An 82-year-old Asian female (weight 55 kg, height 167 cm), with a known history of hypertension, heart disease, and on hemodialysis 28 months prior to this incident, developed bacteremia with Acinetobacter baumanii and coagulase-negative Staphylococcus. The patient was treated with vancomycin loading dose of 1,500 mg i.v. (27.2 mg/kg) during the last 60 min of dialysis followed by vancomycin 1,000 mg maintenance dose after each subsequent dialysis, along with parenteral gentamicin 160 mg (2.9 mg/kg) loading dose and 60 mg maintenance dose at the end of each dialysis, oral ciprofloxacin 500 mg daily, plus gentamicin 5 mg/mL solution in normal saline lock. The three antibiotics and lock solution were started in the outpatient dialysis unit and were continued for 2 weeks without requiring hospital admission. The patient did not experience recurrent infection for a follow-up period of 1 year and continued dialysis through the same catheter.
A 37-year old African-Canadian male (weight 77 kg, height 180 cm), with a documented history of hypertension and type II diabetes, had been receiving hemodialysis for 4 months prior to this encounter. MSSA was recovered from blood samples withdrawn via CVC (which was inserted 2 months earlier) and peripheral veins. The treatment regimen consisted of cefazolin 2 g i.v. thrice weekly after dialysis plus cefazolin (5 mg/mL)/heparin (5,000 units/mL) antibiotic lock instilled at the end of each dialysis for 2 weeks; the treatment started as inpatient and continued in the outpatient dialysis unit. All repeat cultures were negative and the permanent catheter was not removed for the follow-up period of 3 months.