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.
An 81-year-old quadriplegic African-Canadian female (weight 64 kg, height 152.5 cm), with a known history of hypertension, type II diabetes, and requiring hemodialysis 55 months prior to this encounter, was diagnosed with MSSA bacteremia, with blood samples collected from the CVC (which was inserted 21 months before the incidence of bacteremia) and peripheral veins. A prescription for cefazolin 2 g i.v. after each dialysis and cefazolin (5 mg/mL)/heparin (5,000 units/mL) lock solution for 2 weeks were administered. Treatment was started in the outpatient dialysis unit. All repeat cultures were negative and the catheter was conserved intact. The patient expired 60 days later after admission; she was found unresponsive at a nursing home.