A 34-year-old white female (weight 46 kg, height 166 cm) with a medical history significant for type I diabetes, hypertension, ischemic heart disease, and on hemodialysis for 3 years prior to this encounter, grew coagulase-negative Staphylococcus from her CVC (oxacillin susceptible), where the catheter was changed on the same day of suspected blood stream infection. The patient was treated with parenteral cefazolin 2 g thrice weekly after each dialysis session in addition to cefazolin (5 mg/mL)/heparin (5,000 units/mL) lock solution for the duration of 1 week as deemed appropriate by the prescribing physician. The treatment was initiated and completed in the inpatient setting. Repeated cultures were all negative and the catheter remained in place with no recurrence in the 3-month follow-up period.
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.