Staphylococcal epidermidis infection of a hemodialysis button-graft complex controlled by vancomycin for 11 months

A 54 year old woman had a Bentley DiaTAP button implanted in her thigh for hemodialysis access. She had been started on continuous ambulatory peritoneal dialysis (CAPD) because of intractable vascular access problems. Unfortunately, CAPD had to be discontinued because of fungal peritonitis. Transplantation had not been possible because of circulating cytotoxic antibodies. The prosthetic complex soon became infected with Staphylococcus epidermidis and blood cultures were intermittently positive for 11 months. However, with continuing vancomycin therapy she remained in her usual state of health, without side effects from vancomycin, until venous thrombosis resolved and it became possible to remove the infected prosthetic complex and implant a button in an arm. As a last resort, it may be possible to maintain a patient on dialysis in reasonable health with a DiaTAP button graft complex infected with Staphylococcus epidermidis and intermittent positive blood cultures using long term vancomycin therapy. Such management probably would not be appropriate for any other organism.