Successful Utilization of High-Flux Hemodialysis for Treatment of Vancomycin Toxicity in a Child

Pediatric Intensive Care Unit, Section of Critical Care Medicine, Children's Hospital Colorado and University of Colorado at Denver, 13123 East 17th Avenue, Mail Stop 8414, Aurora, CO 80045, USA.
Case reports in pediatrics 01/2011; 2011(4):678724. DOI: 10.1155/2011/678724
Source: PubMed


Vancomycin is routinely used for empiric antibiotic therapy in children. Higher-serum-concentration targets for serious infections are now being recommended. This recommendation may result in aggressive dosing with increased potential for toxicity. We report a case of a pediatric patient who developed vancomycin toxicity and associated oliguric renal failure who was treated effectively with high-flux hemodialysis for vancomycin toxicity, clearing serum concentrations of vancomycin by over 75% in only 6 hours (213.2 mcg/mL to 51.8 mcg/mL) with subsequent return to baseline renal function and without adverse sequelae. While not historically considered a viable option for drug removal in cases of toxicity, new high-flux hemodialysis techniques can remove significant percentages of vancomycin in short periods of time.

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    ABSTRACT: Vancomycin is the antibiotic of choice in therapy of orthopaedic implant infections caused by methicillin-resistant bacteria but its use poses a risk of toxicity, especially in patients with renal insufficiency. Addition of vancomycin to acrylic cement may cause systemic exposition to this drug eluting from cement to serum, which may require high-flux hemodialysis. Methods. A patient hemodialysed twice a week underwent implantation of a spacer due to methicillin-resistant S. epidermidis infection of knee prosthesis. The spacer was made of acrylic cement loaded with 0,55 g of gentamicin per 40 g of cement and 6 g of vancomycin into totally 120 g of cement. The measurements of vancomycin concentration in serum within 9 days and in intraarticular fluid within 2 days were performed. Results. Maximal intraarticular vancomycin concentration was reached 7 hours after surgery (120 µg/mL) and was over Minimal Inhibitory Concentration for 47 hours. The serum concentration reached maximal value (2,6 µg/mL) 13 hours after implantation of spacer and was 2,3 µg/mL on 9-th postoperative day. Conclusion. This composition of acrylic cement spacer containing gentamicin and vancomycin was found therapeutically effective and not necessitating high-flux hemodialysis in a hemodialysed patient with chronic renal failure.
    Full-text · Article · Jun 2014 · Central European Journal of Medicine