Background and importance Ceftaroline is a new fifth generation cephalosporin indicated for the treatment of severe pneumonia and skin and soft tissue infection, which is particularly effective against methicillin resistant Staphylococcus aureus (MRSA) and penicillin resistant strains of Streptococcus pneumoniae. Some studies have found an association between prolonged use of ceftaroline and a higher incidence of neutropenia.

Aim and objectives To study the incidence and causality of the onset of neutropenia associated with the use of ceftaroline in routine clinical practice.

Material and methods A retrospective observational study was conducted in a tertiary hospital between April 2017 and July 2020. Electronic records were used. Inclusion criteria were: adult patients treated with ceftaroline for >7 days. Exclusion criteria were: oncohaematological patients or those with a neutrophil count <1500 cells/mm³ at the beginning of treatment. Demographic variables recorded were: age, gender, Charlson comorbidity index (CCI), length of treatment, admission to the intensive care unit, diagnosis, concomitant antibiotic therapy, bacteria isolated, nadir neutrophil count during treatment, use of granulocyte colony stimulating factor (G-CSF) and clinical evolution. Causality was analysed with the Naranjo adverse drug reaction probability scale.

Results Between April 2017 and July 2020, 41 patients received ceftaroline (69±11 years, 78% men, CCI=6±2). Median length of treatment was 9 days (IQR 8–12.5). 78% of patients were admitted to the intensive care unit and 76% of cases had a diagnosis of pneumonia. Ceftaroline was used as firstline therapy in 54% of patients, frequently associated with levofloxacin (50%). MRSA was isolated from blood cultures in 20% of cases. During ceftaroline treatment, 15% of patients had a nadir count of <1500 neutrophils/mm³ in a median of 6 days (IQR 4–7). 7% of patients had severe neutropenia (<500 cells/mm³). Only one of the neutropenic patients received a dose of G-CSF. In all cases, neutropenia was considered to be ‘possibly’ associated with ceftaroline. None of the patients discontinued their treatment due to neutropenia.

Conclusion and relevance In patients treated with ceftaroline, neutropenia was an adverse effect that must be considered. More studies are needed to confirm this causality.

Conflict of interest No conflict of interest