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 37-year old African-Canadian male (weight 77 kg, height 180 cm), with a documented history of hypertension and type II diabetes, had been receiving hemodialysis for 4 months prior to this encounter. MSSA was recovered from blood samples withdrawn via CVC (which was inserted 2 months earlier) and peripheral veins. The treatment regimen consisted of cefazolin 2 g i.v. thrice weekly after dialysis plus cefazolin (5 mg/mL)/heparin (5,000 units/mL) antibiotic lock instilled at the end of each dialysis for 2 weeks; the treatment started as inpatient and continued in the outpatient dialysis unit. All repeat cultures were negative and the permanent catheter was not removed for the follow-up period of 3 months.