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Nephropathy associated with methicillin therapy. Prevalence and determinants in patients with staphylococcal
Abstract:
The nephropathy associated with methicillin sodium therapy is considered to be rare, but its prevalence is unknown. We reviewed the antibiotic therapy of 81 cases of Staphylococcus aureus bacteremia to establish the frequency and determinants of methicillin nephropathy in that disease. Fifty-two patients received methicillin; nine (17%) experienced the characteristic clinical signs previously associated with drug-induced acute interstitial nephritis. This nephropathy uniformly subsided after methicillin was withdrawn, and did not always include deterioration of renal function. Factors that correlated with methicillin nephropathy were endocarditis and prolonged treatment, but not intravenous drug abuse. There was only one adverse reaction among 29 patients treated with a cephalosporin. It was similar to the nephropathic reactions to methicillin. Thus, reversible renal abnormalities are prevalent during methicillin therapy, particularly among patients with staphylococcal infections such as endocarditis. When prolonged therapy with methicillin is required, the urinary sediment and renal excretory function should be monitored.
Insights
Methicillin-induced nephropathy, though rare, affects 17% of patients with Staphylococcus aureus bacteremia. This reversible kidney injury is linked to endocarditis and prolonged treatment, necessitating renal monitoring during extended therapy.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Methicillin-induced nephropathy is a rare but serious adverse effect of methicillin sodium therapy.
- Its true prevalence and associated risk factors remain largely unknown.
Purpose of the Study:
- To determine the frequency and determinants of methicillin nephropathy in patients with Staphylococcus aureus bacteremia.
- To assess the clinical presentation and outcomes of this adverse event.
Main Methods:
- Retrospective review of antibiotic therapy in 81 patients with Staphylococcus aureus bacteremia.
- Analysis of clinical signs, renal function, and treatment duration in patients receiving methicillin.
Main Results:
- Nine out of 52 patients (17%) receiving methicillin developed characteristic signs of acute interstitial nephritis.
- Nephropathy resolved after methicillin discontinuation and did not consistently involve renal function decline.
- Endocarditis and prolonged treatment duration were significant risk factors; intravenous drug abuse was not.
Conclusions:
- Reversible renal abnormalities are prevalent during methicillin therapy for staphylococcal infections.
- Close monitoring of urinary sediment and renal function is crucial for patients requiring prolonged methicillin treatment, especially those with endocarditis.