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

Purpose 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. Patients and methods 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. Results 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