Comparative renal safety of teicoplanin versus vancomycin in older patients: a propensity-matched multicenter study

To compare nephrotoxicity between teicoplanin and vancomycin in older patients, investigate the correlation between teicoplanin average steady-state trough concentrations (C_min,ss) and nephrotoxicity, and identify independent risk factors for teicoplanin-associated nephrotoxicity.

This study enrolled older patients treated with teicoplanin or vancomycin at four tertiary hospitals in Beijing, China. Propensity score matching (PSM) was utilized to mitigate potential bias. Dynamic monitoring of C_min,ss was performed, with multivariate analysis used to identify independent risk factors for teicoplanin-associated nephrotoxicity.

After PSM, 186 patients (93 per group) were analyzed. The incidence of nephrotoxicity was significantly lower in teicoplanin than in vancomycin (16.13% vs 32.26%, OR = 3.50, P = 0.006). Among 203 teicoplanin-treated patients, 39 developed nephrotoxicity. Multivariate analysis identified exposure duration (OR = 1.060, P = 0.028) and baseline creatinine (OR = 1.057, P = 0.019) as independent risk factors for teicoplanin-associated nephrotoxicity. Notably, when C_min,ss was <40 mg/L, the risk of nephrotoxicity did not significantly increase with rising values.

Teicoplanin demonstrated superior renal safety compared to vancomycin in older patients. The C_min,ss <40 mg/L was associated with a manageable risk of nephrotoxicity, whereas exposure duration and baseline creatinine could serve as critical parameters for clinical decision-making.