Dr Thomas Robinson1, Professor Paul Lawton2
1Department of Nephrology, Alfred Health, Melbourne , Australia, 2Department of Nephrology, Monash University, Melbourne, Australia
Biography:
Bio to come.
Background:
Management of bacteraemia is paramount in patients with end-stage kidney disease. Due to extracorporeal drug clearance, haemodialysis often poses a challenge in achieving stable and therapeutic antimicrobial levels. Further complicating this issue is the relatively common occurrence of patient hypersensitivity reactions. There is minimal published experience regarding antimicrobial desensitization therapy in patients requiring renal replacement therapy. This case offers insight into the safety and effectiveness of drug desensitization and prolonged antimicrobial infusion therapy for treating bacteraemia in a patient requiring long-term intermittent haemodialysis.
Case Report:
We describe the case of a 76-year-old female on long-term intermittent haemodialysis with a history of beta-lactam anaphylaxis presenting with Streptococcus mitis group bacteraemia and vertebral osteomyelitis. The patient underwent benzylpenicillin desensitization followed by prolonged antibiotic infusion therapy (at a dose of 4.8g/24hrs) for six weeks. Benzylpenicillin serum free-drug levels were monitored during two haemodialysis sessions at one-hourly intervals including pre and post-haemodialysis levels. Pre and post-haemodialysis serum benzylpenicillin levels decreased by a mean of 32.25mg/L. This equated to an average reduction of 75.4% in serum free-drug concentration. Antibiotic levels remained above the Streptococcus mitis group species’ minimum inhibitory concentration of 0.25mg/L throughout dialysis sessions. Therapy was well tolerated and resulted in the resolution of bacteraemia and osteomyelitis without loss of desensitization throughout the treatment course.
Conclusions:
Our case report demonstrates maintenance of therapeutic drug levels and the desensitized state with prolonged antimicrobial infusion therapy despite extracorporeal drug clearance from intermittent haemodialysis. Therefore, intermittent haemodialysis is not a barrier to effectively implementing prolonged antimicrobial infusion and desensitization therapy in patients with hypersensitivity reactions.