Uncommon Pathogens and Unusual Circumstances: Pasteurella multocida Peritonitis in a Patient on Peritoneal Dialysis with Congenital Renal Dysgenesis

Introduction: Peritoneal dialysis associated peritonitis is a common complication in end-stage kidney disease patients, but zoonotic infections remain rare. Pasteurella multocida has infrequently been reported as a cause of PD-related peritonitis in pet owners. Case Description: 44-year-old woman with ESKD on automated peritoneal dialysis (APD) was admitted with severe abdominal pain and fever. Exam was signficant for diffuse abdominal tenderness with clean exit site without signs of tunnel infection. Peritoneal fluid analysis revealed >6,000 WBCs/cumm with 90% neutrophils and Gram stain noted gram-negative rods. Emperic IV antibiotics were initiated, piperacillin-tazobactam and vancomycin. On further questioning patient admitted to owning a cat who frequently was near and played with the PD tubing and may have proceeded to bite the tubing. Culture grew Pasteurella multocida and patient was switched to intraperitoneal ceftazidime for a 14 day course. She did well and continued to be on APD without further complications. Discussion: This case highlights a rare but serious PD-associated infection caused by Pasteurella multocida following pet-related equipment breach. Pasteurella Multocida is a gram negative coccobacillus, part of a normal flora of cats and dogs that can be introduced via the pet's close proximity to PD equipment or licking/biting the PD tubing. Clinical presentation is typically with abdominal pain, cloudy effluent, fever, and occasionally tunnel/exit site infection. Laboratory findings are elevated peritoneal WBC count >100 with neutrophil predominance, gram stain showing gram negative rods with definitive positive culture. It is crucial to ask PD patients about their pet ownership and any contact of pets with the PD equipment/tubing and supplies. Initially, should start empiric treatment, then narrow down to first line therapy with intraperitoneal 3rd or4th generation cephalosporins, like ceftazidime or Cefepime for duration of 14 to 21 days. Catheter is not typically removed unless there is a tunnel infection. Pasteurella multocida peritonitis is a rare but preventable complication in PD patients with pet exposure. Prompt recognition of risk factors are important and patients with domestic animals should receive ongoing education regarding hygiene and catheter care.