Cat-Induced Pasteurella Peritonitis in a Patient on Peritoneal Dialysis

Introduction: Pasteurella multocida remains a rare, but established cause of peritonitis in peritoneal dialysis (PD) patients. Case Description: Here we present a 79-year-old female with a medical history of coronary artery disease and end stage renal disease secondary to diabetes mellitus and hypertension, on chronic PD. She presented to her nephrology clinic with fevers and chills and reported that her kitten had chewed through her PD catheter during her overnight PD session. Intraperitoneal ceftazidime was initiated and peritoneal fluid cultures were drawn, which would later reveal Pasteurella multocida. Initial CT imaging was unremarkable. Oral levofloxacin was added to her antibiotic regimen. Her symptoms developed into pain and induration around the catheter site. She was hospitalized for IV ceftriaxone and PD catheter removal, and then transitioned to oral cefdinir. Despite this therapy, interval CT findings [Figure] suggested abscess formation along the catheter tract. IV ceftriaxone was restarted and a percutaneous drainage catheter was placed with successful evacuation of the collection. Blood and peritoneal cultures remained negative. She was discharged on 10 days of oral cefixime, recovered well and has since had a new PD catheter placed. Discussion: Pasteurella is a gram-negative coccobacilli that is a common inhabitant of the upper airways of healthy pets, such as cats and dogs. Transmission occurs through biting, scratching, or other contact with nasopharyngeal secretions. Pasteurellosis generally features soft tissue or lower respiratory tract infections, both of which may progress to abscess formation. Given that Pasteurella is isolated from approximately 75% of cat-inflicted wounds, and the bacterium’s prevalence in household pets, this case underscores the duty of the clinician to inform the patient of risk factors and adequate preventative measures, such as catheter site protection. Additionally, our case suggests that prolonged IV antibiotics may be necessary when intraabdominal pathology is identified to prevent abscess formation.