Al-Harbi Dimah, Alturaiki Abdulrahman, Alshngeetee Ayshah, Aldabas Haya, AlBreacan Layla, Aljohani Renad, Alshahrani Eid Hussein, Althemery Abdullah, Esba Laila Carolina Abu
King Abdulaziz Medical City, Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Infect Dis Ther. 2022 Aug;11(4):1649-1660. doi: 10.1007/s40121-022-00663-3. Epub 2022 Jun 21.
Linezolid and vancomycin have an important place among therapeutic antimicrobial options for multidrug-resistant gram-positive infections. Thrombocytopenia is an adverse effect reported with both and can lead to treatment interruption. Our objective was to compare the incidence of thrombocytopenia in patients receiving linezolid or vancomycin and to identify risk factors associated with thrombocytopenia.
This was a retrospective observational cohort study that involved patients who received linezolid (intravenously or orally) or vancomycin (intravenously) at a tertiary care hospital, between January 2016 and October 2019, for a minimum of 5 days and in whom platelet values were measured during treatment. Data on platelet count were collected during therapy in each group to identify the incidence of thrombocytopenia.
A total of 453 patients fulfilled the study criteria; 241 patients received linezolid and 212 patients vancomycin. The main logistic regression analysis revealed that patients in the linezolid group had approximately a four times higher incidence of thrombocytopenia (OR 4.39; 95% CI 2.38-8.08) compared to vancomycin. An increased incidence of thrombocytopenia was associated with advanced age, baseline platelet count and vasopressor use.
Clinicians considering vancomycin or linezolid for a susceptible infection should weigh the higher risk of thrombocytopenia that may be observed with linezolid vs. vancomycin in their decision.
利奈唑胺和万古霉素在耐多药革兰氏阳性菌感染的抗菌治疗选择中占据重要地位。血小板减少是二者均有报道的不良反应，可能导致治疗中断。我们的目的是比较接受利奈唑胺或万古霉素治疗的患者中血小板减少的发生率，并确定与血小板减少相关的危险因素。
这是一项回顾性观察队列研究，纳入了2016年1月至2019年10月期间在一家三级护理医院接受利奈唑胺（静脉或口服）或万古霉素（静脉）治疗至少5天且在治疗期间测量了血小板值的患者。收集每组治疗期间的血小板计数数据，以确定血小板减少的发生率。
共有453例患者符合研究标准；241例患者接受利奈唑胺治疗，212例患者接受万古霉素治疗。主要逻辑回归分析显示，与万古霉素相比，利奈唑胺组患者血小板减少的发生率高出约四倍（比值比4.39；95%置信区间2.38 - 8.08）。血小板减少发生率的增加与高龄、基线血小板计数和血管升压药的使用有关。
考虑使用万古霉素或利奈唑胺治疗易感感染的临床医生在决策时应权衡利奈唑胺与万古霉素相比可能出现的更高的血小板减少风险。
