Case Reports

Abstract

Background: Graft infection is sometimes critical for patients receiving hemodialysis therapy. Especially, Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most trouble species. We present a case of graft infection of MRSA and successful treatment with Daptomycin. Case Report: A 77-year-old female, who had been receiving hemodialysis therapy 3 times a week due to end stage renal failure, was admitted to our hospital complaining of fever and shaking chill. Synthetic vascular prosthesis (expanded polytetrafluoroethylene) was used for vascular access. Her skin on graft turned red and swollen with exudate and a little pus. Urine analysis showed bacteria by Gram staining. We diagnosed these phenomena as vascular graft infection and urinary tract infection. We administered antibiotics, Ceftriaxone for urinary tract infection and Vancomycin for graft infection. Bacteria disappeared on urine analysis and we discontinued using Ceftriaxone. MRSA was found by blood culture, and we continued using Vancomycin. Transthoracic echocardiography revealed no apparent vegetation. As we continued administering Vancomycin, swollen and reddened skin turned normal, but MRSA was positive on blood culture. We changed antibiotics, Vancomycin to Daptomycin. By changing antibiotics, blood culture turned negative. After administered antibiotics for 4 weeks, she was discharged and moved to another hospital to receive rehabilitation. Conclusions: Sometimes MRSA forms a biofilm. Vancomycin doesn't permeate a biofilm through inside easily. Daptomycin, however, penetrate through inside and show antibacterial activity. In our case, successful treatment was done with Daptomycin. Daptomycin is one of the choice to treat graft infection by MRSA when it is intractable. Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, NSW; 3 Renal Medicine, St George Hospital, Kograh, NSW, Australia Background: Successful pregnancy outcomes have been increasingly reported in patients with end stage kidney disease (ESKD) with improved haemodialysis regimes. We report 2 successful pregnancies in a 32 year old female with ESKD on chronic haemodialysis. Case Report: Our patient developed ESKD secondary to focal segmental glomerulosclerosis (FSGS) that was treated unsuccessfully with cyclophosphamide and steroids and progressed to dialysis by age 20. She subsequently had a renal transplant aged 25 with disease recurrence resulting in a return to nocturnal haemodialysis within 12 months. A CASE REPORT OF 2 SUCCESSFUL PREGNANCY OUTCOMES IN A FEMALE WITH END STAGE RENAL FAILURE SECONDARY TO FOCAL SEGMENTAL GLOMERULOSCLEROSISSIn 2009 she conceived and was managed with extended dialysis hours (36 hours/week with an average urea of 6 mmol/L) and correction of anaemia with increased dose of erythropoietin stimulating agents. At 33 + 6/40 gestation she developed preterm premature rupture of membranes (PPROM). She delivered a 2.3 kg male who developed severe nephrotic syndrome which resolved spontaneously by day 30. Genetic testing of both ...