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.
An 81-year-old quadriplegic African-Canadian female (weight 64 kg, height 152.5 cm), with a known history of hypertension, type II diabetes, and requiring hemodialysis 55 months prior to this encounter, was diagnosed with MSSA bacteremia, with blood samples collected from the CVC (which was inserted 21 months before the incidence of bacteremia) and peripheral veins. A prescription for cefazolin 2 g i.v. after each dialysis and cefazolin (5 mg/mL)/heparin (5,000 units/mL) lock solution for 2 weeks were administered. Treatment was started in the outpatient dialysis unit. All repeat cultures were negative and the catheter was conserved intact. The patient expired 60 days later after admission; she was found unresponsive at a nursing home.