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 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.