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Prospective evaluation of risk factors for antibiotic-associated bleeding in critically ill patients
T F Goss1, C A Walawander, T H Grasela
1Department of Pharmacy, School of Pharmacy, State University of New York, Buffalo 14260.
Abstract:
A prospective surveillance program was initiated to determine the relative role of antibiotics containing N-methylthiotetrazole (NMTT) versus patient risk factors in producing antibiotic-associated bleeding. Five hundred forty-six critically ill patients with serum albumin 30 g/L or below were evaluated for evidence of a bleeding event as documented by clinical observation, hemoglobin changes, and transfusions. Bleeding events occurred in 16% of patients receiving an aminoglycoside combination, 10% receiving antibiotics with the NMTT side chain, and 14.5% receiving antibiotics not containing NMTT (p greater than 0.05). The bleeding rate was highest in febrile patients with cancer (14.5%) and lowest in those with a suspected or documented abdominal infection (10%) (p = 0.04), but within each patient group there was no difference among the antibiotics. We conclude that the use of NMTT-containing antibiotics is not an independent risk factor for bleeding, but the role of severity of illness may be underappreciated.
Insights
Antibiotics with N-methylthiotetrazole (NMTT) side chains do not independently increase bleeding risk in critically ill patients. Patient factors, like cancer and fever, are more significant contributors to bleeding events.
Area of Science:
- Pharmacology
- Clinical Medicine
- Critical Care
Background:
- Antibiotic-associated bleeding is a concern in critically ill patients.
- The N-methylthiotetrazole (NMTT) side chain in some antibiotics has been implicated.
- Patient-specific risk factors may also contribute to bleeding events.
Purpose of the Study:
- To evaluate the role of NMTT-containing antibiotics in antibiotic-associated bleeding.
- To compare bleeding rates between NMTT antibiotics and other antibiotic classes.
- To assess the influence of patient risk factors on bleeding events.
Main Methods:
- Prospective surveillance of 546 critically ill patients with low serum albumin.
- Documentation of bleeding events through clinical observation, hemoglobin changes, and transfusions.
- Analysis of bleeding rates based on antibiotic type and patient characteristics.
Main Results:
- Bleeding occurred in 10% of patients receiving NMTT antibiotics, 16% with aminoglycoside combinations, and 14.5% with non-NMTT antibiotics (p > 0.05).
- Higher bleeding rates were observed in febrile cancer patients (14.5%) compared to those with abdominal infections (10%) (p = 0.04).
- No significant difference in bleeding rates was found among antibiotic types within patient groups.
Conclusions:
- NMTT-containing antibiotics are not an independent risk factor for bleeding.
- Severity of illness and patient-specific conditions appear to be more influential.
- Further research may be needed to fully understand the role of illness severity in antibiotic-associated bleeding.