RESUMO
The standard treatment for an infected pressure ulcer (PU) with osteomyelitis is debridement, wound coverage and antibiotic administration. However, systemic administration of antibiotics in patients with osteomyelitis is controversial, and the optimal treatment duration for chronic osteomyelitis has not been standardised. We report a case of sudden severe thrombocytopenia induced by piperacillin/tazobactam (PIPC/TAZ) in a patient with PU-related osteomyelitis. A 57-year-old male patient with paraplegia, using a wheelchair full-time, presented to our plastic surgery department with infection of a stage IV hard-to-heal ischial PU. We surgically debrided the necrotising tissue and raised an ipsilateral biceps femoris musculocutaneous propeller flap for wound coverage. Polymicrobial infections, including Pseudomonas aeruginosa, were detected in the bone biopsy sample; therefore, systemic PIPC/TAZ was administered for the osteomyelitis. Unexpectedly, during the next 12 days of antibiotic administration, the patient's platelet count acutely dropped to 1×103/µl over three days. Based on a series of examinations, PIPC/TAZ was suspected to be the most likely cause of the severe thrombocytopenia. After drug discontinuation, the thrombocytopenia gradually improved. PIPC/TAZ is one of the most widely used antibiotic combinations in the plastic surgery field; it is conventionally administered for hard-to-heal wounds such as PUs and diabetic foot. The present case suggests that surgeons must take special precautions for patients undergoing PIPC/TAZ treatment. In this report, PIPC/TAZ-induced thrombocytopenia and the efficacy of antibiotic treatment for PU-related osteomyelitis are discussed in light of the available literature.
Assuntos
Antibacterianos , Osteomielite , Combinação Piperacilina e Tazobactam , Úlcera por Pressão , Trombocitopenia , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera por Pressão/tratamento farmacológico , Combinação Piperacilina e Tazobactam/efeitos adversos , Combinação Piperacilina e Tazobactam/uso terapêutico , Osteomielite/tratamento farmacológico , Trombocitopenia/induzido quimicamente , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Piperacilina/efeitos adversos , Piperacilina/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/efeitos adversos , Ácido Penicilânico/uso terapêutico , DesbridamentoAssuntos
Antibacterianos , Hipersensibilidade a Drogas , Combinação Piperacilina e Tazobactam , beta-Lactamas , Humanos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/etiologia , Combinação Piperacilina e Tazobactam/efeitos adversos , beta-Lactamas/efeitos adversos , beta-Lactamas/imunologia , Masculino , Feminino , Antibacterianos/efeitos adversos , Antibacterianos/imunologia , Pessoa de Meia-Idade , Idoso , Rotulagem de Medicamentos , Adulto , Piperacilina/efeitos adversos , Piperacilina/imunologiaAssuntos
Antibacterianos , Febre , Abscesso Hepático Amebiano , Combinação Piperacilina e Tazobactam , Humanos , Masculino , Combinação Piperacilina e Tazobactam/uso terapêutico , Combinação Piperacilina e Tazobactam/efeitos adversos , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Abscesso Hepático Amebiano/tratamento farmacológico , Adulto , Piperacilina/efeitos adversos , Piperacilina/uso terapêuticoAssuntos
Injúria Renal Aguda , Antibacterianos , Modelos Animais de Doenças , Combinação Piperacilina e Tazobactam , Vancomicina , Vancomicina/efeitos adversos , Vancomicina/administração & dosagem , Vancomicina/toxicidade , Animais , Injúria Renal Aguda/induzido quimicamente , Combinação Piperacilina e Tazobactam/administração & dosagem , Antibacterianos/efeitos adversos , Antibacterianos/administração & dosagem , Camundongos , Sinergismo Farmacológico , Rim/efeitos dos fármacos , Rim/patologia , Piperacilina/efeitos adversos , Piperacilina/administração & dosagem , Quimioterapia CombinadaRESUMO
INTRODUCCIÓN: La neutropenia febril en niños con patología oncohematològica requiere un tratamiento empírico precoz y adecuado. Esta revisión sistemática se realizó para evaluar si piperacilina/tazobactam (PTZ) monoterapia es más efectiva y segura que los comparadores, en niños con episodios de neutropenia febril de causa oncológica. MATERIAL Y MÉTODOS: Se realizó una búsqueda bibliográfica en Embase, MEDLINE utilizando los términos de búsqueda (('febrile neutropenia' OR hemato oncology OR haemato oncology OR 'immunocompromised host' OR 'immunocompromised patient' OR 'chemotherapy-induced febrile neutropenia') AND (piperacillin OR tazobactam OR 'piperacillin plus tazobactam' OR 'piperacillin/tazobactam' OR 'piperacillin-tazobactam' OR tazocin OR 'piperacillin-tazobactam drug combination')). El criterio de valoración de eficacia fue la incidencia de fracaso terapéutico. El punto final de seguridad fue la ausencia de cualquier efecto adverso (EA). RESULTADOS: Se identificaron 1.388 estudios, de los cuales se incluyeron 11 que cumplían los criterios de elegibilidad. Los estudios presentaron notable homogeneidad ( I 2 0%) y no se detectó sesgo de publicación (p 0,36). El riesgo de fracaso terapéutico de PTZ no fue mayor que en los comparadores (RR global: 0,94; IC95% 0,83 a 1,07) como tampoco lo fue, la incidencia de EA. CONCLUSIONES: El riesgo de fracaso terapéutico no fue superior para la PTZ como monoterapia frente a los comparadores
BACKGROUND: Febrile neutropenia in children with onco-hematological diseases is an important cause of morbidity and mortality and requires early and adequate empirical treatment. This systematic review was conducted to evaluate if piperacillin/ tazobactan (PTZ) monotherapy leads to a lower incidence of therapeutic failures than comparators. METHODS: A literature search was carried out in Embase, and MEDLINE databases using the search terms ('febrile neutropenia' OR hemato oncology OR haemato oncology OR 'immunocompromised host' OR 'immunocompromised patient' OR 'chemotherapy-induced febrile neutropenia') AND (piperacillin OR tazobactam OR 'piperacillin plus tazobactam' OR 'piperacillin/tazobactam' OR 'piperacillin-tazobactam' OR tazocin OR 'piperacillin-tazobactam drug combination')), Efficacy endpoint was treatment failure rate. The safety end-point was absence of any adverse effects (AE). RESULTS: Eleven studies were included. No heterogeneity was detected ( I 2 0%). The risk of failure was not superior for piperacillin/tazobactan to comparators (Global RR: 0.94; IC95% 0.83 a 1.07). Rates of adverse events were similar among studies. No publication bias was detected (p 0.36). CONCLUSIONS: This systematic review and meta-analysis showed that treating episodes of febrile neutropenia in oncology pediatric patients, the risk of failure for PTZ was not superior to comparators. Adverse events were similar to the comparators.
Assuntos
Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neutropenia/tratamento farmacológico , Piperacilina/efeitos adversos , Hospedeiro Imunocomprometido , Ácido Penicilânico/efeitos adversos , Quimioterapia Combinada , Antibacterianos/efeitos adversos , Neutropenia/induzido quimicamenteRESUMO
Mostra a biodisponibilidade, a farmacinética, a atividade in vitro, os estudos clínicos, a segurança, os efeitos colaterias, a posologia e a relação custo/benfício da junção da pipericilina sódica com a tazobactama sódica