Spontaneous bacterial peritonitis by Pasteurella multocida under treatment with rifaximin

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Recently, rifaximin, a non-absorbable antibiotic which is used to prevent recurrent hepatic encephalopathy, has been proposed as effective prophylaxis for SBP. Here, we present an unusual case of SBP under...

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Bibliographic Details
Published in:Infection 2014-02, Vol.42 (1), p.175-177
Main Authors: Lutz, P., Parcina, M., Bekeredjian-Ding, I., Hoerauf, A., Strassburg, C. P., Spengler, U.
Format: Article
Language:English
Subjects:
Anti-Infective Agents - therapeutic use
Antibiotic Prophylaxis - methods
Case Report
Ceftriaxone - therapeutic use
Family Medicine
Female
General Practice
Humans
Infectious Diseases
Internal Medicine
Liver Cirrhosis - complications
Medicine
Medicine & Public Health
Microbial Sensitivity Tests
Middle Aged
Pasteurella Infections - diagnosis
Pasteurella Infections - microbiology
Pasteurella Infections - pathology
Pasteurella Infections - prevention & control
Pasteurella multocida - drug effects
Pasteurella multocida - isolation & purification
Peritonitis - diagnosis
Peritonitis - microbiology
Peritonitis - pathology
Peritonitis - prevention & control
Rifamycins - therapeutic use
Treatment Outcome
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Summary:Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Recently, rifaximin, a non-absorbable antibiotic which is used to prevent recurrent hepatic encephalopathy, has been proposed as effective prophylaxis for SBP. Here, we present an unusual case of SBP under treatment with rifaximin. A 50-year-old woman with liver cirrhosis was admitted because of tense ascites and abdominal pain. She was under long-term oral prophylaxis with rifaximin due to hepatic encephalopathy. Paracentesis revealed SBP caused by Pasteurella multocida , which was sensitive to multiple antibiotics, including rifaximin. Treatment with ceftriaxone resulted in rapid resolution of the peritonitis and restoration of the patient. Since P. multocida is usually transmitted from pets, the patient’s cat was tested and could be identified as the most likely source of infection. This case should elicit our awareness that uncommon pathogens and unusual routes of transmission may lead to SBP, despite antibacterial prophylaxis with non-absorbable antibiotics. Nevertheless, such infections may still remain sensitive to systemic therapy with conventional antibiotics.
ISSN:0300-8126
1439-0973
DOI:10.1007/s15010-013-0449-4