Comparative Effectiveness of Teicoplanin Versus Standard of Care Antibiotics for the Treatment of Gram-Positive Bacteremia: A Seven-Year Retrospective Analysis

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ID: 322462
2026
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Abstract
Abstract Background Glycopeptide antibiotics remain the cornerstone of therapy for serious Gram-positive bacteremia, yet comparative real-world effectiveness data between teicoplanin and standard-of-care agents remain limited in Middle Eastern healthcare settings. Objective To compare clinical outcomes, safety profiles, and predictors of treatment failure between teicoplanin and standard-of-care antibiotics in adult patients with microbiologically confirmed Gram-positive bacteremia. Methods We conducted a seven-year retrospective cohort study (January 2018–January 2025) at two tertiary care centers in Riyadh, Saudi Arabia. Adult patients receiving ≥72 hours of teicoplanin or standard-of-care antibiotics, including prespecified organism-directed beta-lactam therapy when clinically indicated, for Gram-positive bacteremia were included. Propensity score matching (1:1 ratio, caliper 0.2) was employed to balance baseline characteristics. Primary outcome was clinical cure at end of therapy. Secondary outcomes included 90-day all-cause mortality, nephrotoxicity, 14-day treatment failure, 30-day relapse, and antimicrobial switch due to toxicity. Results Among 547 screened patients, 312 met inclusion criteria (teicoplanin n=124; standard-of-care n=188). Pre-match analysis revealed significantly higher baseline illness severity in the teicoplanin cohort (median APACHE II 18 vs. 14, p=0.02). Propensity score matching yielded 102 well-balanced pairs. Clinical cure rates were comparable between groups (teicoplanin 78.4% vs. standard-of-care 72.5%; p=0.31). Nephrotoxicity occurred significantly less frequently with teicoplanin (6.8% vs. 18.2%; p=0.01). Antimicrobial switch due to toxicity was lower in teicoplanin-treated patients (8.8% vs. 22.5%; p=0.01). Ninety-day mortality did not differ significantly (hazard ratio 0.89, 95% CI 0.54–1.45; log-rank p=0.64). Within the teicoplanin cohort, failure to administer a loading dose (odds ratio 3.5, 95% CI 1.21–10.12; p=0.02) and infective endocarditis as the infection source (odds ratio 4.1, 95% CI 1.38–12.18; p=0.01) independently predicted treatment failure. Subgroup analysis demonstrated optimal teicoplanin efficacy in catheter-related bloodstream infections (cure rate 85.2%), with attenuated efficacy in pneumonia (65.0%) and endocarditis (55.5%). Conclusions Teicoplanin was associated with comparable clinical efficacy and lower nephrotoxicity compared with standard-of-care antibiotics. It may represent a reasonable alternative, particularly in patients at increased risk of renal adverse events. Prospective studies are warranted.
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Authors Eman Alawad, Turki Assiri, Maha Alharthi, Amal Bin Akrash, Nisreen AlSherbeeni, AbdulKarim Bahloul, Mohammed Alraddadi, Deena Alharbi, Abdulaziz Kardam
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag462
URL
https://doi.org/10.1093/ofid/ofag462
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