Carbapenem-Induced Platelet Abnormalities: A Systematic Review Literature Analysis of Platelet Abnormality Caused by Carbapenems

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Objective: To analyze and discuss the clinical characteristics of carbapenem-induced platelet abnormalities. Methods: The databases of CNKI, Wanfang Data, Chinese VIP, Web of science, PubMed, Embase and Elsevier were searched (up to June 30,2025), and the case reports of carbapenem-induced platelet abnormalities were collected and descriptively analyzed. Results: A total of 42 patients (21 males and 21 females) were included, with a median age of 64 years (range:0– 96 years). Thrombocytosis was observed in 20 patients, while thrombocytopenia occurred in 22 patients. Platelet abnormality most often occurred in patients receiving meropenem (64.3%) followed by imipenem (26.2%). All cases occurred during carbapenem therapy. The median time to platelet count abnormality was 3 days (range 0.125– 12), with 79.5% of cases occurring within one week. Specifically, the median time to carbapenem-induced thrombocytopenia was 2.5 days (range 0.125– 9), while the median time to carbapenem-induced thrombocytosis was 3 days (range 3– 12). The nadir of platelet count was reached at 5 days (range 1– 10) after medication, with a median platelet count nadir of 21.5× 10 9 /L (range 0– 136). The peak of platelet count was reached at 8 days (range 3– 18), with a median platelet count peak of 900× 10 9 /L (range 570– 1,440). Complications occurred in 10 thrombocytopenia cases, all of which were bleeding events. After discontinuation of the drug and symptomatic treatment, all cases showed significant improvement in platelet counts and resolution of complications, except for one patient who died from multiple organ dysfunction syndrome. Conclusion: Carbapenem-induced platelet abnormalities appear to be more frequent than previously recognized, predominantly occurring within the first week of therapy. This potentially severe adverse drug reaction should be particularly considered in elderly patients receiving meropenem therapy. Keywords: carbapenem, platelet abnormality, adverse drug reaction, clinical characteristics, systematic review

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