Cossu A P, Musu M, Mura P, De Giudici L M, Finco G
Eur J Clin Pharmacol. 2014 Jan;70(1):23-8. doi: 10.1007/s00228-013-1585-6.
Thrombocytopenia is a common complication in the intensive care unit (ICU), but the incidence of drug-induced thrombocytopenia (DIT) is not well defined. We investigate linezolid-induced thrombocytopenia in patients with impaired renal function. Since recent studies suggest that linezolid clearance is reduced in these patients and there are no precise data confirming that dose-adjustment should be required, we performed a systematic analysis in order to establish whether it is necessary to consider a dose adjustment and promote studies to confirm this concept.
We report a case of thrombocytopenia (nadir 32 × 10(3)/μl) in a patient with acute kidney injury who was treated with linezolid for a MRSA pulmonary infection. We performed a systematic review of the literature through PubMed with the aim to include every case report, case series, prospective and retrospective clinical study reporting linezolid-induced thrombocytopenia with concomitant impaired renal function.
An increasing number of clinical studies suggest a correlation between the onset of linezolid-induced thrombocytopenia and renal dysfunction. Close monitoring of platelet count and hemoglobin is recommended in patients treated with linezolid, especially in those with impaired renal function because the reduction of its clearance causes drug accumulation, as some studies have reported.
Clinicians should consider the potential risk of this complication, especially in elderly patients with end-stage renal disease. Further studies should be encouraged to determine if the incidence of linezolid-related thrombocytopenia could be reduced by a dose adjustment according to renal function, for which currently there is still no specific recommendation.
血小板减少症是重症监护病房（ICU）的常见并发症，但药物性血小板减少症（DIT）的发病率尚不明确。我们调查了肾功能受损患者中利奈唑胺引起的血小板减少症。由于最近的研究表明这些患者中利奈唑胺清除率降低，且尚无确切数据证实需要调整剂量，我们进行了系统分析，以确定是否有必要考虑调整剂量，并推动相关研究来证实这一概念。
我们报告了一例急性肾损伤患者发生血小板减少症（最低点为32×10³/μl）的病例，该患者因耐甲氧西林金黄色葡萄球菌（MRSA）肺部感染接受利奈唑胺治疗。我们通过PubMed对文献进行了系统综述，目的是纳入每一篇报告利奈唑胺引起血小板减少症且伴有肾功能受损的病例报告、病例系列、前瞻性和回顾性临床研究。
越来越多的临床研究表明利奈唑胺引起的血小板减少症的发生与肾功能障碍之间存在关联。建议对接受利奈唑胺治疗的患者，尤其是肾功能受损的患者密切监测血小板计数和血红蛋白，因为正如一些研究所报道 的，其清除率降低会导致药物蓄积。
临床医生应考虑这种并发症的潜在风险，尤其是在老年终末期肾病患者中。应鼓励进一步研究以确定根据肾功能调整剂量是否可以降低利奈唑胺相关血小板减少症的发病率，目前对此仍无具体建议。
