There are as many as 300,000 visits to the emergency department in the U.S. with animal bites every year. The most common infection after cat or dog bite is with Pasteurella multocida. Many people infected will also have long-term central venous access for dialysis or for other reasons. No prior reports or guidelines exist regarding the management of P. multocida bacteremia due to line infection or bacteremia in the presence of long-term central venous access. Martin, et al. (2018) describe the successful treatment of an individual with P. multocida bacteremia secondary to tunneled line infection managed with line retention.
A 21-year-old man with a history of granulomatosis with polyangiitis on home hemodialysis presented with fever and hypotension three days after dialysis catheter replacement. The patient was found to be bacteremic with Pasteurella Multocida and he subsequently reported a history of cat bite to his dialysis catheter. He declined removal of the tunnelled catheter and was thereafter treated for a total of two weeks with intravenous ceftazidime post-dialysis and gentamicin line-locks without recurrence of infection.
The researchers conclude that Pasteurella multocida bacteremia in the presence of a long-term central venous catheter is potentially curable using two weeks of intravenous antibiotics and line retention. Further data regarding outcomes of treatment in this setting are required though in select cases clinicians faced with a similar scenario could opt for trial of intravenous therapy and retention of central venous catheter.
Reference: Martin TCS, et al. Pasteurella multocida line infection: a case report and review of literature. BMC Infectious Diseases. 2018;18:420