Augmented renal vancomycin clearance in cancer patients: a case report and review of the literature.

Background: Bacterial infections are a major cause of morbidity and mortality in cancer patients. Particularly diagnostic and therapeutic procedures (e.g. central venous catheters, paracentesis) increase the risk of infections in this immunocompromised patient population. In the past, antibiotic therapy was empirically initiated in these patients, guided by treatment regimens designed for patients without malignancy; however, the hyperdynamic circulation in systemic inflammatory response syndrome, as well as the presence of malignancy itself, may have a crucial impact on treatment success.

Case Report: Here, we report the case of a 55-year-old patient with advanced pancreatic cancer and Staphylococcus epidermidis bacteremia who, due to increased renal vancomycin clearance, required treatment with high doses of vancomycin in order to reach therapeutic trough levels.

Conclusion: Oncological status can be a cofactor of altered pharmacokinetics in terms of a paraneoplastic syndrome. With the help of this case report we want to call attention to this clinically significant phenomenon with its inherent risk of inefficient antibiotic treatment.