Pasteurella multocida Bacteremia in a Large Community Teaching Hospital, 2011–2020: A Quality Improvement Project—Lessons Learned Regarding Immunizations

Abstract

Abstract Introduction Pasteurella multocida is a small, pleomorphic, nonflagellated, gram-negative coccobacillus found as a commensal of the upper respiratory tract of mammals and birds. Human infections are linked primarily to dog and cat bites, scratches, and licks. As part of an institutional review board–approved quality improvement project, we reviewed 10 years of experience (2011–2020) with P. multocida bacteremia (PMB) at our institution. Materials and Methods We identified all episodes of PMB at our institution from January 1, 2011, to December 31, 2020, from computerized blood culture records. We recorded information regarding epidemiology, source of bacteremia, comorbid medical conditions, laboratory data, radiographic data, antimicrobial treatment, and patient outcomes as well as information regarding providers' inquiries about animal contact, animal rabies vaccine status, and patient tetanus immunization status. Results During the 10-year study period, we identified 21 patients with 20 episodes of PMB. One patient experienced 2 episodes of PMB 1 year apart. The mean/median ages of patients with PMB were 71/68 years, respectively. Of the 21 PMB episodes, 17 (81%) occurred in women. Notably, 8 of 21 episodes (38%) occurred in patients with underlying liver dysfunction: 5 with severe alcohol use disorder (AUD), 1 with chronic hepatitis C virus infection, and 2 with nonalcoholic cirrhosis. Three of 21 patients (14%) died because of complications of PMB despite appropriate antimicrobial therapy. All 3 fatal cases were women who met criteria for severe AUD. In 14 of 21 episodes (65%), the patient was asked about pet exposure: 12 of 14 exposures (86%) involved a cat. Rabies vaccination status of the pet was documented in 3 of 21 episodes (14%). Tetanus vaccination status of the patient was explored in 7 of 21 PMB episodes (33%). Conclusions There were 21 episodes of PMB in 20 patients during the 10-year study period. Pasteurella multocida bacteremia was associated with female sex (81%), multiple comorbid conditions, and, notably, with liver dysfunction resulting from severe AUD, hepatitis C virus infection, or cirrhosis from other causes. Mortality was 3/21 (14%) and all 3 patients who died had underlying liver disease. Opportunities for improvement in patients with PMB were identified including routine inquiries about patient's animal exposure, rabies vaccination status of involved animal, and tetanus verification/administration of patients with PMB. In addition, women with cirrhosis/AUD are at high risk for severe, fatal PMB when it occurs.