title: Prospective evaluation of risk factors for antibiotic-associated bleeding in critically ill patients.
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.
authors.affiliation: Department of Pharmacy, School of Pharmacy, State University of New York, Buffalo 14260.
authors.forename: T F
authors.initials: TF
authors.lastname: Goss
authors.forename: C A
authors.initials: CA
authors.lastname: Walawander
authors.forename: T H
authors.initials: TH
authors.lastname: Grasela
authors.forename: S
authors.initials: S
authors.lastname: Meisel
authors.forename: B
authors.initials: B
authors.lastname: Katona
authors.forename: K
authors.initials: K
authors.lastname: Jaynes
mesh_terms: D000005:Abdomen / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D016638:Critical Illness; D005334:Fever / Q000150:complications; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D009369:Neoplasms / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D013777:Tetrazoles / Q000009:adverse effects*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D012709:Serum Albumin; D013777:Tetrazoles; C038625:1-N-methyl-5-thiotetrazole