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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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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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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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Warda AEA, Sarhan RM, Al-Fishawy HS, Moharram AN, Salem HF. Continuous Versus Intermittent Linezolid Infusion for Critically Ill Patients with Hospital-Acquired and Ventilator-Associated Pneumonia: Efficacy and Safety Challenges. Pharmaceuticals (Basel) 2022; 15:ph15030296. [PMID: 35337094 PMCID: PMC8949268 DOI: 10.3390/ph15030296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/20/2022] [Accepted: 02/26/2022] [Indexed: 02/06/2023] Open
Abstract
High variability of linezolid blood concentrations with partial subtherapeutic levels was observed in critically ill patients who received a standard intravenous dose of linezolid, contributing to drug resistance and toxicity. Continuous infusions of linezolid have been suggested as an alternative and provide good serum and alveolar levels without fluctuations in trough concentration. This study aimed to assess the effectiveness and safety of continuous linezolid infusion versus the standard regimen in critically ill patients. A prospective randomized controlled study was conducted on 179 patients with nosocomial pneumonia. Patients were randomized into two groups. The first group received IV linezolid 600 mg twice daily, while the second group received 600 mg IV as a loading dose, followed by a continuous infusion of 1200 mg/day (50 mg/h) for at least 8−10 days. The continuous infusion group showed a higher clinical cure rate than the intermittent infusion group (p = 0.046). Furthermore, efficacy was proven by greater improvement of P/F ratio (p = 0.030) on day 7 of treatment, a lower incidence of developing sepsis after beginning treatment (p = 0.009), and a shorter time to reach clinical cure (p < 0.001). Hematological parameters were also assessed during the treatment to evaluate the safety between the two groups. The incidence of thrombocytopenia was significantly lower in the continuous infusion group than in the intermittent infusion group. In addition, a stepwise logistic regression model revealed that the intermittent infusion of linezolid was significantly associated with thrombocytopenia (OR =4.128; 95% CI = 1.681−10.139; p =0.001). The current study is the first to assess the clinical aspects of continuous infusion of linezolid beyond pharmacokinetic studies. Continuous infusion of linezolid outperforms intermittent delivery in safety and improves clinical effectiveness in critically ill patients with Gram-positive nosocomial pneumonia.
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Affiliation(s)
- Ahmed E. Abou Warda
- Clinical Pharmacy Department, Faculty of Pharmacy, October 6 University, Giza P.O. Box 12585, Egypt;
| | - Rania M. Sarhan
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef P.O. Box 62514, Egypt
- Correspondence: ; Tel.: +20-100-878-9509
| | - Hussein Saeed Al-Fishawy
- Internal Medicine Department, Faculty of Medicine, Cairo University, Giza P.O. Box 12613, Egypt;
| | - Ayman N. Moharram
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Giza P.O. Box 12613, Egypt;
| | - Heba F. Salem
- Pharmaceutics and Industrial Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef P.O. Box 62514, Egypt;
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Nie X, Jia L, Peng X, Zhao H, Yu Y, Chen Z, Zhang L, Cheng X, Lyu Y, Cao W, Wang X, Ni X, Zhan S. Detection of Drug-Induced Thrombocytopenia Signals in Children Using Routine Electronic Medical Records. Front Pharmacol 2021; 12:756207. [PMID: 34867372 PMCID: PMC8633439 DOI: 10.3389/fphar.2021.756207] [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: 08/10/2021] [Accepted: 10/20/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Drug-induced thrombocytopenia (DITP) is a severe adverse reaction and a significantly under-recognized clinical problem in children. However, for post-marketing pharmacovigilance purposes, detection of DITP signals is crucial. This study aimed to develop a signal detection model for DITP using the pediatric electronic medical records (EMR) data. Methods: This study used the electronic medical records collected at Beijing Children’s Hospital between 2009 and 2020. A two-stage modeling method was developed to detect the signal of DITP. In the first stage, we calculated the crude incidence by mining cases of thrombocytopenia to select the potential suspected drugs. In the second stage, we constructed propensity score–matched retrospective cohorts of specific screened drugs from the first stage and estimated the odds ratio (OR) and 95% confidence interval (CI) using conditional logistic regression models. The novelty of the signal was assessed by current evidence. Results: In the study, from a total of 839 drugs, 21 drugs were initially screened as potentially inducing thrombocytopenia. In total, we identified 18 positive DITP associations. Of these, potential DITP risk of nystatin (OR: 1.75, 95% CI: 1.37–2.22) and latamoxef sodium (OR: 1.61, 95% CI: 1.38–1.88) were two new DITP signals in both children and adults. Six associations between thrombocytopenia and drugs including imipenem (OR: 1.69, 95% CI: 1.16–2.45), teicoplanin (OR: 4.75, 95% CI: 3.33–6.78), fusidic acid (OR: 2.81, 95% CI: 2.06–3.86), ceftizoxime sodium (OR: 1.83, 95% CI: 1.36–2.45), ceftazidime (OR: 2.16, 95% CI: 1.58–2.95), and cefepime (OR: 5.06, 95% CI: 3.77–6.78) were considered as new signals in children. Conclusion: This study developed a two-stage algorithm to detect safety signals of DITP and found eighteen positive signals of DITP, including six new signals in a pediatric population. This method is a promising tool for pharmacovigilance based on EMR data.
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Affiliation(s)
- Xiaolu Nie
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Lulu Jia
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoxia Peng
- Center for Clinical Epidemiology and Evidence-based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Houyu Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yuncui Yu
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Liqiang Zhang
- Hematology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoling Cheng
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yaqi Lyu
- Department of Medical Record Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wang Cao
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaoling Wang
- Department of Pharmacy, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xin Ni
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
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Singhal T, Rodrigues C, Soman R, Wattal C, Swaminathan S, Nambi S, Talwar D, Singh RK, Todi S. Treatment of MRSA infections in India: Clinical insights from a Delphi analysis. Indian J Med Microbiol 2021; 40:35-45. [PMID: 34785281 DOI: 10.1016/j.ijmmb.2021.11.005] [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] [Received: 06/22/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE International and Indian guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections are available, but the local guidelines are not MRSA-specific. This study aimed to provide clinical insights for the treatment of MRSA infections in India. METHODS We used a three-step modified Delphi method to obtain insights. Ten experts comprising infectious disease specialists, microbiologists, pulmonologists, and critical care experts agreed to participate in the analysis. In round 1, a total of 161 statements were circulated to the panel and the experts were asked to 'agree' or 'disagree' by responding 'yes' or 'no' to each statement and provide comments. The same process was used for 73 statements in round 2. Direct interaction with the experts was carried out in round 3 wherein 35 statements were discussed. At least 80% of the experts had to agree for a statement to reach concordance. RESULTS Eighty-eight statements in round 1, thirty-eight statements in round 2, and eight statements in round 3 reached concordance and were accepted without modification. The final document comprised 152 statements on the management of various syndromes associated with MRSA such as skin and soft tissue infections, bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system infections. CONCLUSIONS This analysis will assist clinicians in India to choose an appropriate course of action for MRSA infections.
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Affiliation(s)
- Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | - Chand Wattal
- Clinical Microbiology & Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Subramanian Swaminathan
- Infectious Diseases and Infection Control at Gleneagles Global Hospitals (Chennai, Bangalore, Hyderabad), India
| | | | - Deepak Talwar
- Metro Respiratory Center Pulmonology & Sleep Medicine, Metro Hospital, Noida, India
| | | | - Subhash Todi
- Critical Care Medicine, Department of Academics & Health Research, AMRI Hospitals, Kolkata, India.
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Kato H, Hagihara M, Asai N, Koizumi Y, Yamagishi Y, Mikamo H. A systematic review and meta-analysis of myelosuppression in pediatric patients treated with linezolid for Gram-positive bacterial infections. J Infect Chemother 2021; 27:1143-1150. [PMID: 33727025 DOI: 10.1016/j.jiac.2021.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of linezolid-induced myelosuppression in pediatric patients was reported at large difference among prospective studies, with a range of 0-24%. Additionally, there is little study which evaluated the impact of linezolid administration period on myelosuppression in pediatric patients, while it is one of the most frequent reason that linezolid therapy has to be discontinued in adult patients. Here, we performed a systematic review and meta-analysis to reveal the incidence of linezolid-induced thrombocytopenia and anemia, and impact of the administration period of linezolid on myelosuppression based on individual data analysis of pediatric patients. METHODS We systematically searched the Scopus, EMBASE, Cochrane Central Register of Controlled Trials, PubMed, and CINAHL until April 2020. We investigated the incidence of linezolid-induced thrombocytopenia and anemia using pooled analysis, and evaluated the impact of linezolid administration period on myelosuppression using meta-analysis. RESULTS Thirteen studies with 969 pediatric patients were identified. The pooled incidences of thrombocytopenia and anemia were 9% (95% confidence interval (CI), 3-18%) and 4% (95% CI, 0-12%), respectively. Our meta-analysis showed the extension of linezolid administration period (more than 14 days) resulted in higher incidence of thrombocytopenia (OR 4.86, 95% CI 1.10-21.55) and anemia (OR 4.57, 95% CI 0.13-160.49). CONCLUSIONS The incidence of linezolid-induced myelosuppression in pediatric patients was less than 10%. However, our meta-analysis revealed linezolid administration period for more than 14 days was one of risk factors associated with linezolid-induced myelosuppression. Therefore, especially for pediatric patients treated with linezolid for more than 14 days, careful monitoring of myelosuppression is required.
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Affiliation(s)
- Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan; Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University Hospital, Aichi, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan.
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Kim HS, Lee E, Cho YJ, Lee YJ, Rhie SJ. Linezolid-induced thrombocytopenia increases mortality risk in intensive care unit patients, a 10 year retrospective study. J Clin Pharm Ther 2018; 44:84-90. [PMID: 30243033 DOI: 10.1111/jcpt.12762] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/02/2018] [Accepted: 08/21/2018] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Linezolid-induced thrombocytopenia is one of the many confounding conditions in critically ill patients. It is rare but prognostic importance of linezolid-induced thrombocytopenia in ICU population has not been well investigated. The study is to assess the incidence and risk factors of linezolid-induced thrombocytopenia in ICU patients. METHODS We conducted a retrospective study with ICU patients treated with linezolid between January 2005 and December 2015 at the adult medical, surgical, emergency, and neurological ICUs at 1500-bed tertiary university medical center. RESULTS AND DISCUSSION There were 60 patients (mean age: 69.8 ± 11.9), 29 (48.3%) who developed linezolid-induced thrombocytopenia determined by the Naranjo algorithm on a case-by-case basis during the study period. The patients with linezolid-induced thrombocytopenia had a higher rate of any malignancy (41.4% vs 9.7%, P = 0.007), elevated baseline creatinine levels (median [interquartile range; IQR]: 1.7 mg/dL [0.9-2.5] vs 0.9 mg/dL [0.6-1.3]; P = 0.042), and lower baseline platelet counts (median [IQR] 160 × 109 /L [128-230] vs 194 × 109 /L [118-285]; P = 0.296) than patients without linezolid-induced thrombocytopenia. The patients who developed thrombocytopenia received more platelet transfusions (34.5% vs 6.5%, P = 0.009) and had higher ICU mortality rates (62.1% vs 32.3%, P = 0.037). Logistic regression analysis revealed the following significant risk factors for linezolid-induced thrombocytopenia: presence of any malignancy (odds ratio; OR [95% confidence interval; CI]: 8.667 [1.986-37.831]) and an elevated baseline serum creatinine level (OR: 1.673, CI: 1.046-2.675]). WHAT IS NEW AND CONCLUSION Critically ill patients with any malignancy or an elevated baseline creatinine level who were treated with linezolid in the ICU were more likely to develop thrombocytopenia. More importantly, mortality increased with patients who developed linezolid-induced thrombocytopenia compared to those did not.
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Affiliation(s)
- Hyung-Sook Kim
- Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sandy Jeong Rhie
- Graduate School of Clinical Health Sciences, Ewha Womans University, Seoul, Korea.,Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea.,College of Pharmacy, Ewha Womans University, Seoul, Korea
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9
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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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10
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Rabon AD, Fisher JP, MacVane SH. Incidence and Risk Factors for Development of Thrombocytopenia in Patients Treated With Linezolid for 7 Days or Greater. Ann Pharmacother 2018; 52:1162-1164. [PMID: 29911390 DOI: 10.1177/1060028018783498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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