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Abstract: FR-PO571

PD Peritonitis from Cat Mouth Flora: Pasteurella, Not the Only Thing You Need to Worry About

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Alsouqi, Aseel, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Kochar, Guneet S., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Choi, Jeans L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Burgner, Anna Marie, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Introduction

Neisseria weaveri, previously known as CDC group M-5, is an aerobic gram negative non-motile rod normally found in animal oral flora and associated with infections related to dog bites. We present a case of peritonitis in a patient on peritoneal dialysis (PD) due to this microorganism after a cat bit the PD tubing.

Case Description

A 61 year old female with end stage renal disease (ESRD) due to diabetes and hypertension on PD presented to the emergency department after her domestic cat bit and punctured the PD tubing while undergoing an exchange. She had no evidence of peritonitis and was discharged with prophylactic doxycycline for Pasteurella multocida peritonitis. Eight days later, she returned to the emergency department with abdominal pain and cloudy effluent. A diagnosis of peritonitis was made after peritoneal fluid studies revealed an elevated neutrophil count of 2,248 cells/mcL. The patient received IV loading doses of vancomycin and cefepime and then transitioned to intraperitoneal vancomycin, cefepime and oral metronidazole. Her peritoneal cell counts and symptoms quickly improved on antibiotics. The peritoneal fluid culture isolated Neisseria weaveri however blood cultures did not yield any bacterial growth. After all cultures finalized, antibiotics were narrowed to a two week course of oral ciprofloxacin. Resolution of peritonitis was confirmed after completion of antibiotics with negative peritoneal fluid studies.

Discussion

Neisseria weaveri is found in the normal canine oral flora and has been found in wounds from infected dog bites. A previous case report has been documented of peritonitis from Neiserria weaveri but no mechanism of infection was identified. While cats are less likely to carry Neiserria weaveri, the organism has been isolated from feline oral flora. Care and sterility of peritoneal dialysis equipment is paramount to preventing peritonitis as infection can be devastating for patients on home dialysis modalities. Consideration of the multitude of organisms that have been isolated from feline oral flora (Neisseria, Pasturella, Pasteurellaceae, Moraxella amongst others) must be kept in mind when wet contamination of PD fluid with feline oral flora occurs, with appropriate antimicrobial coverage.