Brown R B, Klar J, Lemeshow S, Teres D, Pastides H, Sands M
Arch Intern Med. 1986 Nov;146(11):2159-64.
Most cases of beta-lactam-associated coagulopathy occur in patients with other risk factors. This study analyzed temporally related clinical bleeding events in 1493 patients who received one antibiotic for at least three days. Univariate and multivariate analyses controlled for condition variables (nutritional status, renal, hepatic, or hematologic dysfunction, intensive care unit stay) and treatment variables (use of antiplatelet agents, anticoagulants, vitamin K, antitumor chemotherapy or antiulcer therapy, steroids) that could have been associated with bleeding independently. Rates of bleeding ranged from 0% (chloramphenicol sodium succinate, vancomycin hydrochloride, erythromycin lactobionate) to 8.2% (cefoxitin) to 22.2% (moxalactam disodium). Multiple logistic regression analyses revealed that only moxalactam (odds ratio, 9.9) and cefoxitin (odds ratio, 2.1) exhibited significantly higher likelihoods of bleeding than other agents. This study statistically confirms increased risk of bleeding with moxalactam, heretofore reported only anecdotally. Cefoxitin may carry risks greater than previously believed.
大多数β-内酰胺类抗生素相关性凝血病病例发生在有其他风险因素的患者中。本研究分析了1493例接受一种抗生素治疗至少三天的患者中与时间相关的临床出血事件。单因素和多因素分析对可能独立与出血相关的病情变量（营养状况、肾、肝或血液系统功能障碍、重症监护病房住院时间）和治疗变量（使用抗血小板药物、抗凝剂、维生素K、抗肿瘤化疗或抗溃疡治疗、类固醇）进行了控制。出血发生率从0%（琥珀氯霉素、盐酸万古霉素、乳糖酸红霉素）到8.2%（头孢西丁）再到22.2%（拉氧头孢钠）不等。多因素logistic回归分析显示，只有拉氧头孢（比值比，9.9）和头孢西丁（比值比，2.1）出现出血的可能性显著高于其他药物。本研究从统计学上证实了拉氧头孢出血风险增加，此前仅有个案报道。头孢西丁可能携带比先前认为更大的风险。
