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Prevalence of acute kidney injury in Staphylococcus aureus bacteraemia treated with cloxacillin: a retrospective cohort study

Hagstrand Aldman, Malin LU orcid ; Sunnerhagen, Torgny LU orcid ; Rasmussen, Magnus LU orcid and Påhlman, Lisa I. LU orcid (2026) In Infectious Diseases p.1-6
Abstract
Background
Preliminary results from the SNAP trial presented at ESCMID Global 2025 reported a high incidence (19.8%) of acute kidney injury (AKI) in patients treated with (flu)cloxacillin for Staphylococcus aureus bacteraemia (SAB).

Objective
In Sweden, cloxacillin is used at lower daily doses, and the risk of nephrotoxicity has not been assessed in this setting.

Methods
We retrospectively evaluated renal outcomes in SAB patients with cloxacillin treatment. Patients on chronic dialysis or lacking creatinine measurements during treatment were excluded. AKI was defined as per the SNAP criteria. Long-term renal function was evaluated using follow-up creatinine values up to 12 months... (More)
Background
Preliminary results from the SNAP trial presented at ESCMID Global 2025 reported a high incidence (19.8%) of acute kidney injury (AKI) in patients treated with (flu)cloxacillin for Staphylococcus aureus bacteraemia (SAB).

Objective
In Sweden, cloxacillin is used at lower daily doses, and the risk of nephrotoxicity has not been assessed in this setting.

Methods
We retrospectively evaluated renal outcomes in SAB patients with cloxacillin treatment. Patients on chronic dialysis or lacking creatinine measurements during treatment were excluded. AKI was defined as per the SNAP criteria. Long-term renal function was evaluated using follow-up creatinine values up to 12 months post-treatment.

Results
Of 275 included patients, 13.8% had pre-existing renal impairment. Cloxacillin doses in median were 8 g/24h (IQR 6–8). AKI occurred in 35 patients (12.8%), of which 26 had AKI stage 1, four had AKI stage 2 and five had AKI stage 3. AKI was associated with higher Pitt Bacteraemia Score, pre-existing renal disease and high-dose cloxacillin. Among survivors (n = 239), only four patients (1.3%) had verified persistent renal impairment at follow-up.

Conclusion
Compared to results from the SNAP trial, cloxacillin was associated with a lower incidence of AKI that was mostly mild and transient. Persistent renal impairment was rare. The data suggest that cloxacillin at lower dosing levels is less nephrotoxic and potentially safe to use. (Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Infectious Diseases
pages
1 - 6
publisher
Taylor & Francis
external identifiers
  • pmid:41785411
ISSN
2374-4235
DOI
10.1080/23744235.2026.2636308
language
English
LU publication?
yes
id
19fbce70-ccca-4341-ad23-b49086514df0
alternative location
https://www.tandfonline.com/doi/full/10.1080/23744235.2026.2636308
date added to LUP
2026-03-06 12:05:44
date last changed
2026-03-07 03:29:03
@article{19fbce70-ccca-4341-ad23-b49086514df0,
  abstract     = {{Background<br/>Preliminary results from the SNAP trial presented at ESCMID Global 2025 reported a high incidence (19.8%) of acute kidney injury (AKI) in patients treated with (flu)cloxacillin for Staphylococcus aureus bacteraemia (SAB).<br/><br/>Objective<br/>In Sweden, cloxacillin is used at lower daily doses, and the risk of nephrotoxicity has not been assessed in this setting.<br/><br/>Methods<br/>We retrospectively evaluated renal outcomes in SAB patients with cloxacillin treatment. Patients on chronic dialysis or lacking creatinine measurements during treatment were excluded. AKI was defined as per the SNAP criteria. Long-term renal function was evaluated using follow-up creatinine values up to 12 months post-treatment.<br/><br/>Results<br/>Of 275 included patients, 13.8% had pre-existing renal impairment. Cloxacillin doses in median were 8 g/24h (IQR 6–8). AKI occurred in 35 patients (12.8%), of which 26 had AKI stage 1, four had AKI stage 2 and five had AKI stage 3. AKI was associated with higher Pitt Bacteraemia Score, pre-existing renal disease and high-dose cloxacillin. Among survivors (n = 239), only four patients (1.3%) had verified persistent renal impairment at follow-up.<br/><br/>Conclusion<br/>Compared to results from the SNAP trial, cloxacillin was associated with a lower incidence of AKI that was mostly mild and transient. Persistent renal impairment was rare. The data suggest that cloxacillin at lower dosing levels is less nephrotoxic and potentially safe to use.}},
  author       = {{Hagstrand Aldman, Malin and Sunnerhagen, Torgny and Rasmussen, Magnus and Påhlman, Lisa I.}},
  issn         = {{2374-4235}},
  language     = {{eng}},
  month        = {{03}},
  pages        = {{1--6}},
  publisher    = {{Taylor & Francis}},
  series       = {{Infectious Diseases}},
  title        = {{Prevalence of acute kidney injury in <i>Staphylococcus aureus</i> bacteraemia treated with cloxacillin: a retrospective cohort study}},
  url          = {{https://lup.lub.lu.se/search/files/244155113/Prevalence_of_acute_kidney_injury_in_Staphylococcus_aureus_bacteraemia_treated_with_cloxacillin_a_retrospective_cohort_study.pdf}},
  doi          = {{10.1080/23744235.2026.2636308}},
  year         = {{2026}},
}