哌拉西林/他唑巴坦钠致骨髓抑制25例回顾分析

Retrospective Analysis of 25 Cases of Myelosuppression Induced by Piperacillin/Tazobactam

目的:探讨哌拉西林/他唑巴坦钠(TZP)致骨髓抑制的临床特征,为提高用药安全提供参考。方法:收集2014~2019年我院TZP致骨髓抑制的25例患者进行回顾性分析,对患者的性别、年龄、感染类型、TZP使用情况、骨髓抑制临床表现、外周血象指标变化等进行统计分析,并根据同期医院TZP使用病例数计算ADR发生率。结果:6年内我院TZP致骨髓抑制发生率为0.93%,ADR病例以年轻和老年男性为主。TZP致骨髓抑制的平均累积剂量为(206.01±107.82)g,累积剂量集中在100~300 g(15例);出现骨髓抑制的平均时间为(15.56±6.37)d,时间分布以8~28 d为主。TZP治疗后外周血WBC、N和Plt值在停药前均明显低于给药前,停药1~7 d内有明显回升(P<0.05);而停药前Hb水平下降不明显(P>0.05),但在停药7 d后才有明显回升(P<0.05)。25例骨髓抑制的严重程度分级:Ⅰ级2例,Ⅱ级6例,Ⅲ级12例,Ⅳ级5例;Ⅲ级发生率最高为0.45%,而Ⅳ级发生率也有0.19%。细胞减少表现以单系WBC减少和二系细胞(WBC+Plt或Hb)减少为主,三系同时减少较罕见,发生率为0.07%。结论:TZP致骨髓抑制是可逆的,但后果可能很严重,应引起临床的重视。TZP治疗时间超过7 d,累积剂量超过100 g时骨髓抑制的风险明显增加。

Objective:To explore the clinical characteristics of piperacillin/tazobactam(TZP) induced myelosuppression, and to provide a reference for improving medication safety. Methods: A total of 25 patients with myelosuppression induced by TZP in our hospital from January 2014 to December 2019 were collected for retrospective analysis. The gender, age, infection type, TZP medication, marrow suppression clinical manifestations, and peripheral blood indicators were statistically analyzed, and the incidence of adverse drug reaction(ADR) was calculated according to the number of TZP cases in the hospital during the same period. Results:The incidence of myelosuppression induced by TZP in our hospital was only 0.93% in 6 years, mainly young and old men. The average cumulative dose of marrow suppression induced by TZP was(206.01±107.82) g, and the cumulative dose was concentrated in the range of 100-300 g. The average time of occurrence of bone marrow suppression was(15.56±6.37) d, and the time distribution was mainly 8-28 days. After TZP treatment, peripheral blood WBC, N and Plt were significantly lower than before, the difference was statistically significant(P<0.05). However, the Hb did not decrease more significantly than before, and the difference was not statistically significant(P>0.05). Within 7 days after withdrawal, WBC, N and Plt were higher than before, and the difference was statistically significant(P<0.05). However, more than 7 days after withdrawal,Hb was significantly higher than before, the difference was statistically significant(P<0.05). In terms of severity, the incidence of grade Ⅲ myelosuppression was highest at 0.45%, while the incidence of severe grade Ⅳ myelosuppression was still 0.19%. The performance of cells was mainly reduced by single lineage WBC and decreased by two lineage cells(WBC+Plt or Hb), while simultaneous decrease of three line cells was rare, with an incidence rate of only 0.07%. Conclusion:The myelosuppression caused by TZP is reversible, but the consequences may be very serious. This adverse reaction should cause clinical attention. TZP treatment duration over 7 days and cumulative dose over 100 g significantly increased the risk of bone marrow suppression.