Treatment of Aerococcus urinae in a Dialysis Patient

Antibiotic Selection

Nitrofurantoin is effective against A. urinae with clinical and microbiological success rates of 71-76%, but should be avoided in patients with renal failure due to nephrotoxicity 1

Ampicillin should be dosed at 1-2g after each dialysis session, as recommended by the Infectious Diseases Society of America 2 3
Penicillin G should be dosed after dialysis sessions, according to the Clinical Infectious Diseases guidelines 2
Vancomycin should be administered as a 20 mg/kg loading dose during the last hour of dialysis, then 500 mg during the last 30 minutes of each subsequent dialysis session, as suggested by the Clinical Infectious Diseases guidelines 4

For uncomplicated UTI, the American College of Physicians recommends 10-14 days of systemic antibiotics 2 5
For complicated infections or bacteremia, the Infectious Diseases Society of America suggests 4-6 weeks of therapy 5
The Clinical Infectious Diseases guidelines recommend considering antibiotic lock therapy as adjunctive treatment if the patient has a dialysis catheter 2

The National Kidney Foundation advises avoiding nephrotoxic antibiotics such as aminoglycosides, which carry substantial risk of irreversible ototoxicity 2 6
The American Society of Nephrology recommends that cephalosporins are generally preferred over aminoglycosides for gram-negative coverage in dialysis patients, but penicillins are more appropriate for Aerococcus 2 5
The Clinical Infectious Diseases guidelines suggest that antibiotic selection should be based on pharmacokinetic characteristics that permit dosing after each dialysis session 5

The Infectious Diseases Society of America recommends obtaining surveillance blood cultures 1 week after completion of antibiotic course if a catheter has been retained 5
The Clinical Infectious Diseases guidelines suggest that if blood cultures remain positive, the catheter should be removed and a new long-term dialysis catheter placed after obtaining negative blood cultures 5
The American College of Physicians recommends monitoring for clinical response within 2-3 days of initiating therapy 7