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Abstract: FR-PO574

Cat Bite-Induced Pasteurella multocida Peritonitis

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Sawaf, Hanny, TriHealth Good Samaritan Hospital, Cincinnati, Ohio, United States
  • Ali, Birmaji, TriHealth Good Samaritan Hospital, Cincinnati, Ohio, United States
  • Neelam Raju, Bharat, TriHealth Good Samaritan Hospital, Cincinnati, Ohio, United States
  • Rajput, Amit K., The Kidney & Hypertension Center, Mason, Ohio, United States
Introduction

Peritoneal dialysis (PD) patients are at an increased risk of developing peritonitis, necessitating the importance of proper sterile technique. While, the majority of peritoneal infections arise from skin flora, an important, but often under-recognized risk factor for peritonitis is pet ownership. This case report will examine an incident of zoonotic infection induced peritonitis.

Case Description

A 70-year-old PD dependent female presented with one day of progressively worsening abdominal pain and cloudy peritoneal fluid, without associated fevers. Physical examination revealed diffuse abdominal tenderness with guarding. There were no concerning findings at the catheter entry site. Initial blood work was unremarkable, except for a mild leukocytosis. A sample of peritoneal fluid was sent for analysis, but returned a nucleated cell count of 0. However, despite a lack of PMNs, the fluid culture grew Pasteurella multocida. This was an unexpected result that prompted further investigation into the patient’s home environment and PD machine. The patient owns 4 cats and 1 dog, but was not restricting pet access to her bedroom with her dialysis machine.

Although the fluid cell count was negative, further investigation showed inadequate dwell time in the ED. The patient was ultimately treated with IP Ceftriaxone. Careful inspection of the PD machine by the PD unit revealed several bite and scratch marks on the tubing. The patient was re-educated on sterile technique and has restricted pet access to her bedroom. She now protects her PD tubing by encasing it with a pool noodle.

Discussion

As PD patients are at an increased risk of infection, education on proper sterile technique and home environment is critical. This case illustrates several key points in the prevention and diagnosis of peritonitis. Clinical suspicion of peritonitis should remain high despite unimpressive fluid cell count. Peritoneal fluid culture should always be checked if clinical suspicion is high. Pet ownership should be assessed in all patients and the importance of restricting pet access to PD machine should be emphasized during initial training. If pets are present, patients should be instructed to limit pet access to the bedroom and storage space for PD equipment. Furthermore, patients should wrap tubing if needed. By addressing pet ownership with patients, we hope to further reduce peritonitis incidence.