Pets-Related Peritonitis in Peritoneal Dialysis: Companion Animals or Trojan Horses?

Abstract

Infectious peritonitis is still a major concern in peritoneal dialysis (PD). Standard antibiotic regimens target common causative microorganisms such as Staphylococcus aureus and epidermidis or Pseudomonas aeruginosa. When the infection does not respond, unusual infective agents are to be considered including zoonoses-infections with an animal source. Companion animals or occupations involving animal contact favor the development of zoonoses, especially for immunocompromised patients such as those with end-stage renal disease. We reviewed the literature for all animals-related peritonitis in PD and analyzed data from our own PD unit and from the French-speaking registry for peritoneal dialyis (RDPLF) to assess both the frequency and the potential risk for PD patients in owning a pet or to working with animals. In a literature search, we identified 124 cases of PD peritonitis caused by 12 different zoonotic agents. Animals were involved in 24% of the cases. Overall mortality rate was 13.5% and Tenckhoff catheters had to be removed in 27% of the cases. The results from RDPLF analysis show that zoonotic microorganisms were responsible for 0.54% of the peritonitis episodes (51 out of a total of 9433 during a 9-year period). In our unit, zoonotic microorganisms were responsible for 0.03% of the peritonitis episodes (four out of a total of 128 during a 9-year period). Considering those results, some specific treatment recommendations can be made, but the major factor still remains prevention, by insisting on strict hygenic measures when a PD patient owns a pet.

Difficult peritonitis cases in children undergoing chronic peritoneal dialysis: relapsing, repeat, recurrent and zoonotic episodes

“…At the same time, there have now been at least 125 cases of peritonitis caused by 12 different zoonotic agents; 31 of these infections have followed contact with an animal [40,43]. Whereas a number of organisms can give rise to infections in humans as a result of the ingestion of contaminated food or water, organisms that have been associated with the development of peritonitis secondary to the direct transmission from dogs and cats to humans include Pasteurella spp., Brucella spp., Capnocytophaga spp., Leptospira spp., Cryptosporidium spp., Septospira spp., Yersinia spp., Bordetella bronchiseptica, Listeria spp.…”

“…Peritonitis secondary to zoonotic microorganisms is uncommon, but must be considered in any patient on chronic PD because of the common presence of pets in the home [40]. Remarkably, there are more than 70 million pet cats and dogs in the USA and more than 40 million in Europe.…”

“…Interestingly, the majority (15/18) of reported cases of peritonitis secondary to animal bites or scratches when the dialysis modality is known are in patients receiving CCPD, with the long tubing apparently the "target" of the cats [49]. There are no characteristic findings on initial presentation with peritonitis, and culture positivity may require more than 48 h. Penicillin is the antibiotic of choice for the 2-to 3-week course of therapy, but the organism is also susceptible to aminoglycosides, fluoroquinolones and cephalosporins [40,50]. Typically, patients are symptom free 48-96 h following the initiation of the appropriate antibiotic therapy.…”

Staphylococcus lentus Peritonitis: A Case Report

“…Patients may rarely require a VPS and renal replacement therapy concurrently (1). Although some concerns may arise about the safety of peritoneal dialysis (PD), it is not accepted as a contraindication in patients with a VPS (2,3).…”

“…Zoonosis in patients on PD represents 0.03 -0.54% of total peritonitis episodes (1,2). It has been isolated in less than 15 different microorganisms causing peritonitis of animal origin.…”