Yaşlı hastalarda linezolide bağlı trombositopeninin incelenmesi: bir palyatif bakım ünitesinden yansımalar
Öz
Amaç: Linezolid (LZD) dirençli gram-pozitif bakterilere karşı etkili bir antibiyotiktir. Bu çalışmada linezolide bağlı trombositopeninin (LIT) özelliklerini ve risk faktörlerini araştırmayı amaçladık.
Gereç ve Yöntem: Bu tek merkezli ve retrospektif çalışmaya bir palyatif bakım ünitesinde en az 7 gün süreyle LZD ile tedavi edilen 93 yaşlı hasta dahil edildi. Trombositopeni, trombosit sayısının 150x103/mm3'ün altına düşmesi veya ≥ %50 azalması olarak tanımlandı. Tam kan sayımı (CBC) ve biyokimyasal analizler tedavinin ilk, 3., 7., son gününde ve tedavi sonrasında yapıldı.
Bulgular: Hastaların yaş ortalaması 73.7±7.9 yıl idi. Trombositopeni 48 hastada görüldü. LIT olan hastaların ortalama yaşı, ortalama hastanede yatış süresi ve LZD tedavisi daha yüksek, bazal serum albümin konsantrasyonu ve kalsiyum düzeyi daha düşüktü. LIT, yaşı ≥ 75 olan, bazal albümin düzeyi <25 g/L ve bazal trombosit sayısı <200x103/mm olan gruplarda anlamlı olarak daha sık görülmüştür. Tekrarlanan ölçümler ANOVA analizi, trombosit sayıları ve maruziyet süresi arasında anlamlı bir etkileşim etkisi olduğunu göstermiştir. Çok değişkenli lojistik regresyon analizine göre, kadın cinsiyet, yaş ≥75, LZD tedavi süresi >14 gün, serum bazal albümin <25g/L ve trombosit sayısı <200x103/mm3 LIT için risk faktörleri olarak belirlenmiştir.
Sonuç: Palyatif bakım ünitesinde LZD tedavisi alan ve risk faktörleri olan yaşlı hastalar hematolojik açıdan yakından izlenmelidir. Trombositopenik komplikasyonları önlemek için CBC tedavinin ilk haftasında bir kez ve 14. gününde yapılmalıdır.
Anahtar Kelimeler
Kaynakça
- Eliopoulos GM. Quinupristin-dalfopristin and linezolid: evidence and opinion. Clin Infect Dis. 2003;36:473-81.
- Wu VC, Wang YT, Wang CY, Tsai IJ, Wu KD, Hwang JJ et al. High frequency of linezolid-associated thrombocytopenia and anemia among patients with end-stage renal disease. Clin Infect Dis. 2006;42:66-72.
- Senneville E, Legout L, Valette M, Yazdanpanah Y, Beltrand E, Caillaux M et al. Effectiveness and tolerability of prolonged linezolid treatment for chronic osteomyelitis: a retrospective study. Clin Ther. 2006;28:1155-63.
- Douros A, Grabowski K, Stahlmann R. Drug-drug interactions and safety of linezolid, tedizolid, and other oxazolidinones. Expert Opin Drug Metab Toxicol. 2015;11:1849-59.
- Baik SH, Choi YK, Kim HS, Yoon YK, Sohn JW, Kim MJ. A probable case of syndrome of inappropriate antidiuretic hormone secretion associated with linezolid. Am J Health Syst Pharm. 2015;72:1865-9.
- Talaie H, Hosseini SM, Nazari M, Esfahani MS, Barari B. Risk factors of hospital-acquired thrombocytopenia in toxicological intensive care unit. International Journal of Medical Toxicology and Forensic Medicine. 2020;10:32256
- Bernstein WB, Trotta RF, Rector JT, Tjaden JA, Barile AJ. Mechanisms for linezolid-induced anemia and thrombocytopenia. Ann Pharmacother. 2003;37:517-20.
- Hanai Y, Matsuo K, Ogawa M, Higashi A, Kimura I, Hirayama S et al. A retrospective study of the risk factors for linezolid-induced thrombocytopenia and anemia. J Infect Chemother. 2016;22:536-42.
- Gerson SL, Kaplan SL, Bruss JB, Le V, Arellano FM, Hafkin B, et al. Hematologic effects of linezolid: summary of clinical experience. Antimicrob Agents Chemother. 2002;46:2723-6.
- Moraza L, Leache L, Aquerreta I, Ortega A. Linezolid-induced haematological toxicity. Farm Hosp. 2015;39:320-6.
- Lima LS, Brito E, Mattos K, Parisotto EB, Perdomo RT, Weber SS. A retrospective cohort study to screen linezolid-induced thrombocytopenia in adult patients hospitalized in the Midwestern Region of Brazil. Hematol Transfus Cell Ther. 2020;42:230-7.
- McMahon CM, Cuker A. Hospital-acquired thrombocytopenia. Hosp Pract (1995). 2014;42:142-52.
- Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med. 2007;357:580-7.
- 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. 2019;44:84-90.
- Han X, Wang J, Zan X, Peng L, Nie X. Risk factors for linezolid-induced thrombocytopenia in adult inpatients. Int J Clin Pharm. 2022;44:330-8.
- 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;52:1162-4.
- Bai AD, McKenna S, Wise H, Loeb M, Gill SS. Safety profile of linezolid in older adults with renal impairment: a population-based retrospective cohort study. Open Forum Infect Dis. 2022;12;9:669.
- Bi LQ, Zhou J, Huang M, Zhou SM. Efficacy of linezolid on gram-positive bacterial infection in elderly patients and the risk factors associated with thrombocytopenia. Pak J Med Sci. 2013;29:837-42.
- Takahashi Y, Takesue Y, Nakajima K, Ichiki K, Tsuchida T, Tatsumi S et al. Risk factors associated with the development of thrombocytopenia in patients who received linezolid therapy. J Infect Chemother. 2011;17:382-7.
- Matsumoto K, Takeshita A, Ikawa K, Shigemi A, Yaji K, Shimodozono Y et al. Higher linezolid exposure and higher frequency of thrombocytopenia in patients with renal dysfunction. Int J Antimicrob Agents. 2010;36:179-81.
- Sisson LT, Jungbluth G, Hopkins N. Age and sex effects on the pharmacokinetics of linezolid. Eur J Clin Pharmacol. 2002;57:793-7.
- Thirot H, Briquet C, Frippiat F, Jacobs F, Holemans X, Henrard S et al. Clinical use and adverse drug reactions of linezolid: a retrospective study in four Belgian hospital centers. Antibiotics (Basel). 2021;10.
- Attassi K, Hershberger E, Alam R, Zervos MJ. Thrombocytopenia associated with linezolid therapy. Clin Infect Dis. 2002;34:695-8.
- Chen C, Guo DH, Cao X, Cai Y, Xu Y, Zhu M et al. Risk factors for thrombocytopenia in adult chinese patients receiving linezolid therapy. Curr Ther Res Clin Exp. 2012;73:195-206.
- Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41:67-76.
- Natsumoto B, Yokota K, Omata F, Furukawa K. Risk factors for linezolid-associated thrombocytopenia in adult patients. Infection. 2014;42:1007-12.
- Stalker DJ, Jungbluth GL. Clinical pharmacokinetics of linezolid, a novel oxazolidinone antibacterial. Clin Pharmacokinet. 2003;42:1129-40.
- Hirano R, Sakamoto Y, Tachibana N, Ohnishi M. Retrospective analysis of the risk factors for linezolid-induced thrombocytopenia in adult Japanese patients. Int J Clin Pharm. 2014;36:795-9.
- Dai Y, Jiang S, Chen X, Han L, Zhang C, Yu X et al. Analysis of the risk factors of linezolid-related haematological toxicity in Chinese patients. J Clin Pharm Ther. 2021;46:807-13.
- Zhou ZY, Zhao XQ, Shan BZ, Zhu J, Zhang X, Tian QF et al. Efficacy and safety of linezolid in treating gram-positive bacterial infection in the elderly: a retrospective study. Indian J Microbiol. 2014;54:104-7.
- Ray JB, Brereton WF, Nullet FR. Intravenous immune globulin for the treatment of presumed quinidine-induced thrombocytopenia. DICP. 1990;24:693-5.
Assessment of linezolid-induced thrombocytopenia in older patients: reflections from a palliative care unit
Öz
Purpose: Linezolid (LZD) is an antibiotic which is effective against resistant gram-positive bacteria. The aim of this study was to investigate the characteristics and risk factors of linezolid-induced thrombocytopenia (LIT).
Materials and Methods: This monocentric and retrospective study comprised 93 older patients treated with LZD for a minimum of seven days in a palliative care unit. Thrombocytopenia was defined as a decrease in platelet count below 150x103/mm3 or a ≥ 50% decrease. Complete blood count (CBC) and biochemical analyses were performed on the first, third, seventh, last day of treatment and after treatment.
Results: The mean age of the patients was 73.7 years (±7.9 years). Thrombocytopenia was observed in 48 patients. The mean age, median duration of hospitalisation and LZD treatment were higher, and baseline serum albumin concentration and calcium level were lower in patients with LIT. In the groups aged ≥75 years, with albumin levels <25 g/L and platelet counts <200x103/mm, LIT was more frequent. Repeated measures ANOVA analysis was conducted, which revealed a significant interaction effect between platelet counts and the duration of exposure. Multivariate logistic regression analysis identified female gender, age ≥75 years, LZD treatment duration >14 days, serum baseline albumin <25g/L and platelet count <200x103/mm3 as risk factors for LIT.
Conclusion: Older patients receiving LZD treatment in a palliative care unit with risk factors should be closely monitored hematological. CBC should be performed once in the first week, and 14th day of treatment to prevent thrombocytopenic complications.
Anahtar Kelimeler
Kaynakça
- Eliopoulos GM. Quinupristin-dalfopristin and linezolid: evidence and opinion. Clin Infect Dis. 2003;36:473-81.
- Wu VC, Wang YT, Wang CY, Tsai IJ, Wu KD, Hwang JJ et al. High frequency of linezolid-associated thrombocytopenia and anemia among patients with end-stage renal disease. Clin Infect Dis. 2006;42:66-72.
- Senneville E, Legout L, Valette M, Yazdanpanah Y, Beltrand E, Caillaux M et al. Effectiveness and tolerability of prolonged linezolid treatment for chronic osteomyelitis: a retrospective study. Clin Ther. 2006;28:1155-63.
- Douros A, Grabowski K, Stahlmann R. Drug-drug interactions and safety of linezolid, tedizolid, and other oxazolidinones. Expert Opin Drug Metab Toxicol. 2015;11:1849-59.
- Baik SH, Choi YK, Kim HS, Yoon YK, Sohn JW, Kim MJ. A probable case of syndrome of inappropriate antidiuretic hormone secretion associated with linezolid. Am J Health Syst Pharm. 2015;72:1865-9.
- Talaie H, Hosseini SM, Nazari M, Esfahani MS, Barari B. Risk factors of hospital-acquired thrombocytopenia in toxicological intensive care unit. International Journal of Medical Toxicology and Forensic Medicine. 2020;10:32256
- Bernstein WB, Trotta RF, Rector JT, Tjaden JA, Barile AJ. Mechanisms for linezolid-induced anemia and thrombocytopenia. Ann Pharmacother. 2003;37:517-20.
- Hanai Y, Matsuo K, Ogawa M, Higashi A, Kimura I, Hirayama S et al. A retrospective study of the risk factors for linezolid-induced thrombocytopenia and anemia. J Infect Chemother. 2016;22:536-42.
- Gerson SL, Kaplan SL, Bruss JB, Le V, Arellano FM, Hafkin B, et al. Hematologic effects of linezolid: summary of clinical experience. Antimicrob Agents Chemother. 2002;46:2723-6.
- Moraza L, Leache L, Aquerreta I, Ortega A. Linezolid-induced haematological toxicity. Farm Hosp. 2015;39:320-6.
- Lima LS, Brito E, Mattos K, Parisotto EB, Perdomo RT, Weber SS. A retrospective cohort study to screen linezolid-induced thrombocytopenia in adult patients hospitalized in the Midwestern Region of Brazil. Hematol Transfus Cell Ther. 2020;42:230-7.
- McMahon CM, Cuker A. Hospital-acquired thrombocytopenia. Hosp Pract (1995). 2014;42:142-52.
- Aster RH, Bougie DW. Drug-induced immune thrombocytopenia. N Engl J Med. 2007;357:580-7.
- 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. 2019;44:84-90.
- Han X, Wang J, Zan X, Peng L, Nie X. Risk factors for linezolid-induced thrombocytopenia in adult inpatients. Int J Clin Pharm. 2022;44:330-8.
- 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;52:1162-4.
- Bai AD, McKenna S, Wise H, Loeb M, Gill SS. Safety profile of linezolid in older adults with renal impairment: a population-based retrospective cohort study. Open Forum Infect Dis. 2022;12;9:669.
- Bi LQ, Zhou J, Huang M, Zhou SM. Efficacy of linezolid on gram-positive bacterial infection in elderly patients and the risk factors associated with thrombocytopenia. Pak J Med Sci. 2013;29:837-42.
- Takahashi Y, Takesue Y, Nakajima K, Ichiki K, Tsuchida T, Tatsumi S et al. Risk factors associated with the development of thrombocytopenia in patients who received linezolid therapy. J Infect Chemother. 2011;17:382-7.
- Matsumoto K, Takeshita A, Ikawa K, Shigemi A, Yaji K, Shimodozono Y et al. Higher linezolid exposure and higher frequency of thrombocytopenia in patients with renal dysfunction. Int J Antimicrob Agents. 2010;36:179-81.
- Sisson LT, Jungbluth G, Hopkins N. Age and sex effects on the pharmacokinetics of linezolid. Eur J Clin Pharmacol. 2002;57:793-7.
- Thirot H, Briquet C, Frippiat F, Jacobs F, Holemans X, Henrard S et al. Clinical use and adverse drug reactions of linezolid: a retrospective study in four Belgian hospital centers. Antibiotics (Basel). 2021;10.
- Attassi K, Hershberger E, Alam R, Zervos MJ. Thrombocytopenia associated with linezolid therapy. Clin Infect Dis. 2002;34:695-8.
- Chen C, Guo DH, Cao X, Cai Y, Xu Y, Zhu M et al. Risk factors for thrombocytopenia in adult chinese patients receiving linezolid therapy. Curr Ther Res Clin Exp. 2012;73:195-206.
- Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41:67-76.
- Natsumoto B, Yokota K, Omata F, Furukawa K. Risk factors for linezolid-associated thrombocytopenia in adult patients. Infection. 2014;42:1007-12.
- Stalker DJ, Jungbluth GL. Clinical pharmacokinetics of linezolid, a novel oxazolidinone antibacterial. Clin Pharmacokinet. 2003;42:1129-40.
- Hirano R, Sakamoto Y, Tachibana N, Ohnishi M. Retrospective analysis of the risk factors for linezolid-induced thrombocytopenia in adult Japanese patients. Int J Clin Pharm. 2014;36:795-9.
- Dai Y, Jiang S, Chen X, Han L, Zhang C, Yu X et al. Analysis of the risk factors of linezolid-related haematological toxicity in Chinese patients. J Clin Pharm Ther. 2021;46:807-13.
- Zhou ZY, Zhao XQ, Shan BZ, Zhu J, Zhang X, Tian QF et al. Efficacy and safety of linezolid in treating gram-positive bacterial infection in the elderly: a retrospective study. Indian J Microbiol. 2014;54:104-7.
- Ray JB, Brereton WF, Nullet FR. Intravenous immune globulin for the treatment of presumed quinidine-induced thrombocytopenia. DICP. 1990;24:693-5.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Bulaşıcı Hastalıklar, Geriatri ve Gerontoloji |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Haziran 2025 |
| Gönderilme Tarihi | 13 Şubat 2025 |
| Kabul Tarihi | 10 Haziran 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 50 Sayı: 2 |
