643. Acute Kidney Injury Associated with Trimethoprim/Sulfamethoxazole
Session: Poster Abstract Session: Pharmacokinetics and Adverse Drug Reactions
Friday, October 21, 2011
Room: Poster Hall B1
  • TMPSMX IDSA.pdf (245.7 kB)
  • Background:  Trimethoprim/sulfamethoxazole (TMP/SMX) is important for treating community-acquired staphylococcal infections and urinary tract infections, both of which tend to occur in patients with risk factors for renal impairment.  A paucity of data exists on the frequency of acute kidney injury (AKI) in patients who receive TMP/SMX; acute interstitial nephritis (AIN) is thought to be the usual mechanism.  We systematically studied the adverse effects of TMP/SMX on renal function in a middle-aged veteran population.

    Methods:  We reviewed complete electronic records for 1,662 patients who received TMP/SMX for any indication to identify those who had received >6 days of treatment and for whom a baseline and follow-up determination of serum creatinine and blood urea nitrogen (BUN) were available. For a comparison, we reviewed records of 895 patients who were treated with clindamycin to find those who had received >6 days of treatment for skin and soft tissue infections with baseline and follow-up creatinine and BUN.  We defined AKI in patients with initially normal renal function as an absolute increase in the serum creatinine concentration of ≥0.3 mg/dL from baseline in accord with Acute Kidney Injury Network guidelines and in patients with chronic kidney disease as an increase in serum creatinine of ≥50%; to be classified in the AKI group, patients needed to exhibit an increase in BUN of ≥50 percent.

    Results:  Of 573 patients taking TMP/SMX who met inclusion criteria, 64 (11.2%) developed AKI and five (0.9%) had only an elevation in serum creatinine.  Pyuria appeared in only 2 patients and eosinophiluria in none of 18 in whom it was sought.  Patients with hypertension and diabetes mellitus had an increased risk for AKI, especially if these conditions were poorly controlled.  Renal insufficiency resolved promptly after discontinuation of therapy, and only one patient required dialysis.  Of 44 patients taking clindamycin who met inclusion criteria, none had AKI, although two (4.5%) developed elevations in creatinine only.

    Conclusion: Acute kidney injury is more common with TMP/SMX therapy than previously reported and is transient if therapy is discontinued. An ntrinsic renal mechanism distinct from AIN appears responsible for the great majority of cases.

    Subject Category: A. Antimicrobial agents and Resistance

    Traci Fraser1, Andres Arturo Avellaneda Ojeda2, Edward Graviss, PhD, MPH3 and Daniel Musher, MD, FIDSA1,4, (1)Baylor College of Medicine, Houston, TX, (2)General Surgery, Baylor College of Medicine, Houston, TX, (3)The Methodist Hospital Research Institute, Houston, TX, (4)Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX


    T. Fraser, None

    A. A. Avellaneda Ojeda, None

    E. Graviss, None

    D. Musher, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.