Abstract
To establish a method of administering vancomycin (VCM) to hemodialysis patients infected with MRSA, in vitro and clinical investigations were performed using three dialyzers, including the Cuprophan membrane and two high performance membranes (EVAL, PEPA).
In vitro investigation: Two experimental models, employing normal saline and bovine blood, in which the VCM concentration was 30-40μg/ml, were devised. During dialysis, the VCM concentration was measured periodically. VCM was removed by all dialyzers, though the ratios of VCM elimination differed. The ratio of VCM removal by high performance membranes, especially the PEPA membrane, was significantly (p<0.01) higher than that of the Cuprophan membrane.
Clinical investigation: VCM doses were administered to 5 hemodialysis patients with MRSA infection. The concentration of serum VCM was measured in a manner identical to that of the in vitro investigation. All dialyzers eliminated VCM. The ratio of VCM removal by the PEPA membrane was significantly (p<0.01) higher than that of the Cuprophan membrane. However, the ratio of VCM elimination in the clinical study was significantly (p<0.01) lower than that in vitro study, for all dialyzers.
Recognizing that the VCM elimination characteristics of dialyzers are variable, care should be taken in administering VCM to hemodialysis patients. Patients with MRSA infection treated by VCM must maintain an effective VCM serum concentration, such that supplementation of the dose of VCM removed by hemodialysis is necessary.
