In a 47-year-old Caucasian male (weight 70 kg, height 177 cm), with a known history of hypertension, beta-lactam-documented allergy, and on hemodialysis for 3 years prior to this event, a dialysis catheter was inserted 30 months prior to the incident. Peripheral blood cultures as well as blood drawn from the catheter revealed methicillin-sensitive S. aureus (MSSA) bacteremia. To avoid possible allergic manifestations, the patient was treated with vancomycin 2,000 mg i.v. (28.5 mg/kg) as a loading dose in the last 90 min of dialysis followed by 1,000 mg i.v. (14.2 mg/kg) after each subsequent dialysis (in the last 30–60 min of dialysis) plus combination vancomycin (2.5 mg/mL)/4% citrate antibiotic lock for 3 weeks. Vancomycin pre-hemodialysis concentrations were > 15 mg/L (target 15–20 mg/L) during the 2 weeks of intravenous antibiotic therapy. The treatment was initiated while the patient was an outpatient. The patient experienced complete resolution of bacteremia confirmed by negative blood cultures. The catheter was removed 5 months after transplant surgery.
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.