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.
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.