Fry Will, McCafferty Sean, Gooday Catherine, Nunney Ian, Dhatariya Ketan K
Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
Diabetes Ther. 2018 Feb;9(1):219-228. doi: 10.1007/s13300-017-0357-1. Epub 2018 Jan 4.
Piperacillin/tazobactam is a commonly used antibiotic for the empirical treatment of severe diabetic foot infections. One of the most feared complications of this drug is the development of pancytopenia. The aim of this study was to determine whether the use of piperacillin/tazobactam caused any hematological changes in patients admitted with severe diabetes-related foot infections from a specialist multidisciplinary foot clinic. Specifically, looking at whether it caused anemia, leukopenia, neutropenia, or thrombocytopenia.
A 1-year retrospective analysis of patients admitted to a tertiary care center for treatment of diabetes-related foot infection using piperacillin/tazobactam. Hematological indices, urea and electrolytes, and C-reactive protein (CRP) were recorded pretreatment, during treatment, and posttreatment. HbA1c, vitamin B, folate, thyroid-stimulating hormone, and free thyroxin were also analyzed to exclude any potential confounders as a cause of pancytopenia.
A total of 154 patients were admitted between 1 January 2016 and 31 December 2016 who received piperacillin/tazobactam for severe diabetes-related foot infection. On admission, white cell count and CRP were raised and fell significantly within the first 48 h. Other hematological factors did not change. Five patients developed a mild pancytopenia, of which three were unexplained.
In this relatively small cohort, pancytopenia did not occur. As such, piperacillin/tazobactam appeared to have a low risk of adverse hematological outcomes and remains the treatment of choice for severe diabetes-related foot infections.
哌拉西林/他唑巴坦是用于严重糖尿病足感染经验性治疗的常用抗生素。该药物最可怕的并发症之一是全血细胞减少症的发生。本研究的目的是确定使用哌拉西林/他唑巴坦是否会使来自专科多学科足部诊所的严重糖尿病相关足部感染患者出现任何血液学变化。具体而言，观察其是否会导致贫血、白细胞减少、中性粒细胞减少或血小板减少。
对一家三级医疗中心收治的使用哌拉西林/他唑巴坦治疗糖尿病相关足部感染的患者进行为期1年的回顾性分析。记录治疗前、治疗期间和治疗后的血液学指标、尿素和电解质以及C反应蛋白（CRP）。还分析了糖化血红蛋白、维生素B、叶酸、促甲状腺激素和游离甲状腺素，以排除任何可能导致全血细胞减少症的潜在混杂因素。
2016年1月1日至2016年12月31日期间，共有154例因严重糖尿病相关足部感染接受哌拉西林/他唑巴坦治疗的患者入院。入院时白细胞计数和CRP升高，并在最初48小时内显著下降。其他血液学因素未发生变化。5例患者出现轻度全血细胞减少症，其中3例原因不明。
在这个相对较小的队列中，未发生全血细胞减少症。因此，哌拉西林/他唑巴坦似乎具有较低的不良血液学结局风险，仍然是严重糖尿病相关足部感染的治疗选择。
