Roy Marie-Pier, Calon Frédéric, Simonyan David, Bergeron Luc
, MSc, is with the CHU de Québec-Université Laval, Québec, Quebec.
, PhD, is with the Faculty of Pharmacy, Université Laval, and the Centre de recherche du CHU de Québec-Université Laval, Québec, Quebec.
Can J Hosp Pharm. 2022 Jul 4;75(3):186-192. doi: 10.4212/cjhp.3161. eCollection 2022 Summer.
Neutropenia is an adverse effect associated with the use of several antibiotics, including piperacillin-tazobactam (P/T). Previous findings have suggested that the risk of neutropenia in children is significantly higher with P/T than with ticarcillin-clavulanate.
To compare the risk of neutropenia associated with P/T and with cefazolin in an adult population and to describe the characteristics of neutropenia episodes observed.
This descriptive retrospective study involved patients aged 18 years or older who received a minimum of 10 days of treatment with P/T or cefazolin between January 2009 and December 2013. Patients who experienced neutropenia (absolute neutrophil count < 1.5 × 10/L) were compared, using univariate and multivariate logistic regression models, between those who received P/T and those who received cefazolin.
A total of 207 patients were included (104 who received P/T and 103 who received cefazolin). Ten episodes of neutropenia were observed, 5 with each antibiotic (4.8% and 4.9%, respectively; odds ratio 0.99, 95% confidence interval 0.278-3.527). The mean cumulative dose of piperacillin was 290.4 g among patients who experienced neutropenia and 247.0 g among all patients treated with P/T, and the mean treatment duration was 24.0 days and 21.0 days, respectively. The average time before the onset of neutropenia was slightly longer with P/T than with cefazolin (22.0 versus 17.2 days, = 0.38).
Although these results require confirmation in a larger clinical trial (to lessen possible attribution bias), the risk of neutropenia appeared to be similar between P/T and cefazolin.
中性粒细胞减少是使用包括哌拉西林 - 他唑巴坦（P/T）在内的多种抗生素相关的不良反应。先前的研究结果表明，儿童使用P/T时发生中性粒细胞减少的风险显著高于替卡西林 - 克拉维酸。
比较成人中与P/T和头孢唑林相关的中性粒细胞减少风险，并描述观察到的中性粒细胞减少发作的特征。
这项描述性回顾性研究纳入了2009年1月至2013年12月期间接受至少10天P/T或头孢唑林治疗的18岁及以上患者。使用单因素和多因素逻辑回归模型，比较发生中性粒细胞减少（绝对中性粒细胞计数<1.5×10⁹/L）的患者中接受P/T和接受头孢唑林的患者。
共纳入207例患者（104例接受P/T，103例接受头孢唑林）。观察到10次中性粒细胞减少发作，每种抗生素各5次（分别为4.8%和4.9%；比值比0.99，95%置信区间0.278 - 3.527）。发生中性粒细胞减少的患者中哌拉西林的平均累积剂量为290.4 g，接受P/T治疗的所有患者中为247.0 g，平均治疗持续时间分别为24.0天和21.0天。P/T导致中性粒细胞减少发作的平均时间略长于头孢唑林（22.0天对17.2天，P = 0.38）。
尽管这些结果需要在更大规模的临床试验中得到证实（以减少可能的归因偏倚），但P/T和头孢唑林之间中性粒细胞减少的风险似乎相似。
