Blood coagulation disorder that occurred after the use of cephem antibiotics with an NMTT group: A case report

Abstract

We encountered a case of blood coagulation disorder due to vitamin K deficiency in a patient who received cephem antibiotics for the prevention of postoperative infection. We started the administration of a combination of cefoperazone and sulbactam (SPZ/SBT) after surgery and on day 5, an abnormally prolonged prothrombin time (PT) and an activated partial thromboplastin time (APTT) were observed. On the basis of the results of a cross-mixing test and tests for the coagulation factors VIII and IX, we suspected vitamin K deficiency. Immediately after impaired clotting was found, we administered vitamin K and changed the antibiotics, which improved PT and APTT, and no bleeding was observed on the following day. As the causes of vitamin K deficiency, dietary vitamin K insufficiency and impaired vitamin K metabolism caused by an N-methyl tetrazole thiol group (NMTT group) in some cephem antibiotics were considered. In patients with severe symptoms, particularly those with poor ingestion, taking the possibility of blood coagulation disorder into account, regular coagulation tests and prophylactic administration of vitamin K should be considered.