A 36-year-old white male (weight 71 kg, height 175 cm) with hypertension, type I diabetes, heart disease, and on hemodialysis 51 months prior to this incident, developed MRSA bacteremia as shown by both CVC (which was inserted 1 week before the incidence of infection due to poor blood flow) and peripheral line blood cultures. The patient was treated with vancomycin 1,000 mg i.v. (14 mg/kg) initially, then 1,500 mg (21 mg/kg) after the subsequent dialysis (due to low trough level) followed by 1,000 mg i.v. after each subsequent dialysis with pre-hemodialysis concentrations > 15 mg/L (MRSA MIC was 0.5 mg/mL). Treatment was initiated in the inpatient setting and was completed in the outpatient dialysis unit. The patient was also treated with vancomycin (2.5 mg/mL)/4% citrate lock solution for a 2-week period. Microbiological eradication and resolution of symptoms were observed. The catheter was removed 1 month later after the patient had a successful kidney transplant.
A 34-year-old white female (weight 46 kg, height 166 cm) with a medical history significant for type I diabetes, hypertension, ischemic heart disease, and on hemodialysis for 3 years prior to this encounter, grew coagulase-negative Staphylococcus from her CVC (oxacillin susceptible), where the catheter was changed on the same day of suspected blood stream infection. The patient was treated with parenteral cefazolin 2 g thrice weekly after each dialysis session in addition to cefazolin (5 mg/mL)/heparin (5,000 units/mL) lock solution for the duration of 1 week as deemed appropriate by the prescribing physician. The treatment was initiated and completed in the inpatient setting. Repeated cultures were all negative and the catheter remained in place with no recurrence in the 3-month follow-up period.