Dear experts, I have a male patient , 49 yo , on regular dialysis 4 months ago . the problem wuth him is that his vascular access is through a temporary subclavian catheter which stayed in him for the whole 4 months . 2 days ago the patient came to our unit with severe shortness of breath as the patient was severely overloaded , i started dialysis immediately for him with removal of 4 liters .the patient then complaint of chills and shivering despite absence of fever .I changed his catheter on a guide wire and recommenced the dialysis . O2 Therapy , lasix , aminophylline , and sublingual nitrates were given and the patient was improved markedly . on the next session the patient again had chills and shivering after 2 hours of the dialysis . i stopped the session and removed the new catheter . what is your advice regarding his antibiotic therapy ? to start with vancomycin , or aminoglycoside , or both? should this patient be admitted in a hospital provided that we are only a center ?
Hello,
It is imperative to get a microbiologic diagnosis. Although infection is most likely, many patients develop chills on dialysis without infection. Having said this, I agree with treating as infection first, until proven otherwise. Our approach is use empiric antibiotics upon suspicion of line infection and reevaluation once cultures are available. Because our local incidence of MRSA is significantly high, we use empiric vancomycin, and for gram negative coverage we add an aminoglycoside in the absence of residual renal function or ciprofloxacin or ceftazidime in the presence of residual renal function.
Jordan
It is imperative to get a microbiologic diagnosis. Although infection is most likely, many patients develop chills on dialysis without infection. Having said this, I agree with treating as infection first, until proven otherwise. Our approach is use empiric antibiotics upon suspicion of line infection and reevaluation once cultures are available. Because our local incidence of MRSA is significantly high, we use empiric vancomycin, and for gram negative coverage we add an aminoglycoside in the absence of residual renal function or ciprofloxacin or ceftazidime in the presence of residual renal function.
Jordan
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