japan
| | - Kiyo Suzuki
- Department of Pharmacy, Kagawa University Hospital, Ikenobe, Miki, Kagawa, Japan
| | - Takahiro Motoki
- Department of Pharmacy, Kagawa University Hospital, Ikenobe, Miki, Kagawa, Japan
| | - Kenji Kanenishi
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Ikenobe, Miki, Kagawa, Japan
| | - Shinji Kosaka
- Department of Pharmacy, Kagawa University Hospital, Ikenobe, Miki, Kagawa, Japan
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Al-Sardi M, Ali H, Handoo F, AlJawad M. A Rare Case of Rapid Onset Thrombocytopenia Induced by Piperacillin/Tazobactam in a Liver Transplant Recipient. Cureus 2021; 13:e18000. [PMID: 34667676 PMCID: PMC8519584 DOI: 10.7759/cureus.18000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/15/2021] [Indexed: 02/03/2023] Open
Abstract
Drug-induced thrombocytopenia is a relatively common clinical condition. However, acute thrombocytopenia after initiation of piperacillin/tazobactam is rare, with only a few cases reported in the literature. The mechanism by which it happens is still unclear but it is thought to be immune-mediated. We present the first case of rapid-onset thrombocytopenia induced by piperacillin/tazobactam in a liver transplant recipient. Our patient had previous exposure to the antibiotic, and thrombocytopenia was treated by merely stopping the culprit antibiotic (piperacillin/tazobactam). The patient had a successful challenge with cefepime afterward despite possible cross-reactivity, making this the second case report of successful re-challenging with cefepime.
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Affiliation(s)
- Mais Al-Sardi
- Internal Medicine, King Fahad Specialist Hospital, Dammam, SAU
| | - Hala Ali
- Hepatology, King Fahad Specialist Hospital, Dammam, SAU
| | - Fayaz Handoo
- Hepatology, King Fahad Specialist Hospital, Dammam, SAU
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Siddiqui RS, Lakhdar S, Buttar C, Saliaj M. Thrombocytopenia Secondary to Herpes Simplex Virus-2 Infection Successfully Treated by Acyclovir. Cureus 2020; 12:e12338. [PMID: 33520534 PMCID: PMC7837646 DOI: 10.7759/cureus.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Thrombocytopenia is a common clinical condition associated with a wide variety of clinical conditions including infections, malignancy, medications, liver disorder, and autoimmune conditions, etc. The association between thrombocytopenia and herpes simplex virus (HSV) is reported only once in a case report dating back to 1978. We report a case of a 66-year-old female with generalized weakness, mechanical fall, genital ulcerations, and breast fold and genital area skin redness, warmth, and mild tenderness. Initial labs showed mild leukocytosis, normal platelet count, mild lactic acidosis, and urine analysis suggestive of urinary tract infection. The patient was started on broad-spectrum antibiotics. During the course of hospitalization, the patient developed severe thrombocytopenia with platelet counts dropping less than 40000/μL (normal range: 150,000-450,000/μL), and genital pain and ulceration worsened. The genital swab was sent which came back positive for the HSV-2 virus. Soon after the start of acyclovir for HSV-2 infection, the genital pain and ulceration improved and platelet counts gradually increased to 157,000/μL. Other causes of thrombocytopenia such as sepsis, heparin-induced thrombocytopenia, consumptive coagulopathy, medication-induced thrombocytopenia, immune thrombocytopenia, and thrombotic thrombocytopenic purpura were ruled out.
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Hematologic adverse effects induced by piperacillin-tazobactam: a systematic review of case reports. Int J Clin Pharm 2020; 42:1026-1035. [PMID: 32500262 DOI: 10.1007/s11096-020-01071-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Background Piperacillin/tazobactam, a semisynthetic antibiotic, is widely used to treat polymicrobial infections. Its hematologic adverse reactions are rare and the severity can be mild to life-threatening. To our knowledge, there has not been a publication reviewing hematologic abnormalities attributable to piperacillin/tazobactam. Aim of the review To evaluate the characteristic, clinical identification, mechanism and treatment of the hematologic toxicity caused by piperacillin/tazobactam. Method A search of Medline and Embase electronic databases was performed for case reports of adverse reactions of hematologic system related to piperacillin/tazobactam from inception to December 2018. Statistical analysis of demographic, clinical features, laboratory Indexes and treatments was performed using Microsoft EXCEL 2007. Results Fifty-nine references were obtained involving 62 patients. The adverse drug reactions were mainly hemolytic anemia (25, 40.3%), thrombocytopenia (23, 37.1%), and neutropenia (12, 19.4%), which might be accompanied by some typical symptoms. Hemolytic anemia or thrombocytopenia was generally believed to be immune-mediated and often appeared within 10 days, and neutropenia was thought to be related to bone marrow suppression and usually occurred 2 weeks after the initiation of piperacillin/tazobactam. Most patients improved or recovered within a week with treatment or not, and fewer high-quality evidence-based treatments were identified. Conclusion Although part of the patients have clinical symptom, the hematologic adverse drug reactions of piperacillin/tazobactam are easily overlooked or misdiagnosed. Take special caution for patients with prolonged piperacillin/tazobactam treatment or specific disease, and prompt recognition and treatment of the adverse drug reactions are essential and can hasten recovery regardless of the type of side reactions.
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Veiga RP, Paiva JA. Pharmacokinetics-pharmacodynamics issues relevant for the clinical use of beta-lactam antibiotics in critically ill patients. Crit Care 2018; 22:233. [PMID: 30244674 PMCID: PMC6151903 DOI: 10.1186/s13054-018-2155-1] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/08/2018] [Indexed: 12/15/2022] Open
Abstract
Antimicrobials are among the most important and commonly prescribed drugs in the management of critically ill patients and beta-lactams are the most common antibiotic class used. Critically ill patient's pathophysiological factors lead to altered pharmacokinetics and pharmacodynamics of beta-lactams.A comprehensive bibliographic search in PubMed database of all English language articles published from January 2000 to December 2017 was performed, allowing the selection of articles addressing the pharmacokinetics or pharmacodynamics of beta-lactam antibiotics in critically ill patients.In critically ill patients, several factors may increase volume of distribution and enhance renal clearance, inducing high intra- and inter-patient variability in beta-lactam concentration and promoting the risk of antibiotic underdosing. The duration of infusion of beta-lactams has been shown to influence the fT > minimal inhibitory concentration and an improved beta-lactam pharmacodynamics profile may be obtained by longer exposure with more frequent dosing, extended infusions, or continuous infusions.The use of extracorporeal support techniques in the critically ill may further contribute to this problem and we recommend not reducing standard antibiotic dosage since no drug accumulation was found in the available literature and to maintain continuous or prolonged infusion, especially for the treatment of infections caused by multidrug-resistant bacteria.Prediction of outcome based on concentrations in plasma results in overestimation of antimicrobial activity at the site of infection, namely in cerebrospinal fluid and the lung. Therefore, although no studies have assessed clinical outcome, we recommend using higher than standard dosing, preferably with continuous or prolonged infusions, especially when treating less susceptible bacterial strains at these sites, as the pharmacodynamics profile may improve with no apparent increase in toxicity.A therapeutic drug monitoring-guided approach could be particularly useful in critically ill patients in whom achieving target concentrations is more difficult, such as obese patients, immunocompromised patients, those infected by highly resistant bacterial strains, patients with augmented renal clearance, and those undergoing extracorporeal support techniques.
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Affiliation(s)
- Rui Pedro Veiga
- Centro Hospitalar São João, EPE – Intensive Care Department, Porto, Portugal
- Faculty of Medicine – University of Porto, Porto, Portugal
- Grupo Infeção e Sepsis, Porto, Portugal
| | - José-Artur Paiva
- Centro Hospitalar São João, EPE – Intensive Care Department, Porto, Portugal
- Faculty of Medicine – University of Porto, Porto, Portugal
- Grupo Infeção e Sepsis, Porto, Portugal
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Chen H, Fan Z, Guo F, Yang Y, Li J, Zhang J, Wang Y, LE J, Wang Z, Zhu J. Tazobactam and piperacillin-induced thrombocytopenia: A case report. Exp Ther Med 2016; 11:1223-1226. [PMID: 27073426 PMCID: PMC4812091 DOI: 10.3892/etm.2016.3062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 10/29/2015] [Indexed: 12/01/2022] Open
Abstract
The present study reports a case of tazobactam and piperacillin (TZP)-induced thrombocytopenia in an elderly patient, from which complete clinical data and peripheral blood samples were collected. Platelet numbers were decreased 1 day following TZP treatment initiation; however, they were revealed to have increased 1–2 days following withdrawal of TZP, and had reached normal levels 3–5 days later. There was no evidence of bone marrow suppression, antibodies against peripheral plasma platelets were absent and levels of complement C3 were decreased. These results suggested that TZP was able to cause rapid and reversible thrombocytopenia, which was not associated with bone marrow suppression but may have involved activation of complement C3. The results of the present study therefore suggest that doctors should be aware of the risk of thrombocytopenia in patients treated with TZP.
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Affiliation(s)
- Hong Chen
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Zhen Fan
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Fei Guo
- Clinical Laboratory, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Yumin Yang
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Jie Li
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Jie Zhang
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Yudan Wang
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Jianwei LE
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Zhiyu Wang
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
| | - Jianhua Zhu
- Intensive Care Unit, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China; Intensive Care Unit, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang 315000, P.R. China
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