Li Meng Mei, Shen Wen Cheng, Li Yu Jin, Teng Jun
Qingdao Central Hospital, The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, People's Republic of China.
Department of Emergency, Qingdao Municipal Hospital (Group), Qingdao, People's Republic of China.
Infect Drug Resist. 2022 Sep 19;15:5509-5517. doi: 10.2147/IDR.S375694. eCollection 2022.
Linezolid is classed as oxazolidinone antibiotics which can be used to treat severe infections caused by vancomycin-resistant Enterococcus faecium, hospital-acquired pneumonia caused by Staphylococcus aureus, complicated skin, and uncomplicated skin structure infections (SSSIs) caused by methicillin-susceptible S. aureus or Streptococcus pyogenes, and community-acquired pneumonia caused by Streptococcus pneumoniae. However, many studies have suggested it can also cause thrombocytopenia and pancytopenia.
We report on three patients with linezolid-pancytopenia. Patients in cases 1 and 2 were diagnosed with heart failure with preserved ejection fraction (HFpEF) and were both administered with dapagliflozin, one of the sodium-dependent glucose transporters 2 inhibitors (SHLT-2i).
Two patients were diagnosed with type 2 diabetes, pneumonia, and hyponatremia. Severe myelosuppression occurred in both patients, with a severe decrease in leukocytes and platelets and a moderate decrease in hemoglobin, who eventually passed away despite the discontinuation of linezolid and adopting appropriate treatment measures. The patient in case 3 was diagnosed with pneumonia, type 2 diabetes, and sequelae of cerebral thrombosis. After twelve days of treatment, the patient developed moderate thrombocytopenia and anemia. She recovered without any additional treatment after the discontinuation of linezolid.
In this case series, two patients with irreversible myelosuppression were treated with both linezolid and SGLT-2i, and one diabetic patient with single linezolid use presented with reversible pancytopenia, suggesting that SGLT-2i may exacerbate myelosuppression of linezolid. Linezolid should be used with caution in infectious patients with a history of SGLT-2i. We will conduct relevant animal experiments to clarify the interaction between the two drugs.
利奈唑胺属于恶唑烷酮类抗生素，可用于治疗由耐万古霉素粪肠球菌引起的严重感染、由金黄色葡萄球菌引起的医院获得性肺炎、由甲氧西林敏感金黄色葡萄球菌或化脓性链球菌引起的复杂性皮肤及非复杂性皮肤结构感染（SSSI），以及由肺炎链球菌引起的社区获得性肺炎。然而，许多研究表明它也可导致血小板减少和全血细胞减少。
我们报告了3例利奈唑胺相关性全血细胞减少的患者。病例1和病例2的患者被诊断为射血分数保留的心力衰竭（HFpEF），均接受了钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）之一的达格列净治疗。
2例患者被诊断为2型糖尿病、肺炎和低钠血症。2例患者均发生严重骨髓抑制，白细胞和血小板严重减少，血红蛋白中度减少，尽管停用利奈唑胺并采取了适当的治疗措施，最终仍死亡。病例3的患者被诊断为肺炎、2型糖尿病和脑血栓后遗症。治疗12天后，患者出现中度血小板减少和贫血。停用利奈唑胺后未进行任何额外治疗即康复。
在本病例系列中，2例不可逆骨髓抑制患者同时接受了利奈唑胺和SGLT-2i治疗，1例仅使用利奈唑胺的糖尿病患者出现可逆性全血细胞减少，提示SGLT-2i可能会加重利奈唑胺的骨髓抑制作用。对于有SGLT-2i使用史的感染患者，应谨慎使用利奈唑胺。我们将进行相关动物实验以阐明两种药物之间的相互作用。
