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Kazemzadeh J, Pakzad S, Parizad N, Jafari Y. Skin graft surgery and its impact on platelet counts in Iranian burn patients: a non-randomized clinical trial. BMC Surg 2024; 24:200. [PMID: 38956520 PMCID: PMC11220946 DOI: 10.1186/s12893-024-02489-x] [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: 01/28/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Platelets are critical in maintaining homeostasis and immune response in burn patients. The concentration of platelets decreases in burn patients, and any intervention that increases serum platelet concentration can prevent serious consequences and patient death. The present study aimed to assess the impact of skin graft surgery on burn patients' platelet counts. METHODS In this non-randomized clinical trial, 200 burn patients were investigated. The patients were recruited from the surgical ward of Imam Khomeini Teaching Hospital during the first six months of 2021. After completing the checklist, patients underwent skin graft surgery. Blood was taken from the patients during surgery in the operating room and on the third and fifth day after the surgery to check platelets. Data analysis was conducted using SPSS software (ver. 22.0). RESULTS Most patients (63.5%) were male, and 73 (36.5%) were female. One hundred eighty-one patients (90.5%) had deep burns, and 19 (9.5%) had superficial burns. The mean burns percentage in the patients was 19.3 ± 15.4%, the lowest was 2%, and the highest was 90%. The most common burns were caused by flame (42%) and boiling water (30.5%). The patients' outcomes revealed that 6% gained complete recovery, 86.5% partial recovery, 2.5% showed transplant rejection, and 5% died. Mean platelet levels in deceased patients had an upward trend. The mean platelet counts of patients were elevated during surgery (289,855 ± 165,378), decreased three days after surgery (282,778 ± 317,310), and elevated again five days after surgery (330,375 ± 208,571). However, no significant difference was found between the mean platelet counts during surgery, the third and fifth days after surgery in patients undergoing skin grafts (P = 0.057). CONCLUSIONS This study suggests that skin graft positively increases the patient's platelets. Further studies are needed to confirm the findings and elucidate the mechanism. Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N8 & 06/01/2024).
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Affiliation(s)
- Jafar Kazemzadeh
- Reconstructive and Burn Surgery Department, Urmia University of Medical Sciences, Urmia, Iran
| | - Shiva Pakzad
- Reconstructive and Burn Surgery Department, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Parizad
- Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran.
- Nursing and Midwifery Faculty, Campus Nazlu, 11 KM Road Seru, Urmia, 575611-5111, West Azerbaijan, Iran.
| | - Yashar Jafari
- Department of General surgery, Urmia University of Medical Sciences, Urmia, Iran
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Roh S, Hashimoto K, Kiriishi R, Matsubara K, Isozaki Y, Tanaka H, Kuwata T. Piperacillin/tazobactam-induced sudden severe thrombocytopenia in a patient with a pressure ulcer: a case report. J Wound Care 2024; 33:S25-S30. [PMID: 38843043 DOI: 10.12968/jowc.2021.0074] [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] [Indexed: 06/10/2024]
Abstract
The standard treatment for an infected pressure ulcer (PU) with osteomyelitis is debridement, wound coverage and antibiotic administration. However, systemic administration of antibiotics in patients with osteomyelitis is controversial, and the optimal treatment duration for chronic osteomyelitis has not been standardised. We report a case of sudden severe thrombocytopenia induced by piperacillin/tazobactam (PIPC/TAZ) in a patient with PU-related osteomyelitis. A 57-year-old male patient with paraplegia, using a wheelchair full-time, presented to our plastic surgery department with infection of a stage IV hard-to-heal ischial PU. We surgically debrided the necrotising tissue and raised an ipsilateral biceps femoris musculocutaneous propeller flap for wound coverage. Polymicrobial infections, including Pseudomonas aeruginosa, were detected in the bone biopsy sample; therefore, systemic PIPC/TAZ was administered for the osteomyelitis. Unexpectedly, during the next 12 days of antibiotic administration, the patient's platelet count acutely dropped to 1×103/μl over three days. Based on a series of examinations, PIPC/TAZ was suspected to be the most likely cause of the severe thrombocytopenia. After drug discontinuation, the thrombocytopenia gradually improved. PIPC/TAZ is one of the most widely used antibiotic combinations in the plastic surgery field; it is conventionally administered for hard-to-heal wounds such as PUs and diabetic foot. The present case suggests that surgeons must take special precautions for patients undergoing PIPC/TAZ treatment. In this report, PIPC/TAZ-induced thrombocytopenia and the efficacy of antibiotic treatment for PU-related osteomyelitis are discussed in light of the available literature.
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Affiliation(s)
- Solji Roh
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Kohei Hashimoto
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Rina Kiriishi
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Ken Matsubara
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | - Yuki Isozaki
- Department of Plastic Surgery, Asahi General Hospital, Japan
| | | | - Tomoyuki Kuwata
- Department of Plastic Surgery, Asahi General Hospital, Japan
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3
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Adhikari S, Buoniconti P, Allam ML. Zosyn-Induced Rapid Thrombocytopenia in a Patient With End-Stage Renal Disease and HIV: A Case Report. Cureus 2023; 15:e50167. [PMID: 38186511 PMCID: PMC10771741 DOI: 10.7759/cureus.50167] [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] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Thrombocytopenia is a rare but potentially serious complication associated with the use of various medications, including antibiotics. Piperacillin-tazobactam (Zosyn), a commonly used broad-spectrum antibiotic, has been reported as an infrequent cause of drug-induced thrombocytopenia. We present a case of a 65-year-old female with end-stage renal disease (ESRD) on hemodialysis, HIV, and multiple comorbidities who developed rapid-onset thrombocytopenia shortly after receiving Zosyn. The patient's platelet count dropped from a baseline of 291,000/μL on admission to a nadir of 8,000/μL within 36 hours of starting Zosyn. The administration of Zosyn was promptly discontinued, and the patient's platelet count gradually increased to 134,000/μL within two days after discontinuation. The patient had no apparent bleeding manifestations during her hospital stay. Further workup for other causes of thrombocytopenia, including heparin-induced thrombocytopenia (HIT), was negative. This case highlights the importance of vigilance for drug-induced thrombocytopenia in patients receiving Zosyn and the need for prompt recognition and management to prevent potential complications.
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Yang S, Guo W, Chen M, Hu J, Feng N, Ju M, Qian Y. Prevalence and risk factors for severe linezolid-associated thrombocytopenia in pediatric patients: An analysis of a public database. Medicine (Baltimore) 2023; 102:e34059. [PMID: 37327288 PMCID: PMC10270524 DOI: 10.1097/md.0000000000034059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Linezolid is widely used in various clinical settings. Studies have revealed that it may cause thrombocytopenia in adults. However, the correlation between the use of linezolid and thrombocytopenia in pediatric patients is still unclear. This study aimed to identify the impact of Linezolid on the occurrence of thrombocytopenia in children. A retrospective observational study was conducted using data on patients treated with linezolid from the Pediatric Intensive Care clinical database. Univariate and multiple logistic regression analyses were performed to identify the risk factors of linezolid-related severe thrombocytopenia. A total of 134 patients were included. The prevalence of severe thrombocytopenia was 8.96% (12/134). Univariate analysis indicated that the severe thrombocytopenia group showed significantly higher proportion of concomitant carbapenem (75% vs 44.3%; P < .05) and piperacillin/tazobactam (25% vs 6.6%; P < .05) than that of the non-severe thrombocytopenia group. Multivariate analysis also revealed that the occurrence of severe thrombocytopenia was significantly associated with concurrent use of carbapenem (odd ratio = 4.058; 95% confidence interval: 1.012-16.274; P = .048) and piperacillin/tazobactam (odd ratio = 5.335; 95% confidence interval: 1.117-25.478; P = .036). 75% of patients (9/12) developed severe thrombocytopenia within the first 7 days of linezolid use. The concomitant use of carbapenem and piperacillin/tazobactam was associated with an increased probability of severe thrombocytopenia in pediatric patients undergoing linezolid treatment. Further prospective clinical studies are required, and more detailed mechanisms of blood toxicity in pediatric patients must be investigated.
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Affiliation(s)
- Shibo Yang
- Department of Emergency, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Wencheng Guo
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Ming Chen
- Department of Respiratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Jindong Hu
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Nana Feng
- Department of Respiratory and Critical Medicine, Shanghai Eighth People’s Hospital Affiliated to Jiangsu University, Shanghai, People’s Republic of China
| | - Mohan Ju
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yiyi Qian
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
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5
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He X, Huang W, Wan X, Li X, Chang Q, Ding L. Cross-reactivity between piperacillin-tazobactam and cefoperazone-sulbactam in drug-induced immune thrombocytopenia. J Int Med Res 2023; 51:3000605231162434. [PMID: 36967671 PMCID: PMC10052494 DOI: 10.1177/03000605231162434] [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] [Indexed: 03/29/2023] Open
Abstract
Beta-lactam antibiotics commonly cause immune thrombocytopenia. Cross-reactivity in patients with drug-induced immune thrombocytopenia has rarely been reported. In this study, we describe the case of a 79-year-old man who developed thrombocytopenia after receiving piperacillin-tazobactam for an acute exacerbation of chronic obstructive pulmonary disease, and he was successfully treated with meropenem and cefotiam. However, thrombocytopenia recurred after cefoperazone-sulbactam administration. This indicated that cross-reactivity of platelet-specific antibodies occurred between piperacillin-tazobactam and cefoperazone-sulbactam. However, the responsible drug structures remain unknown, requiring further investigation. Likewise, chemical structure similarities among beta-lactam antibiotics must be examined to determine the risk of immune thrombocytopenia in the clinical setting.
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Affiliation(s)
- Xiaoyan He
- Department of Pharmacy, Chongqing University Jiangjin Hospital, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
- Department of Pharmacy, Central Hospital of Jiangjin District, Chongqing, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
| | - Wanting Huang
- Department of Pharmacy, Chongqing University Jiangjin Hospital, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
- Department of Pharmacy, Central Hospital of Jiangjin District, Chongqing, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
| | - Xiong Wan
- Department of Respiratory Medicine, Chongqing University Jiangjin Hospital, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, China
- Department of Respiratory Medicine, Central Hospital of Jiangjin District, Chongqing, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
| | - Xiaoya Li
- Department of Pharmacy, Chongqing University Jiangjin Hospital, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
- Department of Pharmacy, Central Hospital of Jiangjin District, Chongqing, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
| | - Qiuhong Chang
- Department of Pharmacy, Chongqing University Jiangjin Hospital, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
- Department of Pharmacy, Central Hospital of Jiangjin District, Chongqing, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
| | - Ling Ding
- Department of Pharmacy, Chongqing University Jiangjin Hospital, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
- Department of Pharmacy, Central Hospital of Jiangjin District, Chongqing, 725 Jiangzhou Avenue, Jiangjin District, Chongqing, 402260, China
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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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8
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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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Abstract
Drug-induced thrombocytopenia (DITP) has been described as a sudden and severe hematologic complication of piperacillin/tazobactam. The proposed mechanism by which piperacillin/tazobactam causes DITP involves the formation of a covalent bond to platelet membrane protein thereby inducing a humoral immune response. Given the immunogenic nature of this adverse event and the structural similarities across beta-lactam antibiotics, the potential for cross-reactivity between agents within the class should be considered. However, the structural moiety of piperacillin/tazobactam responsible for this immunogenic response has not been identified-the relationship between structure and activity for this phenomenon remains unknown. Data on the safety and cross-reactivity of other beta-lactam agents in this setting is lacking. We report the first case of piperacillin/tazobactam DITP successfully challenged by the use of cefepime for the treatment of aspiration pneumonia. Further studies are needed to determine the structural moiety of piperacillin/tazobactam responsible for this immunogenic response and evaluate the safety of other beta-lactam antibiotics in this clinical setting.
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10
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Alzahrani M, Alrumaih I, Alhamad F, Abdel Warith A. Rapid onset severe thrombocytopenia following reexposure to piperacillin-tazobactam: report of two cases and review of the literature. Platelets 2018; 29:628-631. [DOI: 10.1080/09537104.2018.1468025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Musa Alzahrani
- Oncology Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Alrumaih
- Internal Medicine Program, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Alhamad
- Intensive Care Unit, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Abdel Warith
- Oncology Center, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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11
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Cato LD, Wearn CM, Bishop JR, Stone MJ, Harrison P, Moiemen N. Platelet count: A predictor of sepsis and mortality in severe burns. Burns 2018; 44:288-297. [DOI: 10.1016/j.burns.2017.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/20/2017] [Accepted: 08/22/2017] [Indexed: 12/22/2022]
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12
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Patel S, Levin-Epstein R, Kobashigawa J. Piperacillin-induced Thrombocytopenia in a Dual Heart and Kidney Transplant Patient: A Case Report. Transplant Proc 2017; 49:1672-1674. [DOI: 10.1016/j.transproceed.2017.02.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/07/2017] [Indexed: 01/16/2023]
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13
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Manappallil R, Karadan U, Kumar P, Sabir M, Supreeth R. Acute delirium following administration of Piperacillin-Tazobactam in an elderly patient with chronic liver disease. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Boyce K, Brar H, Stabler SN. Piperacillin/tazobactam-induced immune-mediated thrombocytopenia in the intensive care unit. J Clin Pharm Ther 2016; 41:730-732. [PMID: 27670947 DOI: 10.1111/jcpt.12458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/04/2016] [Indexed: 02/05/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug-induced immune-mediated thrombocytopenia is a rare adverse event that remains a diagnostic challenge, especially in the critically ill population. There are only two previously reported cases of rapid and profound thrombocytopenia after administration of piperacillin/tazobactam. CASE SUMMARY A 64-year-old man experienced several episodes of isolated thrombocytopenia after receiving piperacillin/tazobactam. Interestingly, the degree of thrombocytopenia varied with the amount of corticosteroid therapy the patient was receiving. Due to the complexity of thrombocytopenia in critically ill patients, other potential causes were extensively worked up and ruled out. WHAT IS NEW AND CONCLUSION We describe the first case of piperacillin/tazobactam-induced immune-mediated thrombocytopenia that was mitigated by the administration of corticosteroid therapy. This case highlights the importance of identifying potential drug-related causes of isolated thrombocytopenia.
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Affiliation(s)
- K Boyce
- Department of Critical Care and Department of Pharmacy Services, Surrey Memorial Hospital, Surrey, BC, Canada
| | - H Brar
- Department of Critical Care and Department of Pharmacy Services, Surrey Memorial Hospital, Surrey, BC, Canada
| | - S N Stabler
- Department of Critical Care and Department of Pharmacy Services, Surrey Memorial Hospital, Surrey, BC, Canada.
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