Huang Yu-Ting, Yu Chia-I, Chen Pao-Yu, Wang Chi-Chuan, Wu Chien-Chih
Department of Pharmacy, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Infect Drug Resist. 2021 Nov 25;14:4949-4955. doi: 10.2147/IDR.S339188. eCollection 2021.
Antibiotic combination is commonly used to treat multidrug-resistant pathogens. Reports have indicated that tigecycline use is associated with hypofibrinogenemia. However, whether the bleeding risk of tigecycline is higher than that of other antibiotics remains unknown. The aim of this study was to compare the bleeding risk between colistin-tigecycline and colistin-carbapenem treatment.
This retrospective cohort study enrolled adult patients treated with colistin along with tigecycline or carbapenems (doripenem, imipenem-cilastatin, or meropenem) for ˃72 hours during hospitalization. The primary outcome was major bleeding events, which were determined by a hemoglobin drop of ≥2 g/d and receipt of blood transfusions with whole blood or packed red blood cells. Multivariate logistic regression was applied to determine risk factors for bleeding events.
In total, 106 and 268 patients in the colistin-tigecycline and colistin-carbapenem groups met the criteria for analysis, respectively. The two groups did not differ significantly in demographic data, except for alanine aminotransferase (ALT), serum creatinine (S) and ulcer disease. The colistin-tigecycline group had a higher ALT, S and a lower proportion of ulcer disease. Major bleeding events did not differ significantly between the colistin-tigecycline and colistin-carbapenem groups (12.26% vs 9.33%, = 0.40). Antibiotic duration [OR = 1.06 (1.02-1.11), =0.007)] and anticoagulant use [OR = 2.16 (1.05-4.42), =0.04] were associated with major bleeding events.
Colistin-tigecycline treatment was not associated with a higher bleeding risk. Antibiotic duration and concurrent use of anticoagulant were the risk factors of bleeding events.
抗生素联合用药常用于治疗多重耐药病原体。有报告表明，使用替加环素与低纤维蛋白原血症有关。然而，替加环素的出血风险是否高于其他抗生素仍不清楚。本研究的目的是比较黏菌素-替加环素与黏菌素-碳青霉烯类药物治疗的出血风险。
这项回顾性队列研究纳入了住院期间接受黏菌素联合替加环素或碳青霉烯类药物（多利培南、亚胺培南-西司他丁或美罗培南）治疗超过72小时的成年患者。主要结局是严重出血事件，通过血红蛋白下降≥2g/d以及接受全血或红细胞输血来确定。采用多因素逻辑回归分析确定出血事件的危险因素。
黏菌素-替加环素组和黏菌素-碳青霉烯类药物组分别有106例和268例患者符合分析标准。除丙氨酸氨基转移酶（ALT）、血清肌酐（S）和溃疡病外，两组的人口统计学数据无显著差异。黏菌素-替加环素组的ALT、S较高，溃疡病比例较低。黏菌素-替加环素组和黏菌素-碳青霉烯类药物组的严重出血事件发生率无显著差异（12.26%对9.33%，P = 0.40）。抗生素使用时间[比值比（OR）=1.06（1.02-1.11），P = 0.007]和抗凝剂使用[OR = 2.16（1.05-4.42），P = 0.04]与严重出血事件有关。
黏菌素-替加环素治疗与较高的出血风险无关。抗生素使用时间和抗凝剂的同时使用是出血事件的危险因素。
