Pasteurella multocida peritonitis associated with a cat in a peritoneal dialysis patient using an automated cycler device

Abstract

Pasteurella multocida (P. multocida) is an aerobic Gram-negative coccobacillus, which is found as part of the natural oral flora of many animals, including most healthy cats and dogs. However, it can cause a variety of infections in humans, usually as a result of the patient being bitten or scratched by a cat or dog. There have been 22 reported cases of P. multocida peritonitis in patients undergoing peritoneal dialysis (PD). Of these, 66.7 % occurred within 12 months of the initiation of PD. Only two cases (11.1 %) developed more than 60 months after the commencement of PD. We report a case of P. multocida peritonitis involving a 45-year-old patient who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 84 months without a previous history of peritonitis, who developed P. multocida peritonitis associated with a domestic cat on the very night on which he began using an automated cycler device to switch from CAPD to continuous cyclic peritoneal dialysis (CCPD). Patients maintained on PD who keep pets such as cats or dogs at home should be educated about the risk of developing peritonitis related to their domestic pets, and this warning should be repeated when such patients switch from CAPD to CCPD. Physicians should consider using empiric therapy to prevent P. multocida in pet-owning PD patients who present with a history of PD fluid leakage and peritonitis, especially in patients who use cycler devices.

A Case Report onPasteurella multocidaPeritoneal Dialysis-Associated Peritonitis: When Cats Think Medical Equipment Are Toys

“…PD-peritonitis prevention through proper hygiene and technique, or immediate treatment upon its occurrence, is critical due to the risk of possible peritoneal membrane failure because of severe and prolonged peritonitis. is is a major cause of PD termination and switching to hemodialysis [2]. Most cases of PD-peritonitis caused by P. multocida are resolved without catheter removal; however, the catheter should be removed if the patient continues to have cloudy effluent a er an appropriate antibiotic treatment for 5 days, indicating refractory peritonitis [2].…”

“…is is a major cause of PD termination and switching to hemodialysis [2]. Most cases of PD-peritonitis caused by P. multocida are resolved without catheter removal; however, the catheter should be removed if the patient continues to have cloudy effluent a er an appropriate antibiotic treatment for 5 days, indicating refractory peritonitis [2].…”

“…erefore, pet contact with dialysis equipment should be prevented and environmental hygiene maintained in patients who wish to have their pets at home. Additionally, patients should be continuously educated and encouraged to be cautious, especially during their switch from CAPD to CCPD [2].…”

“…Additionally, 20% of cats are found to have Pasteurella spp. on their claws [2]. e organism is spread through bites, scratches, and licking.…”

“…Acute bacterial peritonitis in patients undergoing PD is a major cause of hospitalizations, transfer to hemodialysis, and catheter removal, presenting signi cant limitations to its utilization [2]. e major pathogens associated with peritoneal dialysis-associated peritonitis (PD-peritonitis) are the gram-positive cocci, Staphylococcus aureus and S. epidermidis, accounting for 42% of cases.…”