{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T02:50:19Z","timestamp":1773283819328,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Cephalosporins containing N-hydroxyethyltetrazolethiol\u00a0(HTT) or N-methylthiotetrazole (NMTT) side chains, such as flomoxef and cefoperazone, have been linked to coagulation abnormalities. Cefazolin, which contains an N-methylthiadiazolethiol (MTD) side chain, may also interfere with vitamin K metabolism. However, comparative clinical evidence remains limited. This study evaluated the associations between selected cephalosporins and coagulopathy risk. Materials and Methods: We conducted a retrospective cohort study using a comprehensive clinical database. Patients receiving cefazolin, flomoxef, or cefoperazone\u2013sulbactam were compared with those receiving reference antibiotics. Coagulopathy was defined as either a \u226525% increase in prothrombin time (PT) from baseline or a PT exceeding the upper limit of normal by more than 3 s within three days before or after antibiotic cessation. Inverse probability of treatment weighting based on propensity scores was applied. Weighted logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: After weighting, no significant association with coagulopathy was observed for cefazolin (OR, 1.05; 95% CI, 0.86\u20131.29), flomoxef (OR, 1.00; 95% CI, 0.77\u20131.29), or cefoperazone\u2013sulbactam (OR, 0.88; 95% CI, 0.67\u20131.15). Although international normalized ratio &gt;1.2 was more frequent with cefoperazone\u2013sulbactam, the risk of bleeding events showed a marginal increase compared with the reference group (OR, 1.06; 95% CI, 1.00\u20131.11). Conclusions: Cefoperazone\u2013sulbactam was associated with more frequent laboratory INR elevation and a borderline increase in bleeding risk. Given the observational design, these findings should be interpreted cautiously, and close clinical monitoring may be considered when prescribing cefoperazone\u2013sulbactam.<\/jats:p>","DOI":"10.3390\/medicina62030519","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T10:43:27Z","timestamp":1773225807000},"page":"519","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the Risk of Coagulopathy in Cephalosporins with Different Side Chains: A Propensity Score\u2013Weighted Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9938-3202","authenticated-orcid":false,"given":"Chien-Hsiang","family":"Tai","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 801, Taiwan"},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan"},{"name":"Center for General Education, Cheng Shiu University, Kaohsiung 833, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fu-Wen","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Center for Big Data Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9302-5220","authenticated-orcid":false,"given":"Chen-Hsiang","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan"},{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","unstructured":"GBD 2019 Antimicrobial Resistance Collaborators (2022). 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