Department of Pharmacy, Virginia Commonwealth University Health, 401 North 12th Street, P.O. Box 980042, Richmond, VA, 23298-0042, USA.
Department of Anesthesiology, Virginia Commonwealth University Health/Medical College of Virginia Hospitals, 1200 E. Broad Street, 7th Floor, P.O. Box 980695, Richmond, VA, 23298-0695, USA.
J Thromb Thrombolysis. 2019 Jul;48(1):167-170. doi: 10.1007/s11239-019-01848-3.
Drug-induced thrombocytopenia (DITP) has been described as a sudden and severe hematologic complication of piperacillin/tazobactam. The proposed mechanism by which piperacillin/tazobactam causes DITP involves the formation of a covalent bond to platelet membrane protein thereby inducing a humoral immune response. Given the immunogenic nature of this adverse event and the structural similarities across beta-lactam antibiotics, the potential for cross-reactivity between agents within the class should be considered. However, the structural moiety of piperacillin/tazobactam responsible for this immunogenic response has not been identified-the relationship between structure and activity for this phenomenon remains unknown. Data on the safety and cross-reactivity of other beta-lactam agents in this setting is lacking. We report the first case of piperacillin/tazobactam DITP successfully challenged by the use of cefepime for the treatment of aspiration pneumonia. Further studies are needed to determine the structural moiety of piperacillin/tazobactam responsible for this immunogenic response and evaluate the safety of other beta-lactam antibiotics in this clinical setting.
药物诱导的血小板减少症（DITP）已被描述为哌拉西林/他唑巴坦的一种突然且严重的血液学并发症。哌拉西林/他唑巴坦引起 DITP 的机制涉及与血小板膜蛋白形成共价键，从而诱导体液免疫反应。鉴于这种不良事件的免疫原性以及β-内酰胺类抗生素之间的结构相似性，应考虑该类药物之间的交叉反应性。然而，导致这种免疫反应的哌拉西林/他唑巴坦的结构部分尚未确定-这种现象的结构与活性之间的关系仍不清楚。关于在这种情况下其他β-内酰胺类药物的安全性和交叉反应性的数据尚缺乏。我们报告了首例哌拉西林/他唑巴坦 DITP 病例，通过使用头孢吡肟成功治疗吸入性肺炎。需要进一步研究来确定导致这种免疫反应的哌拉西林/他唑巴坦的结构部分，并评估其他β-内酰胺类抗生素在这种临床环境中的安全性。
