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 62-year-old white male (weight 125 kg, height 167 cm), with a known history of type II diabetes, heart disease, hypertension, stroke (paraplegic), and on hemodialysis 98 months prior to this infection incident, developed bacteremia secondary to coagulase-negative Staphylococcus from the CVC. The patient received vancomycin 2,000 mg i.v. (16 mg/kg) for 2 consecutive dialysis sessions followed by vancomycin 1,000 mg i.v. after each subsequent dialysis plus vancomycin 2.5 mg/mL/4% citrate lock for 2 weeks total with complete cure, and the patient continued using the same catheter in the 6-month follow-up period.