Immune thrombocytopenia induced by beta‐lactam antibiotics: Cross‐reactions of responsible antibodies with other beta‐lactam drugs

Transfusion ◽  
2021 ◽  
Author(s):  
Matthew Slaught ◽  
Mark Rasmussen ◽  
Daniel Bougie ◽  
Richard Aster
Keyword(s):  
Immune Thrombocytopenia ◽  
Beta Lactam ◽  
Cross Reactions ◽  
Beta Lactam Antibiotics

scholarly journals Cross-Reactivity of Drug-Dependent Antibodies in Patients with Immune Thrombocytopenia Induced By Beta-Lactam Antibiotics

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2350-2350
Author(s):  
Matthew John Slaught ◽  
Daniel W. Bougie ◽  
Richard H. Aster
Keyword(s):  
Bacterial Infections ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
Cross Reactivity ◽  
Beta Lactam ◽  
Cross Reactions ◽  
Beta Lactam Antibiotics ◽  
Wide Range ◽  
Group 2 ◽  
Group 1

More than 50 beta lactam (BL) antibiotics are now in active use for treatment of a wide range of bacterial infections. BL antibiotics are among the most common drugs capable of inducing antibodies (DDAbs) that cause drug-induced immune thrombocytopenia (DITP). Most DDAbs are highly specific for the sensitizing drug but beta lactams all have a common core structure and many similarities among side groups that are added to augment potency and modify specificity, raising the possibility that a DDAb specific for one BL may cross-react with another. We studied DDAbs from 33 patients with DITP induced by 9 commonly used BL drugs to determine whether patterns of cross-reactivity exist that might influence the choice of an alternative antibiotic in a patient with BL-induced DITP. DDAbs were demonstrated in a flow cytometric assay considered to be "positive" when immunoglobulins in patient serum but not normal serum react with normal platelets in the presence, but not in the absence of drug (Blood 2018;131:1486). DDAbs detected in the 33 patients were specific for 9 different BL drugs that were divided into two groups, "penicillins" (Group 1) and cephalosporins (Group 2) on the basis of structural similarities (Figure 1). In Group 1 were 19 DDAbs specific for amoxicillin (2), nafcillin (4) and piperacillin (13). Structurally similar ampicillin and penicillin were also tested with these abs. In Group 2 were 14 DDAbs specific for cefadroxil (1), cefepime (2), ceftazidime (2), ceftizoxime (1), ceftriaxone (7) and cephalexin 1). Cross-reactions identified within these groups of DDAbs are shown in Tables 1 and 2. Cross-reactions, many quite strong (S) were observed among DDAbs specific for drugs in both structural groups (Tables 1 and 2). Particularly noteworthy were cross-reactions of the 19 Group 1 DDAbs with ampicillin (6) and penicillin (6) (Table 1) and of the 14 Group 2 DDAbs with cefepime (6), ceftizoxazole (6) and ceftriaxone (3) (Table 2). The findings show that platelet-specific DDAbs induced by beta lactam antibiotics, in contrast with those induced by medications like quinine, sulfamethoxazole and vancomycin, commonly cross-react with other antibiotics of this class. In patients with immune thrombocytopenia induced by a beta lactam antibiotic, it may be prudent to avoid switching to another beta lactam or, if this is necessary, to monitor platelet counts carefully. Disclosures No relevant conflicts of interest to declare.

scholarly journals 839. Epidemiology of Extended-Spectrum Beta-lactamase (ESBL) Producing Enterobacteriaceae in the South East Tennessee, October-December 2017

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S460-S461
Author(s):  
Daniel Muleta ◽  
Cullen Adre ◽  
Benji-Byrd Warner
Keyword(s):  
Klebsiella Oxytoca ◽  
Health Department ◽  
Population Based ◽  
Klebsiella Pneumonia ◽  
Drug Resistant ◽  
Beta Lactam ◽  
Extended Spectrum Beta Lactamase ◽  
Catchment Population ◽  
Beta Lactam Antibiotics ◽  
Extended Spectrum

Abstract Background The increasing spread of drug resistant gram-negative organisms is one of the major public health challenges. ESBL-producing Enterobacteriaceae has become the most common multi drug resistant pathogen in the last three decades. These organisms confer resistance to most beta-lactam antibiotics, including penicillins, third generation cephalosporins, monobactams and tazobactam. Methods The Tennessee Health Department (TDH) collaborated with CDC to pilot population based surveillance of ESBL producing organisms in Maury, Wayne, Lewis and Marshall Counties during October to December 2017. A case was defined as isolation of Escherichia coli, Klebsiella pneumoniae, or Klebsiella oxytoca resistant to at least one extended-spectrum cephalosporin (ceftazidime, cefotaxime or ceftriaxone) and non-resistant to all carbapenem antibiotics from urine or normally sterile body sites from a resident of the surveillance catchment area. A line list of ESBL-producing organisms was received from the labs that serve the catchment population. Case report forms were completed for the first ESBL culture collected from a single patient in a 30 day-period. Results A total of 154 cases were identified during the study period. E.coli constitutes 92.2% of the ESBL producing organisms followed by Klebsiella pneumonia (5.2%) and K. oxytoca (2.6%). The estimated annual incidence rate was 400.7 per 100,000 population which is more than twice of the average rates of other sites that conducted similar studies. The most common isolate source was urine (97%), and 81.2% of all cases were female. Patient ages ranged from 3-99 years, with average of 67 years. Thirty-two isolates underwent additional sequence typing and 76.7% (23) of the isolates were ST 131. 21 (91.3%) of ST-131 isolates were resistant to ciprofloxacin. Conclusion The study revealed that the incidence of ESBL producing organisms is very high in the Tennessee study area compared to other sites. The most common ESBL-producing pathogen was found to be ST 131 and most of these were resistant to ciprofloxacin suggesting that resistance to fluoroquinolone may be co-transmitted in ESBL producing pathogens through plasmids. Continued surveillance of molecular epidemiology is important to guide the prevention of the spread of drug resistant pathogens. Disclosures All Authors: No reported disclosures

scholarly journals .BETA.-Lactam antibiotics derived from nitrogen heterocyclic acetic acids. 2. Cephalosporin derivatives.

1981 ◽  
Vol 34 (1) ◽  
pp. 40-46 ◽  
Author(s):  
R. E. BAMBURY ◽  
E. H. W. BÖHME ◽  
N. W. BRAKE ◽  
M. L. EDWARDS ◽  
R. C. ERICKSON ◽  
...  
Keyword(s):  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Acetic Acids ◽  
Nitrogen Heterocyclic
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