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Risk factor analysis for linezolid-associated thrombocytopenia in critically ill patients

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Abstract

Linezolid is an antibiotic used against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus. Its primary adverse effect is haematotoxicity. The objective of this study was to analyse the risk factors for onset of thrombocytopenia in critically ill patients treated with linezolid. This was a retrospective, single-centre study of 72 patients. Platelets were measured from D0 to D20 after the start of treatment. The risk factors for thrombocytopenia were identified using a multivariate logistic regression analysis following a Monte Carlo simulation. Following ROC curve analysis, a baseline platelet count lower than 108 × 109/L and a Cmin higher than 4 mg/L, with respective odds ratios of 117 (95% CI [97–206]) and 3 (95% CI [1.5–6.2]) in the simulated population, were identified as risk factors. Among the source population patients combining these 2 factors, a significantly higher number developed thrombocytopenia (66.7% vs. 33.3%, p = 0.0042). A baseline platelet count lower than 108 × 109/L and a Cmin higher than 4 mg/L are risk factors for the onset of thrombocytopenia in critically ill patients treated with linezolid.

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Abbreviations

C min :

minimum plasma concentration of linezolid

C max :

maximum plasma concentration of linezolid

MIC:

minimum inhibitory concentration

LNZ:

Linezolid

AUC:

area under the curve

AUIC:

ratio of AUC24h to MIC

ROC:

receiver operating characteristic

PPV:

positive predictive value

NPV:

negative predictive value

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Acknowledgements

The authors would like to acknowledge DRCI of University Hospital of Toulouse for the English language.

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Authors and Affiliations

  1. Intensive Care Unit, University Hospital of Toulouse, 1 Avenue Jean Poulhès, 31059, Toulouse Cedex 9, France

    Julien Cazavet, Fanny Vardon Bounes, Stéphanie Ruiz, Thierry Seguin, Laure Crognier, Antoine Rouget, Olivier Fourcade, Vincent Minville, Jean-Marie Conil & Bernard Georges

  2. Department of Anesthesiology and Critical Care, University Hospital of Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France

    Julien Cazavet, Fanny Vardon Bounes, Stéphanie Ruiz, Thierry Seguin, Laure Crognier, Antoine Rouget, Olivier Fourcade, Vincent Minville, Jean-Marie Conil & Bernard Georges

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  1. Julien Cazavet
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Correspondence to Bernard Georges.

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Approved by the Toulouse Hospital Ethics and Research Committee (SOOM I EC, Toulouse, France, under no. 06 049 02)

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Cazavet, J., Bounes, F.V., Ruiz, S. et al. Risk factor analysis for linezolid-associated thrombocytopenia in critically ill patients. Eur J Clin Microbiol Infect Dis 39, 527–538 (2020). https://doi.org/10.1007/s10096-019-03754-1

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