Cefoperazone/sulbactam may cause fatal vitamin K-dependent coagulopathy, suggesting cephalosporins should be avoided in patients at high risk of bleeding unless compelling.
One case links CPZ/SAM to fatal hemorrhage; hypothesis-generating for cephalosporin coagulopathy risk and needs confirmation.
This case report describes a suspected and fatal adverse reaction involving vitamin K-dependent coagulopathy that might be associated with cefoperazone/sulbactam (CPZ/SAM), a combined antimicrobial formulation. We reported a patient diagnosed with acute cerebral infarction and secondary pulmonary infection who was treated with an intravenous infusion of CPZ/SAM at 3 g twice daily. After receiving treatment with CPZ/SAM, the patient developed a fatal adverse reaction of CPZ-induced hemorrhage. The Naranjo assessment score in this report was 5, suggesting that the patient's coagulation function disorder was potentially associated with the use of CPZ/SAM. To prevent vitamin K-dependent coagulopathy caused by CPZ/SAM, it is suggested to avoid cephalosporins in patients with a high risk of bleeding unless the need for cephalosporins is compelling.
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Huanrong Hu (2019) studied this question.
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