Few data are available on the management of in-hospital anti-infectives-induced acute kidney injury (AKI) according to the underlying nephrotoxic mechanism. We aimed to describe the clinical management of anti-infective-AKI in hospitalized patients, considering the presumed nephrotoxic mechanism.

We conducted a retrospective single-center study using the Clinical Data Warehouse of Rennes University Hospital. Patients with anti-infective-related AKI between 2022 and 2023 were identified using ICD-10 codes (N14.1, N14.2, N14.4) and exposure to systemic anti-infectives (ATCJ). Clinical characteristics, AKI features, diagnostic workup, and management strategies were analyzed.

Twenty-nine cases were included (72.4% male; median age, 66 years). Most had normal or mildly impaired baseline renal function (75.9%) and received concomitant nephrotoxic drugs (86.2%). AKI was mainly structural (65.5%, mostly acute tubular necrosis) and occurred with a median onset of 3.5 days [IQR 1.75–8] after anti-infective initiation. Renal imaging and urine cytology were performed in 62% and 65% of cases, respectively. Therapeutic drug monitoring (TDM) (54.2%) and crystalluria assessment (16.7%), although indicated in selected cases, were not systematically performed. Rehydration was systematically administered. Anti-infective management included discontinuation (60.5%), dose reduction (31.6%), or no change (7.9%) in cases of mucormycosis infection. Renal recovery occurred in 93.1% of patients. Two fatal cases were observed in patients with severe comorbidities and multiorgan failure.

Early renal function monitoring, discontinuation of concomitant nephrotoxic medications, and systematic TDM may help reduce the AKI risk. Hydration and treatment modification were the main interventions, but management could be further refined according to the presumed mechanism, supporting greater standardization of care.