Spontaneous bacterial peritonitis by Pasteurella multocida under treatment with rifaximin

Abstract

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Recently, rifaximin, a non-absorbable antibiotic which is used to prevent recurrent hepatic encephalopathy, has been proposed as effective prophylaxis for SBP. Here, we present an unusual case of SBP under treatment with rifaximin. A 50-year-old woman with liver cirrhosis was admitted because of tense ascites and abdominal pain. She was under long-term oral prophylaxis with rifaximin due to hepatic encephalopathy. Paracentesis revealed SBP caused by Pasteurella multocida, which was sensitive to multiple antibiotics, including rifaximin. Treatment with ceftriaxone resulted in rapid resolution of the peritonitis and restoration of the patient. Since P. multocida is usually transmitted from pets, the patient's cat was tested and could be identified as the most likely source of infection. This case should elicit our awareness that uncommon pathogens and unusual routes of transmission may lead to SBP, despite antibacterial prophylaxis with non-absorbable antibiotics. Nevertheless, such infections may still remain sensitive to systemic therapy with conventional antibiotics.

Disseminated Pasteurella multocida in a patient with liver cirrhosis and spontaneous bacterial peritonitis – The role of cirrhosis-associated immune dysfunction

“…Lutz et al, reported a non-bite case of a patient with a cat at home. This case claimed to be the first case that occurred while a patient was taking Rifaximin for SBP prophylaxis [13] , like in our case. However, routine full susceptibility testing of Pasteurella isolates is not always needed for management, and there is no evidence that Rifaximin is effective for treatment of PM infections in humans.…”

“…Systemic infections are rare and usually present without a recent bite [4] . Endocarditis, meningitis, and peritonitis are considered rare manifestations [4] , [8] , [12] , [13] , [14] , [15] . PM bacteremia can occur from a localized bite wound infection or from another localized source of infection.…”

Pasteurella multocida Bacteremia and Peritonitis in a Patient With Cirrhosis: A Life-Threatening Case From a Prick of a Cactus

“…11 , 13 Another case suggests an alternative theory of human gastrointestinal colonization of P multocida that translocated to the peritoneal fluid to cause peritonitis. 8 However, direct testing for colonization of that patient was not performed. In addition, there are no published reports of P multocida colonization of the skin.…”

“…Of the cirrhotic cases, the outcomes have ranged from complete resolution to death. 8,9 Quite rare there are a few documented accounts of indirect exposures to animals that resulted in severe P multocida infection in patients with cirrhosis. Of those, patients presented with bacteremia, arthritis, pneumonia, or peritonitis.…”

Caractérisation de la flore bactérienne des péritonites communautaires opérées au Burkina Faso

“…Au regard de sa grande diversité, il est donc fondamentale de bien la connaitre ainsi que les facteurs pouvant influencer sa composition. Malgré les importants progrès réalisés dans le domaine médical notamment dans l'efficacité de l'antibiothérapie et des techniques de réanimation, les infections intra-abdominales postopératoires restent une affection grave pour l'Homme [ 1 – 3 ]. Dans plusieurs études expérimentales et cliniques, il a été démontré que la sévérité de ce type d'infection était due à la présence de plusieurs espèces bactériennes qui cohabitent dans la cavité abdominale [ 4 – 7 ].…”