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Bir Periton Diyalizi Hastasında Sefoperazon-sulbaktam Kullanımına Bağlı Gelişen Koagülopati

Cephoperazone-sulbactam Induced Coagulopathy in a Peritoneal Dialysis Patient

Journal Name:

Publication Year:

DOI: 
10.5262/tndt.2010.1001.10

Keywords (Original Language):

Abstract (2. Language): 
A 54-year-old female who had been receiving continuous ambulatory peritoneal dialysis therapy for 5 years because of end-stage renal disease, was admitted to hospital because of peritonitis due to Candida albicans. Ultrasonography showed locular fluid in abdominal subcutaneous tissue. E. coli was isolated from the peritoneal fluid culture and cephoperazone-sulbactam therapy was started. Nose bleeding manifested on the 9th day after initial treatment. Prothrombin time, activated partial thromboplastin time, and INR were found to be 61.1 sec, 159.2 sec, and 5.55, respectively. She had no liver disease, obstructive jaundice, or other disease disrupting the intestinal absorption of vitamin K. Hepatitis markers were negative and liver function tests were normal. Warfarin and conventional heparin were also not used. The coagulation disorder was attributed to treatment with cephoperazonesulbactam and the treatment was discontinued. The bleeding stopped with intravenous vitamin K and fresh frozen plasma and the coagulation tests returned to normal range. Empirical meropenem and vancomycin were started due to ongoing fever. She was connected to a mechanical ventilator because of respiratory failure due to aspiration pneumonia. She later died due to aspiration pneumonia. Cephoperazone-sulbactam may lead to coagulopathy by affecting the metabolism of vitamin K. Clinicians should therefore be careful if they use this drug.
Abstract (Original Language): 
Son dönem böbrek yetmezliği nedeniyle 5 yıldır sürekli ayaktan periton diyalizi yapan elli dört yaşında kadın hasta Candida albicans’ın neden olduğu peritonit sebebiyle yatırıldı. Hastanın yapılan ultrasonografisinde; batında cilt altı dokuda loküle mayi saptandı. Kültürde E. coli üremesi olması üzerine sefoperazon-sulbaktam tedavisi başlandı. Tedavisinin 9. gününde burun kanaması olan hastanın protrombin zamanı 61.1 sn, aktive parsiyel tromboplastin zamanı 159,2 sn, INR 5,55 olarak saptandı. Hastanın bilinen karaciğer hastalığı, tıkanma sarılığı veya K vitamini emilimini bozacak hastalığı yoktu. Hepatit belirteçleri negatif ve karaciğer fonksiyon testleri normaldi. Koagülasyon testlerini bozacak varfarin, klasik heparin kullanmıyordu. Koagülasyon bozukluğu sefoperazon-sulbaktam tedavisine bağlandı ve tedavi kesildi. Tedavilerle kanaması durdu ve koagülasyon testleri normal aralıklara döndü. Ateşi devam eden hastaya, ampirik olarak meropenem ve vankomisin başlandı. Aspirasyon pnömonisi sonucu solunum yetmezliği gelişen hasta mekanik ventilatöre bağlandı. Yoğun bakım ünitesindeki takipleri sırasında aspirasyon pnömonisi nedeniyle hasta kaybedildi. Sefoperazonsulbaktam, vitamin K metabolizmasını etkileyerek koagülopatiye neden olması sebebiyle klinisyenler bu ilacı kullanırken dikkatli olmalıdırlar.

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