A 65‐year‐old Caucasian male, with a past medical history of End Stage Renal Disease on Automated Peritoneal Dialysis (APD), presented with complaints of abdominal cramping and discomfort with associated purulent peritoneal fluids of days duration. He was hemodynamically stable with a blood pressure of 145/49 mmHg, pulse rate of 56/min, respiratory rate of 16/min and oral temperature of 98.0 F. Abdominal examination revealed a soft, non‐distended abdomen with diffuse tenderness but no guarding, rigidity or rebound. Bowel sounds were diminished. Rest of physical examination was otherwise unremarkable. A cloudy yellow peritoneal fluid sample was sent for cell count and differential, which revealed RBC 109,000 /uL and WBC 11,480 /uL with 93% Neutrophils. Peritoneal fluid culture revealed Gram‐negative bacilli compatible with Pasteurella Multocida. The patient declared he had two cats at home. He was started on intra‐peritoneal Ceftazidime (1.5 grams daily) as well as Ciprofloxacin (500 mg daily) for a total duration of 3 weeks. His symptoms improved significantly and his peritoneal fluid cell count and differential normalized. The patient was discharged after 5 days of admission and was monitored as outpatient.
Automated peritoneal dialysis (APD) is more popular option than continuous ambulatory peritoneal dialysis (CAPD) since it offers more flexibility for patients during the daytime. However, in either option, aseptic technique including proper handling of the dialysis tubing and connector in a safe and clean environment are the key to prevent infectious complication such as peritonitis. Pasteurella Multocida is a rare form of PD‐related peritonitis and is closely associated with pets namely cats.
Patients on APD are more affected than those on CAPD since the patient performing the CAPD fluid exchange is in control of his or her surrounding as opposite to the patient on APD where the exposure to hazards such as a pet chewing on dialysis tubing may not be controlled.Our patient’s wife refused to remove the cats from her household regardless the consequences. The patient himself refused to go on CAPD or in‐center hemodialysis as an alternative. His wife then arranged for building gates in their house. Hence, the issue of safety and prevention should be discussed thoroughly with the patients before their discharge with follow up home visit to assure the application of these measures.