The Incidence Rate of Vancomycin-Induced Thrombocytopenia in Orthopedics: A Single-Center Retrospective Case Series

Abstract

1. Abstract 1.1. Objective: Vancomycin has been an indispensable alternative for the treatment of severe and complicated infections, especially in orthopedics department. However, as a severe adverse drug effect, vancomycin-induced thrombocytopenia (VIT) has not attracted enough attention. The objective of the research was to analyze the incidence rate of VIT in orthopedic patients. 1.2. Methods: The medical records of inpatients receiving intravenous vancomycin medication from January 2015 to December 2020 in a single center of orthopedics department were retrospectively reviewed. The gender, age, diagnosis, duration of vancomycin usage and changes of platelet counts were collected to analyze the occurrence of VIT and its incidence rate. 1.3. Results: A total of 258 cases receiving intravenous vancomycin medication (≥3 days) were enrolled in the study. The mean age was 57.3 years and the mean duration of vancomycin usage was 11.2 days. There were 141 cases in the treatment group and 117 cases in the prevention group. The changes of platelet counts were recorded and reviewed carefully. VIT was diagnosed in 2 patients, which were both in treatment group. The incidence rate of VIT in orthopedics was 0.78%. 1.4. Conclusion: Whenever acute thrombocytopenia occurs without a known cause in patients receiving vancomycin medication, VIT should be considered. This is the first clinical report of VIT and incidence rate in orthopedics. Although the incidence rate of VIT in orthopedics was 0.78% in our research, the clinical rare adverse effect should also attract enough attention and close monitoring. 2. Introduction Vancomycin is a glycopeptide antibiotic with activity against most Gram-positive microorganisms. It prevents the formation of peptidoglycans of the bacterial cellular wall and inhibits the growth of bacteria [1]. Since developed in 1956, Vancomycin was widely used for the treatment of different severe infections caused by Gram-positive bacteria and in patients allergic to penicillin. Nowadays, Vancomycin has been an indispensable alternative for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant Streptococcus [2]. However, the adverse effect related to vancomycin should not be neglected. Vancomycin-induced thrombocytopenia (VIT) was first reported in 1985 and was further explained in the published case reports [3]. Thrombocytopenia is strongly associated with poor clinical outcomes, illness severity, the development of multiple organ failure, the length of hospital stays and mortality. Vancomycin has been widely used in the orthopedics department because of the high incidence of device-associated infections, mostly due to coagulase-negative staphylococci and other organisms that are sensitive only to vancomycin [4]. However, the real incidence rate and details of VIT in orthopedics remains unknown. In the current study, we retrospectively reviewed the records of inpatients using intravenous vancomycin in a single orthopedics center and analyzed the incidence rate of VIT.