Pseudoaneurysm formation after Pasteurella multocida lower extremity vascular bypass graft infection

Area of Science:

• Infectious Diseases
• Vascular Surgery
• Microbiology

Background:

• Prosthetic vascular bypass graft infections are uncommon but serious complications.
• Early diagnosis and pathogen identification are crucial for effective management.
• Polytetrafluoroethylene (PTFE) grafts are used in peripheral artery bypass procedures.

Observation:

• A 66-year-old woman presented with left lower extremity pain and a pseudoaneurysm 7 months post-femoral to peroneal artery bypass using a PTFE graft.
• The patient reported a new kitten that frequently bit her lower extremities.
• Pasteurella multocida was identified in blood and tissue cultures.

Findings:

• Pasteurella multocida, often associated with animal bites, was the causative agent of the prosthetic graft infection.
• The patient underwent re-exploration and received a jump graft.
• Treatment involved a 6-week course of intravenous ertapenem followed by long-term oral antibiotic suppression.

Implications:

• This case highlights Pasteurella multocida as a potential pathogen in prosthetic vascular graft infections, particularly in patients with animal contact.
• Prolonged antibiotic therapy, including suppression, may be a viable limb salvage strategy, potentially avoiding amputation in complex cases.
• Vigilance for rare pathogens and consideration of patient exposures are important in managing prosthetic graft infections.