Comparative Efficacy and Safety of Antibiotic Regimens in Sepsis-Induced Acute Kidney Injury: A Retrospective Cohort Study.

PURPOSE: Acute kidney injury (AKI) is a prevalent and serious complication in septic patients, potentially exacerbated by certain medications, which significantly affects morbidity and mortality rates. This study aims to evaluate the comparative efficacy and safety of different antibiotic regimens for treating sepsis-induced AKI.

METHODS

This retrospective cohort study analyzed adult patients with AKI resulting from sepsis between 2022 and 2024. Patients were divided into three groups: Group 1 received beta-lactam monotherapy (e.g., piperacillin-tazobactam); Group 2 was treated with non-beta-lactam antibiotics (e.g., fluoroquinolones, macrolides); and Group 3 received combination therapy (e.g., betalactam plus vancomycin for MRSA). Data on demographics, clinical parameters, and outcomes-including in-hospital mortality, length of stay, and renal function-were collected.

FINDINGS: A total of 552 patients were included, with no significant differences in baseline characteristics among the groups. The combination therapy group experienced a shorter duration of fever (1.33 ± 0.57 days, P = 0.001), lower 30-day mortality, and shorter ICU stays (4.36 = 0.81 days, P = 0.001). Serum creatinine levels rose significantly across all groups (P = 0.005), with the highest levels observed in the combination therapy group. AKI incidence was 25.3% in fluoroquinolone patients, 15.7% in beta-lactam patients, and 18.9% in the combination therapy group. Renal replacement therapy was required for 11.2% of betalactam and 16.5% of fluoroquinolone patients.

IMPLICATIONS: This study underscores significant differences in renal outcomes associated with various antibiotic regimens in septic patients with AKI. While combination therapy may improve infection control, it also poses risks to renal function. Clinicians should consider these findings when selecting antibiotic regimens for septic patients, particularly those with preexisting renal impairment.