ABSTRACT
Infections are among the risks related to prosthetic hemodialysis access grafts. However, dialysis access graft infections caused by Pasteurella multocida have not been reported previously. We report a case of a P. multocida-infected nonfunctioning expanded polytetrafluoroethylene graft in the forearm after a cat bite. At surgery, the graft was completely unincorporated and was completely excised. Operative culture results were positive for P. multocida, a common oral flora found in cats and dogs. The patient was treated with intravenous ceftriaxone, and the wounds healed with local care.
Subject(s)
Arteriovenous Shunt, Surgical/adverse effects , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis/adverse effects , Forearm/blood supply , Pasteurella Infections/microbiology , Pasteurella multocida/isolation & purification , Polytetrafluoroethylene , Prosthesis-Related Infections/microbiology , Renal Dialysis , Adult , Animals , Anti-Bacterial Agents/administration & dosage , Arteriovenous Shunt, Surgical/instrumentation , Bites and Stings/complications , Blood Vessel Prosthesis Implantation/instrumentation , Cats , Ceftriaxone/administration & dosage , Device Removal , Female , Humans , Pasteurella Infections/diagnosis , Pasteurella Infections/therapy , Prosthesis Design , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/therapy , Reoperation , Treatment Outcome , Wound HealingABSTRACT
BACKGROUND: African Americans appear relatively potassium (K(+))-deficient compared with Caucasian Americans whether on unregulated diets or on diets controlled for K(+) content. METHODS: To determine whether extrarenal K(+) disposal was affected by race, KCl (0.5 mEq/kg in 0.9% saline) was infused over 48 minutes to 12 African American and 12 Caucasian American normotensive, healthy subjects. Identical infusions were administered before and after 10 days of fixed electrolyte intake. In addition to serum K(+), glucose, insulin, renin, and aldosterone were measured in blood, and K(+) and sodium (Na(+)) in urine voided spontaneously during the infusions. Data were analyzed using a two-factor analysis of variance (ANOVA) with repeated measures. RESULTS: Basal serum K(+) did not differ between races (African American 3.97 +/- 0.06 mEq/L and Caucasian American 3.98 +/- 0.05, P= NS). The rise in serum K(+) during the infusion and the area under the curve of serum K(+) over the 3.5 hours of observation were both greater in African American (African American +0.82 +/- 0.07 mEq/L and Caucasian American +0.61 +/- 0.06, P= 0.001; and African American 6.9 +/- 0.5 units and Caucasian American 5.1 +/- 0.6, P= 0.0012). The 10-day period of controlled intake did not abolish these differences. Aldosterone at baseline was lower and insulin was higher in African Americans at the end of the infusion. Urinary K(+), plasma glucose, and renin levels did not differ between African Americans and Caucasian Americans. CONCLUSION: Disposal of an intravenous (iv) K(+) load is decreased in African Americans compared with Caucasian Americans, which may reflect decreased Na(+),K(+)-ATPase activity in African Americans in vivo.
