Hemolytic Anemia and Reactive Thrombocytosis Associated With Cefoperazone/Sulbactam

Cefoperazone-Sulbactam-Induced Coagulopathy in Critically Ill Egyptian Patients: Role of Vitamin K Prophylactic Doses

Aim: Evaluating the impact of vitamin K prophylaxis on cefoperazone-sulbactam-induced coagulopathy in critically ill patients. Methods: We conducted a randomized controlled trial on critically ill adult patients treated with cefoperazone-sulbactam. Patients received systemic cefoperazone-sulbactam antibiotics of 1.5 to 2 g every 12 hours. Patients were randomized into 2 groups: the intervention group (Gp-I), who received a 10 mg intravenous dose of vitamin K every week until cefoperazone-sulbactam therapy ended, and the control group (Gp-C), who received only cefoperazone-sulbactam. Results: Our main finding was the significantly higher survival probability from coagulopathy in Gp-I than in Gp-C using the Kaplan-Myers curve (χ2 = 25.5, P < .001). The adjusted hazard ratios for coagulopathy obtained from the Cox regression analysis revealed that the intervention was significantly associated with a 99% reduction in the hazard of coagulopathy relative to Gp-C (HR = 0.01, P = .001). The Kaplan-Myers curve indicated a significantly higher survival probability from bleeding in Gp-I than in Gp-C (χ2 = 9, degree of freedom = 1, P = .005). Conclusion: In critically ill patients, intravenous prophylactic doses of vitamin K of 10 mg per week prevent cefoperazone-sulbactam-induced coagulopathy. Therefore, we recommend adding vitamin K supplementation to ICU protocols in Egypt for cefoperazone-sulbactam safety.

Cefoperazone/sulbactam-induced hemolytic anemia

Drug-induced hemolytic anemia (DIHA) is a rare complication of drug therapy and usually underdiagnosed. Cefoperazone/sulbactam is a compound prepared from the third generation of cephalosporin and β-lactamase inhibitor. There are limited data of DIHA induced from cefoperazone/sulbactam. A 93-year-old female patient, who had an operation on the biliary tract 3 months ago, was admitted to our hospital with an abdominal infection. After cefoperazone/sulbactam was given as anti-infection treatment, the patient developed hemolytic anemia on the third day. Cefoperazone/sulbactam was discontinued and replaced with meropenem. Subsequently the level of red blood cells, hemoglobin, and hematocrit returned to normal. Clinicians should pay attention to monitoring the possible adverse reactions during the use of cefoperazone/sulbactam and should be aware of the occurrence of DIHA, so as to give timely treatment.

Case Report: Drug-Induced Immune Haemolytic Anaemia Caused by Cefoperazone-Tazobactam/ Sulbactam Combination Therapy

There has previously been a report of a patient developing haemolytic anaemia following exposure to cefoperazone. Another case has been reported involving the detection of cefoperazone-dependent antibodies in the absence of immune haemolytic anaemia. To date, no serological evidence has been reported to suggest that cefoperazone can lead to drug-induced immune haemolytic anaemia (DIIHA). This report aims to fill these gaps in knowledge by describing a case of DIIHA caused by cefoperazone-dependent antibodies. A 59-year-old man developed fatal haemolytic anaemia while receiving cefoperazone-tazobactam or cefoperazone-sulbactam for the treatment of a lung infection that occurred after craniocerebral surgery. This eventually led to renal function impairment. Prior to the discontinuation of cefoperazone treatment, the patient showed strong positive (4+) results for both anti-IgG and anti-C3d direct antiglobulin test (DAT), while cefoperazone-dependent IgM and IgG antibodies were detected. The patient's plasma and O-type RBCs were incubated with tazobactam or sulbactam solution at 37°C for 3 h, the results of DAT for anti-IgG and anti-C3d were both positive. Forty-three days after the discontinuation of cefoperazone, the results of DAT for anti-IgG and anti-C3d were negative. Meanwhile incubation of the patient's fresh serum and his own RBCs with cefoperazone at 37°C, gave rise to mild haemolysis, and the results of DAT for both anti-IgG and anti-C3d were positive. It is suggested that cefoperazone-dependent antibodies can activate complement, and the non-immunologic protein adsorption effect of tazobactam or sulbactam can enhance IgG and complement binding to RBCs. This may promote the formation of immunocomplexes and complement activation, thereby aggravating haemolysis.

Effect of cefoperazone sulbactam sodium combined with meropenem on the immune function in the treatment of neonatal pneumonia caused by multidrug-resistant bacteria

OBJECTIVE

To explore the effect of cefoperazone sulbactam sodium combined with meropenem on the immune function in the treatment of neonatal multi-drug resistant pneumonia.

METHODS

Altogether 130 children with pneumonia caused by multi-drug resistant bacteria admitted to our hospital from January 2016 to January 2019 were recruited as the study cohort. The children were randomly divided into a combined group (n=80, combined therapy) and a control group (n=50, cefoperazone sulbactam sodium therapy). Their clinical indexes and their pulmonary function indexes, their serum heparin-binding protein (HBP) 1,25-dihydroxy vitamin D3 [1,25-(OH)2D3] levels, and their inflammatory factors and immune indexes were observed. The bacterial eradication rates, total effective rates, and adverse reaction rates of the two groups were investigated.

RESULTS

Compared with the control group, the cough disappearance times, the antipyretic times, the pulmonary rales disappearance times, and the hospital stay lengths in the combination group were shorter, the FEV1% Pred (the percentage of forced expiratory volume in one second compared to the predicted value) and the FEV1/Fvc% (the percentage of forced expiratory volume in one second compared to the forced vital capacity) were higher, the HBP levels and the inflammatory factor CRP and IL-6 levels were lower, the 1,25-(OH)2D3, and the immune index gA, IgG, and C4 levels were higher, and the bacterial eradication rates and the total effective rates were higher, and the incidence of adverse reactions was lower.

CONCLUSION

Cefoperazone sulbactam sodium combined with meropenem can improve the immune function of newborn children with multi-drug resistant pneumonia.