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Fernandez-Sanchez J, Rodgers R, Maknojia AA, Shaikh N, Yan H, Mejia ME, Hendricks H, Jenq RR, Reddy P, Banerjee R, Schraw JM, Baldridge MT, King KY. Antibiotic-associated neutropenia is marked by depletion of intestinal Lachnospiraceae in pediatric patients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.25.24306386. [PMID: 38712139 PMCID: PMC11071563 DOI: 10.1101/2024.04.25.24306386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Hematologic side effects are associated with prolonged antibiotic exposure in up to 34% of patients. Neutropenia, reported in 10-15% of patients, increases the risk of sepsis and death. Murine studies have established a link between the intestinal microbiota and normal hematopoiesis. We sought to identify predisposing factors, presence of microbiota-derived metabolites, and changes in intestinal microbiota composition in otherwise healthy pediatric patients who developed neutropenia after prolonged courses of antibiotics. In this multi-center study, patients with infections requiring anticipated antibiotic treatment of two or more weeks were enrolled. Stool samples were obtained at the start and completion of antibiotics and at the time of neutropenia. We identified 10 patients who developed neutropenia on antibiotics and 29 controls matched for age, sex, race, and ethnicity. Clinical data demonstrated no association between neutropenia and type of infection or type of antibiotic used; however intensive care unit admission and length of therapy were associated with neutropenia. Reduced intestinal microbiome richness and decreased abundance of Lachnospiraceae family members correlated with neutropenia. Untargeted stool metabolomic profiling revealed several metabolites that were depleted exclusively in patients with neutropenia, including members of the urea cycle pathway, pyrimidine metabolism and fatty acid metabolism that are known to be produced by Lachnospiraceae . Our study confirms a relationship between intestinal microbiota disruption and abnormal hematopoiesis and identifies taxa and metabolites likely to contribute to microbiota-sustained hematopoiesis. As the microbiome is a key determinant of stem cell transplant and immunotherapy outcomes, these findings are likely to be of broad significance. Key Points Neutropenia occurred in 17% of patients receiving prolonged antibiotic therapy.We found no association between neutropenia and type of infection or class of antibiotic used. Development of neutropenia after prolonged antibiotic treatment was associated with decreased prevalence of Lachnospiraceae and Lachnospiraceae metabolites such as citrulline.
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Holz JM, Chevtchenko AV, Aitullina A. Acute antibiotically induced neutropenia: A systematic review of case reports. Br J Clin Pharmacol 2021; 88:1978-1984. [PMID: 34897762 DOI: 10.1111/bcp.15170] [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: 04/11/2021] [Revised: 10/20/2021] [Accepted: 11/21/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS Acute neutropenia induced by antibiotics is a rare side effect of this frequently prescribed class of drugs. We aim to find similarities and differences between reported cases. METHODS Through a database search (PubMed, 1968-2020), we identified published case reports and extracted, among other data, patient demographics, duration of treatment with the respective agent, and duration of recovery. RESULTS Overall, 83 cases were included. Neutropenia developed after a median (min-max) of 21 (17.5-28.5) days of treatment and was resolved after a median (min-max) of 6 (3.0-8.75) days. Vancomycin and ceftaroline emerged as the two most commonly described antibiotics. In 51.8% of cases, the suspected antibiotic was discontinued; in 37.4% of cases, it was substituted by another agent. Only three case reports mentioned death as a result of neutropenia. The use of granulocyte colony-stimulating growth factors (CSFs) shortened the duration of neutropenia and improved outcome for patients' health. CONCLUSION Neutropenia induced by antibiotics remains a rare or rarely reported side effect. Long-term and high-dose treatment regimens expose a higher risk of development. Thus, regular full blood counts are advised during therapy.
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Affiliation(s)
- Julian M Holz
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
| | | | - Aleksandra Aitullina
- Department of Pharmacology, Paul Stradins Clinical University Hospital, Riga Stradins University, Riga, Latvia
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李 丽, 杨 波, 高 翔, 任 漪, 苏 敏, 杨 春, 黄 迪, 王 惠. [Risk factors for neutropenia of late newborns]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:375-380. [PMID: 33840410 PMCID: PMC8050555 DOI: 10.7499/j.issn.1008-8830.2012026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study the risk factors and treatment for neutropenia of late newborns (NLN). METHODS Related clinical data were collected from the preterm infants and critically ill neonates who were admitted to the neonatal intensive care unit from July 2019 to January 2020. A total of 46 newborns with a blood absolute neutrophil count (ANC) of < 1.5×109/L for two consecutive times at weeks 2-4 after birth were enrolled as the NLN group. A total of 92 late newborns with a blood ANC of ≥ 1.5×109/L, matched at a ratio of 1:2, were enrolled as the control group. Possible risk factors associated with NLN and the treatment process were recorded. A logistic regression analysis was performed to identify the risk factors for NLN. RESULTS Among the 46 neonates in the NLN group, 29 had a gestational age of < 32 weeks, 14 had a gestational age of 32-37 weeks, and 3 had a gestational age of > 37 weeks. There was no significant difference between the two groups in the incidence rates of gestational hypertension, premature rupture of membranes > 18 hours and intrauterine distress, 5-minute Apgar score, the duration of positive pressure ventilation, the incidence rate of early-onset sepsis, and the type of initially used antibiotics (P > 0.05). Compared with the control group, the NLN group had a higher incidence rate of late-onset sepsis and a longer duration of antibiotic use (P < 0.05). Late-onset sepsis and prolonged duration of antibiotic use were independent risk factors for NLN (P < 0.05). With the presence of late-onset sepsis, the risk of NLN was increased by 1.537 times in neonates, and the risk of NLN was increased by 76.9% for every 3-day increase in the duration of antibiotic use. The mean age at the diagnosis of NLN was (21±6) days for the 46 neonates in the NLN group. Thirteen neonates with NLN were administered with recombinant human granulocyte colony-stimulating factor (G-CSF, 10 μg/kg) once or twice. O the 13 neonates, 6 had an ANC of < 0.5×109/L and 7 had a gestational age of < 32 weeks or severe disease conditions. After treatment the ANC returned to > 1.0×109/L in the 13 neonates. No drug-related adverse reactions were found. After the diagnosis of NLN, 2 neonates developed sepsis, and the remaining 44 neonates did not develop any common purulent infections. CONCLUSIONS The risk of NLN increases with the presence of late-onset sepsis and the increase in the duration of antibiotic use. NLN is generally a benign process. G-CSF appears to be safe and effective for NLN with severe disease conditions or severe reduction in ANC.
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Affiliation(s)
- 丽 李
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 波 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 翔羽 高
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 漪 任
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 敏 苏
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 春艳 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 迪 黄
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 惠颖 王
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
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李 丽, 杨 波, 高 翔, 任 漪, 苏 敏, 杨 春, 黄 迪, 王 惠. [Risk factors for neutropenia of late newborns]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:375-380. [PMID: 33840410 PMCID: PMC8050555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/03/2021] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To study the risk factors and treatment for neutropenia of late newborns (NLN). METHODS Related clinical data were collected from the preterm infants and critically ill neonates who were admitted to the neonatal intensive care unit from July 2019 to January 2020. A total of 46 newborns with a blood absolute neutrophil count (ANC) of < 1.5×109/L for two consecutive times at weeks 2-4 after birth were enrolled as the NLN group. A total of 92 late newborns with a blood ANC of ≥ 1.5×109/L, matched at a ratio of 1:2, were enrolled as the control group. Possible risk factors associated with NLN and the treatment process were recorded. A logistic regression analysis was performed to identify the risk factors for NLN. RESULTS Among the 46 neonates in the NLN group, 29 had a gestational age of < 32 weeks, 14 had a gestational age of 32-37 weeks, and 3 had a gestational age of > 37 weeks. There was no significant difference between the two groups in the incidence rates of gestational hypertension, premature rupture of membranes > 18 hours and intrauterine distress, 5-minute Apgar score, the duration of positive pressure ventilation, the incidence rate of early-onset sepsis, and the type of initially used antibiotics (P > 0.05). Compared with the control group, the NLN group had a higher incidence rate of late-onset sepsis and a longer duration of antibiotic use (P < 0.05). Late-onset sepsis and prolonged duration of antibiotic use were independent risk factors for NLN (P < 0.05). With the presence of late-onset sepsis, the risk of NLN was increased by 1.537 times in neonates, and the risk of NLN was increased by 76.9% for every 3-day increase in the duration of antibiotic use. The mean age at the diagnosis of NLN was (21±6) days for the 46 neonates in the NLN group. Thirteen neonates with NLN were administered with recombinant human granulocyte colony-stimulating factor (G-CSF, 10 μg/kg) once or twice. O the 13 neonates, 6 had an ANC of < 0.5×109/L and 7 had a gestational age of < 32 weeks or severe disease conditions. After treatment the ANC returned to > 1.0×109/L in the 13 neonates. No drug-related adverse reactions were found. After the diagnosis of NLN, 2 neonates developed sepsis, and the remaining 44 neonates did not develop any common purulent infections. CONCLUSIONS The risk of NLN increases with the presence of late-onset sepsis and the increase in the duration of antibiotic use. NLN is generally a benign process. G-CSF appears to be safe and effective for NLN with severe disease conditions or severe reduction in ANC.
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Affiliation(s)
- 丽 李
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 波 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 翔羽 高
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 漪 任
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 敏 苏
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 春艳 杨
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 迪 黄
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
| | - 惠颖 王
- />徐州市中心医院/南京医科大学徐州临床医学院新生儿科, 江苏徐州 221009Department of Neonatology, Xuzhou Central Hospital/Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, Jiangsu 221009, China
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