Hematologic Adverse Effects of Prolonged PiperacillinTazobactam Use in Adults

Lower Charlson Comorbidity Index score, lower initialleukocyte count, combination of TZP with another antibiotic, and totalduration of TZP therapy were found to be independent risk factors forleukopenia, while initial higher eosinophil count (IHEC) and usage ofTZP for >20 days were independent risk factors for neutropenia andIHEC and total duration of TZP therapy were independent risk factorsfor eosinophilia.Conclusion: Longer duration of therapy, combination with otherantibiotics, younger age with fewer comorbidities, and IHEC couldresult in hematologic adverse effects in patients treated with TZP.Patients with IHEC may be more prone to allergic reactions, soimmunological mechanisms may facilitate the development ofhematological adverse effects of TZP.

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: We aimed to find the incidence and risk factors ofhematologic adverse effects of piperacillin-tazobactam (TZP).Materials and Methods: Adult patients who used TZP for more than10 days were included in the study.Results: The incidence of leukopenia, neutropenia, and eosinophiliain 110 TZP therapy episodes was found to be 16.3%, 10%, and 10%,respectively.

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Key Findings & Data:Objective: We aimed to find the incidence and risk factors ofhematologic adverse effects of piperacillin-tazobactam (TZP).Materials and Methods: Adult patients who used TZP for more than10 days were included in the study.Results: The incidence of leukopenia, neutropenia, and eosinophiliain 110 TZP therapy episodes was found to be 16.3%, 10%, and 10%,respectively.

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Conclusion & Impact:Lower Charlson Comorbidity Index score, lower initialleukocyte count, combination of TZP with another antibiotic, and totalduration of TZP therapy were found to be independent risk factors forleukopenia, while initial higher eosinophil count (IHEC) and usage ofTZP for >20 days were independent risk factors for neutropenia andIHEC and total duration of TZP therapy were independent risk factorsfor eosinophilia.Conclusion: Longer duration of therapy, combination with otherantibiotics, younger age with fewer comorbidities, and IHEC couldresult in hematologic adverse effects in patients treated with TZP.Patients with IHEC may be more prone to allergic reactions, soimmunological mechanisms may facilitate the development ofhematological adverse effects of TZP.

🔬Design:Research Article

📍Scope:Comprehensive Sample

⚙️Variables:Domain Parameters

Abstract

Objective: We aimed to find the incidence and risk factors ofhematologic adverse effects of piperacillin-tazobactam (TZP).Materials and Methods: Adult patients who used TZP for more than10 days were included in the study.Results: The incidence of leukopenia, neutropenia, and eosinophiliain 110 TZP therapy episodes was found to be 16.3%, 10%, and 10%,respectively. Lower Charlson Comorbidity Index score, lower initialleukocyte count, combination of TZP with another antibiotic, and totalduration of TZP therapy were found to be independent risk factors forleukopenia, while initial higher eosinophil count (IHEC) and usage ofTZP for >20 days were independent risk factors for neutropenia andIHEC and total duration of TZP therapy were independent risk factorsfor eosinophilia.Conclusion: Longer duration of therapy, combination with otherantibiotics, younger age with fewer comorbidities, and IHEC couldresult in hematologic adverse effects in patients treated with TZP.Patients with IHEC may be more prone to allergic reactions, soimmunological mechanisms may facilitate the development ofhematological adverse effects of TZP.

Özet

Amaç: Piperasilin-tazobaktamın (TZP) hematolojik istenmeyen etki insidansını ve risk faktörlerini bulmayı amaçladık. Gereç ve Yöntemler: On günden uzun süre TZP kullanan erişkin hastalar çalışmaya dahil edildi. Bulgular: Yüz on tedavi epizodunda lökopeni, nötropeni ve eozinofili insidansları sırasıyla %16,3, %10 ve %10 olarak bulundu. Charlson’ın Komorbidite İndeksi’nin düşük olması, başlangıç lökosit sayısının düşük olması, TZP ile başka antibiyotiğin kombine kullanılması ve TZP’nin toplam tedavi süresi; başlangıç eozinofil sayısının yüksek olması (BESYO) ve 20 günden uzun süreli TZP kullanımı; BESYO ve TZP’nin toplam tedavi süresi sırasıyla lökopeni, nötropeni ve eozinofili için bağımsız risk faktörleri olarak bulundu. Sonuç: TZP ile tedavi edilen hastaların tedavi süresinin uzun olması, kombine antibiyotik tedavisi almaları, daha genç yaşta daha az komorbiditelerinin olması ve BESYO hematolojik istenmeyen etkilerin gelişmesine neden olabilir. BESYO olması hastaların alerjik reaksiyonlara daha yatkın olmasına neden olabilir, bu nedenle immünolojik mekanizmalar TZP kullanımıyla hematolojik istenmeyen etkilerin gelişmesini kolaylaştırabilir.

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Cite This Article

ÇAĞATAY, A., BAŞARAN, S., ŞİMŞEK-YAVUZ, S., ÖZSÜT, H., ERAKSOY, H., BENLİ, A. (2022). Hematologic Adverse Effects of Prolonged PiperacillinTazobactam Use in Adults. Turkish Journal of Hematology, Cilt: 35 - Sayı: 4, 290–295. https://ajindex.com/articles/607063

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References (11)

Doi Y, Chambers H. Penicillins and β-lactamase inhibitors. In: Bennett J, Dolin R, Blaser M, (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Disease. Philadelphia, Elsevier Saunders, 2015.
Daley D, Mulgrave L, Munro S, Smith H, Dimech W. An evaluation of the in vitro activity of piperacillin/tazobactam. Pathology 1996;28:167-172.
Scheetz MH, McKoy JM, Parada JP, Djulbegovic B, Raisch DW, Yarnold PR, Zagory J, Trifilio S, Jakiche R, Palella F, Kahn A, Chandler K, Bennett CL. Systematic review of piperacillin-induced neutropenia. Drug Saf 2007;30:295-306.
Peralta FG, Sanchez MB, Roiz MP, Pena MA, Tejero MA, Arjona R. Incidence of neutropenia during treatment of bone-related infections with piperacillintazobactam. Clin Infect Dis 2003;37:1568-1572.
Lemieux P, Gregoire JP, Thibeault R, Bergeron L. Higher risk of neutropenia associated with piperacillin-tazobactam compared with ticarcillinclavulanate in children. Clin Infect Dis 2015;60:203-207.
Reichardt P, Handrick W, Linke A, Schille R, Kiess W. Leukocytopenia, thrombocytopenia and fever related to piperacillin/tazobactam treatment - a retrospective analysis in 38 children with cystic fibrosis. Infection 1999;27:355-356.
Kumar A, Choudhuri G, Aggarwal R. Piperacillin induced bone marrow suppression: a case report. BMC Clin Pharmacol 2003;3:2. Khan F. Severe neutropenia secondary to piperacillin/tazobactam therapy. Indian J Pharmacol 2005;37:192-193.
Ruiz-Irastorza G, Barreiro G, Aguirre C. Reversible bone marrow depression by high-dose piperacillin/tazobactam. Br J Haematol 1996;95:611-612.
Neftel KA, Wälti M, Spengler H, von Felten A, Weitzman SA, Bürgi H, de Weck AL. Neutropenia after penicillins: toxic or immune-mediated? Klin Wochenschr 1981;59:877-888.
Arcieri GM, Becker N, Esposito B, Griffith E, Heyd A, Neumann C, O’Brien B, Schacht P. Safety of intravenous ciprofloxacin. A review. Am J Med 1989;87:92-97.
Vardakas KZ, Tansarli GS, Bliziotis IA, Falagas ME. β-Lactam plus aminoglycoside or fluoroquinolone combination versus β-lactam monotherapy for Pseudomonas aeruginosa infections: a meta-analysis. Int J Antimicrob Agents 2013;41:301-310.