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 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.