CEFAZOLIN AS EMPIRIC THERAPY IN HEMODIALYSIS-RELATED INFECTIONS - EFFICACY AND BLOOD-CONCENTRATIONS

Concern about the increasing incidence of vancomycin-resistant organis ms has tempered the enthusiasm for indiscriminate vancomycin use. Cefa zolin has an antibacterial activity profile similar to vancomycin agai nst most pathogens encountered in the hemodialysis (HD) population. We evaluated the clinical efficacy and serum concentrations that were ac hieved during empiric cefazolin use. Fifteen consecutive HD patients ( five, conventional HD; five, high-efficiency HD; and five, high-flux H D) with suspected or documented infections warranting antibiotic inter vention, including access-related, respiratory tract, urinary tract, o r wound infections, were enrolled. Each patient received intravenous c efazolin (20 mg/kg actual body weight rounded to the nearest 500-mg in crement [range, 1 to 2 g]) after each dialysis treatment for at least three doses. Cefazolin concentrations were obtained before and immedia tely after the next three consecutive dialysis treatments. Thirteen pa tients were evaluated for efficacy and all 15 were evaluated for toxic ity and cefazolin blood concentrations. All patients showed at least a short-term (3-week) clinical resolution of infection with cefazolin t reatment. No central nervous system toxicities were noted and no other adverse events were expressed by the patients during the course of ce fazolin treatment. Predialysis cefazolin concentrations, as determined by high-performance liquid chromatography, were 70.2 +/- 42.7 (conven tional HD), 45.6 +/- 18.9 (high-efficiency HD), and 41.6 +/- 23.9 mg/L (high-flux HD) over the three dialysis sessions. Cefazolin at doses o f approximately 20 mg/kg administered post-ND appears to be a safe and effective empiric therapy and yields predialysis cefazolin concentrat ions of 2.5 times or greater than those considered to be the minimum i nhibitory concentration breakpoint (16 mg/L) for susceptible organisms . These data support the broader use of cefazolin for empiric treatmen t in the HD population, allowing vancomycin to be reserved for confirm ed resistant organisms. (C) 1998 by the National Kidney Foundation, In c.