{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:36:38Z","timestamp":1791387398092,"version":"4.3.3"},"reference-count":11,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Cefazolin is a widely used first-generation cephalosporin. While generally well tolerated, several case reports have described severe coagulopathy induced by intravenous (IV) cefazolin. This was seen particularly in patients with impaired renal function, where antibiotic choice is limited and may require specific dose adjustments. Altered renal handling of antibiotics and their metabolites may potentiate toxicity and side effects. We report a case of a 72-year-old Chinese man who had been treated for methicillin-sensitive staphylococcus aureus (MSSA, coagulase-positive) infective endocarditis with cefazolin and, consequently, developed significantly elevated international normalised ratio (INR) while on therapy. This resolved within 48 h after cessation of cefazolin and administration of oral vitamin K. Malnourished patients with pre-existing or acute kidney injury may be at an increased risk of cefazolin-related coagulopathy.<\/jats:p>","DOI":"10.3390\/idr13010021","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T10:25:18Z","timestamp":1614594318000},"page":"187-190","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Deranged Coagulation Profile Secondary to Cefazolin Use: Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3339-7281","authenticated-orcid":false,"given":"Jinghao Nicholas","family":"Ngiam","sequence":"first","affiliation":[{"name":"Department of Medicine, National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tze Sian","family":"Liong","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai Meng","family":"Tham","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanawin","family":"Pramotedham","sequence":"additional","affiliation":[{"name":"Department of Medicine, National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawan","family":"AlAgha","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Anantharajah","family":"Tambyah","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore"},{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel Hon Wai","family":"Lum","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"823","DOI":"10.2146\/ajhp070243","article-title":"Cefazolin-induced hypoprothrombinemia","volume":"65","author":"Chung","year":"2008","journal-title":"Am. J. Health Syst. Pharm."},{"key":"ref_2","first-page":"54","article-title":"Cefazolin and Coagulation Disorder: A case report and review of literature","volume":"21","author":"Shaikh","year":"2013","journal-title":"Qatar. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1056\/NEJM197406062902317","article-title":"Letter: Coagulopathy with cefazolin in uremia","volume":"290","author":"Lerner","year":"1974","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1002\/j.1552-4604.1988.tb03106.x","article-title":"Mechanism of cephalosporin-induced hypoprothrombinemia: Relation to cephalosporin side chain, vitamin K metabolism, and vitamin K status","volume":"28","author":"Shearer","year":"1988","journal-title":"J. Clin. 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Belg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1093\/ndt\/17.3.532","article-title":"Intracerebral haemorrhage caused by cefazoline induced hypoprothrombinaemia in a renal transplant recipient","volume":"17","author":"Kuypers","year":"2002","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1128\/AAC.29.6.1108","article-title":"Cephalosporin-induced hypoprothrombinemia: Is the N-methylthiotetrazole side chain the culprit?","volume":"29","author":"Agnelli","year":"1986","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"408","DOI":"10.7326\/0003-4819-97-3-408","article-title":"The new beta-lactamase-stable cephalosporins","volume":"97","author":"Neu","year":"1982","journal-title":"Ann. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3087","DOI":"10.1093\/jac\/dky314","article-title":"Therapeutic drug monitoring of \u03b2-lactam antibiotics in the critically ill: Direct measurement of unbound drug concentrations to achieve appropriate drug exposures","volume":"73","author":"Wong","year":"2018","journal-title":"J. Antimicrob. Chemother."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/13\/1\/21\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:30:49Z","timestamp":1760160649000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/13\/1\/21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["idr13010021"],"URL":"https:\/\/doi.org\/10.3390\/idr13010021","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,1]]}}}