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 67-year-old white female (weight 67 kg, height 160 cm) with a medical history significant for type II diabetes, hypertension, heart disease, and on hemodialysis for 23 months, developed MRSA bacteremia from the arterial line, CVC (which was inserted 4 months prior to this infection incident), and peripheral lines during her hospital admission and was started on both vancomycin 2 g (31.5 mg/kg) loading dose during the last 90 min of dialysis followed by 1 g after each subsequent dialysis with a pre-hemodialysis level between 13 and 15 mg/L (MRSA MIC of ≤0.5 mg/L). The patient also received vancomycin (2.5 mg/mL)/4% citrate lock solution. Due to catheter blockage by a blood clot irresponsive to dissolution by tissue plasminogen activator local treatment, the catheter was removed 6 months later due to loss of function. However, during the interim when the catheter was in use, there was no infection seen.