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Hallowell KL, Hepworth-Warren KL, Dembek K. An updated description of bacterial pneumonia in adult horses and factors associated with death. J Vet Intern Med 2024. [PMID: 39005215 DOI: 10.1111/jvim.17141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Available descriptive studies on equine pneumonia are outdated or focus on specific horse or bacterial populations. OBJECTIVES To describe the clinical presentation and bacterial isolates of adult horses with bacterial pneumonia and identify factors associated with death. ANIMALS One hundred sixteen horses >2 years old with bacterial pneumonia. METHODS Retrospective case series. Data regarding history, physical examination, clinicopathologic features, treatment, bacterial culture and sensitivity, and outcome were collected and analyzed retrospectively. RESULTS Historical risk factors were present for 60% of cases, whereas abnormal vital signs on intake were present for <50%. Most horses (58%) underwent at least 1 change of antimicrobial treatment, and 67% received the highest-priority critically important antimicrobials. Streptococcus zooepidemicus was the most isolated bacteria (44%), followed by Escherichia coli (19%), Klebsiella spp. (18%), other Streptococcus species (17%), and Bacillus spp. (13%). Fusobacterium spp. were the most common anaerobic isolates (11%). Antimicrobial susceptibility varied widely. Survival to discharge was 73%. Heart rate at presentation (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.008-1.17, P = .03) and higher creatinine (OR 14.1, 95% CI 1.56-127.6, P = .02) increased the risk of death. Higher lymphocyte count (OR 0.27, 95% CI 0.08-0.94, P = .04) reduced risk. CONCLUSIONS AND CLINICAL IMPORTANCE Contrasting older literature, Fusobacterium spp. were the most common anaerobes. Streptococcus zooepidemicus remained the most common isolate and was predictably susceptible to penicillin. Antimicrobial susceptibility was otherwise variable and broad applicability is limited as this was a single-center study. Increased risk of death associated with tachycardia and abnormally high serum creatinine concentration is consistent with previous studies.
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Affiliation(s)
- Kimberly L Hallowell
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Kate L Hepworth-Warren
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Katarzyna Dembek
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Minuto J, Bedenice D, Ceresia M, Zaghloul I, Böhlke M, Mazan MR. Clinical effects and pharmacokinetics of nebulized lidocaine in healthy horses. Front Vet Sci 2022; 9:984108. [PMID: 36187809 PMCID: PMC9521615 DOI: 10.3389/fvets.2022.984108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nebulized lidocaine appears promising as a novel corticosteroid-sparing therapeutic for equine asthma, but its safety and pharmacokinetic behavior have yet to be confirmed. Objective To describe the effect of nebulized lidocaine on upper airway sensitivity, lung mechanics, and lower respiratory cellular response of healthy horses, as well as delivery of lidocaine to lower airways, and its subsequent absorption, clearance, and duration of detectability. Animals Six healthy university- and client-owned horses with normal physical examination and serum amyloid A, and no history of respiratory disease within 6 months. Methods Prospective, descriptive study evaluating the immediate effects of 1 mg/kg 4% preservative-free lidocaine following nebulization with the Flexineb®. Prior to and following nebulization, horses were assessed using upper airway endoscopy, bronchoalveolar lavage, and pulmonary function testing with esophageal balloon/pneumotachography and histamine bronchoprovocation. Additionally, blood and urine were collected at predetermined times following single-dose intravenous and nebulized lidocaine administration for pharmacokinetic analysis. Results Upper airway sensitivity was unchanged following lidocaine nebulization, and no laryngospasm or excessive salivation was noted. Lidocaine nebulization (1 mg/kg) resulted in a mean epithelial lining fluid concentration of 9.63 ± 5.05 μg/mL, and a bioavailability of 29.7 ± 7.76%. Lidocaine concentrations were higher in epithelial lining fluid than in systemic circulation (Cmax 149.23 ± 78.74 μg/L, CELF:Cmaxplasma 64.4, range 26.5–136.8). Serum and urine lidocaine levels remained detectable for 24 and 48 h, respectively, following nebulization of a single dose. Baseline spirometry, lung resistance and dynamic compliance, remained normal following lidocaine nebulization, with resistance decreasing post-nebulization. Compared to the pre-nebulization group, two additional horses were hyperresponsive following lidocaine nebulization. There was a significant increase in mean airway responsiveness post-lidocaine nebulization, based on lung resistance, but not dynamic compliance. One horse had BAL cytology consistent with airway inflammation both before and after lidocaine treatment. Conclusions Nebulized lidocaine was not associated with adverse effects on upper airway sensitivity or BAL cytology. While baseline lung resistance was unchanged, increased airway reactivity to histamine bronchoprovocation in the absence of clinical signs was seen in some horses following nebulization. Further research is necessary to evaluate drug delivery, adverse events, and efficacy in asthmatic horses.
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Affiliation(s)
- Jillian Minuto
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Daniela Bedenice
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Michelle Ceresia
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
- Department of Pharmacy Practice, School of Pharmacy, MCPHS University, Boston, MA, United States
| | - Iman Zaghloul
- Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA, United States
| | - Mark Böhlke
- Department of Pharmaceutical Sciences, School of Pharmacy, MCPHS University, Boston, MA, United States
| | - Melissa R. Mazan
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
- *Correspondence: Melissa R. Mazan
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Durham AE. An evaluation of serum gentamicin concentrations and bacterial susceptibility to gentamicin in equine practice. J Vet Intern Med 2018; 32:1194-1201. [PMID: 29575239 PMCID: PMC5980452 DOI: 10.1111/jvim.15078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 09/27/2017] [Accepted: 01/23/2018] [Indexed: 12/01/2022] Open
Abstract
Background Therapeutic drug monitoring and minimum inhibitory concentration (MIC) data allow more informed use of gentamicin. Hypothesis/Objectives To measure peak and trough serum gentamicin concentrations in horses after a 6.6 mg/kg dose of gentamicin given IV and the MIC of gentamicin of bacteria for which gentamicin might be selected. Methods Retrospective analysis of hospital records. Peak and trough plasma gentamicin concentrations were measured after 6.6 mg/kg gentamicin IV in 339 hospitalized horses. The MIC of gentamicin was measured for 503 isolates from ambulatory practice and 33 from hospital practice. The distribution of gentamicin concentrations and MIC results were compared to current recommendations for MIC breakpoints. Results The median serum gentamicin concentration at 60 minutes after administration (C60min) was 21.4 μg/mL with a distribution indicating that bacteria with MIC ≥2 μg/mL were unlikely to be exposed to sufficient gentamicin for effective killing. Approximately 90% of isolates from ambulatory practice and 36% of hospital isolates had MICs at or below breakpoints for susceptibility with most of the remainder unlikely to be responsive, even to higher IV doses. Conclusions and Clinical Importance Gentamicin at a dosage of 6.6 mg/kg IV is likely to be effective against the majority of infections encountered in ambulatory practice, but less effective in an equine hospital. Because there was a dichotomy of most bacteria as being clearly susceptible or clearly resistant to gentamicin, it appears unlikely that higher doses would have been more efficacious, especially in the hospitalized population in our study.
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Affiliation(s)
- Andy E Durham
- Liphook Equine Hospital, Liphook, Hampshire, United Kingdom
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Affiliation(s)
- Rose Tallon
- Bourton Vale Equine Clinic, Wyck Road, Lower Slaughter, Cheltenham, Gloucestershire, GL54 2EX
| | - Kate McGovern
- American, European and RCVS Specialist in Equine Internal Medicine; Donnington Grove Veterinary Group, Oxford Road, Newbury, Berks, RG14 2JB
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Abstract
This article discusses the benefits and limitations of inhalation therapy in horses. Inhalation drug therapy delivers the drug directly to the airways, thereby achieving maximal drug concentrations at the target site. Inhalation therapy has the additional advantage of decreasing systemic side effects. Inhalation therapy in horses is delivered by the use of nebulizers or pressured metered dose inhalers. It also requires the use of a muzzle or nasal mask in horses. Drugs most commonly delivered through inhalation drug therapy in horses include bronchodilators, antiinflammatories, and antimicrobials.
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Affiliation(s)
- Mandy L Cha
- Kulshan Veterinary Hospital, 8880 Benson Rd, Lynden, WA 98264, USA
| | - Lais R R Costa
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.
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Reuss SM, Giguère S. Update on Bacterial Pneumonia and Pleuropneumonia in the Adult Horse. Vet Clin North Am Equine Pract 2015; 31:105-20. [DOI: 10.1016/j.cveq.2014.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Dunkel B, Johns IC. Antimicrobial use in critically ill horses. J Vet Emerg Crit Care (San Antonio) 2015; 25:89-100. [PMID: 25582245 DOI: 10.1111/vec.12275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/15/2014] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To discuss controversies surrounding antimicrobial use in critically ill horses. DATA SOURCES PubMed searches from 1970-present for terms including, but not limited to: "horse," "foal," "antimicrobial," "prophylaxis," "infection," "surgery," "sepsis," and "antimicrobial resistance." HUMAN DATA SYNTHESIS Increasing bacterial antimicrobial resistance has changed first-line antimicrobial choices and prompted shortening of the duration of prophylactic and therapeutic treatment. The need to decrease bacterial resistance development to critically important antimicrobials has been highlighted. VETERINARY DATA SYNTHESIS Veterinary medicine has followed a similar trend but often without a high-level evidence. Common dilemmas include diseases in which the theoretically most effective drug is a reserved antimicrobial, the inability to differentiate infectious from noninfectious disease, the duration and necessity of prophylactic antimicrobials and use of antimicrobials in primary gastrointestinal disease. These problems are illustrated using examples of purulent infections, neonatal sepsis, colic surgery, and treatment of colitis. Although enrofloxacin, cephalosporins, and doxycycline, in contrast to gentamicin, reach therapeutic concentrations within the lungs of healthy horses, the first two should not be used as first line treatment due to their reserved status. Due to the high risk of bacterial sepsis, antimicrobial treatment remains indispensable in compromised neonatal foals but shortening the length of antimicrobial treatment might be prudent. One prospective randomized study demonstrated no difference between 3 and 5 days of perioperative antimicrobial treatment in colic surgery but shorter durations were not evaluated. High-level evidence to recommend antimicrobial treatment of adult horses with undifferentiated diarrhea does not exist. CONCLUSIONS Few evidence-based recommendations can be made. Commonly used antimicrobial combinations remain the mainstay for treating purulent infections. Antimicrobial treatment for compromised foals should not extend beyond recovery. Continuation of prophylactic antimicrobials >3 days is likely unnecessary after colic surgery; shorter durations might be equally effective. Antimicrobial prophylaxis in adult horses with diarrhea is unlikely to be beneficial.
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Affiliation(s)
- Bettina Dunkel
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Hatfield, Hertforshire, United Kingdom, United Kingdom
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Fultz L, Giguère S, Berghaus LJ, Grover GS, Merritt DA. Pulmonary pharmacokinetics of desfuroylceftiofur acetamide after nebulisation or intramuscular administration of ceftiofur sodium to weanling foals. Equine Vet J 2014; 47:473-7. [DOI: 10.1111/evj.12316] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/20/2014] [Indexed: 11/30/2022]
Affiliation(s)
- L. Fultz
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens USA
| | - S. Giguère
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens USA
| | - L. J. Berghaus
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens USA
| | - G. S. Grover
- Metabolism and Safety; Zoetis; Kalamazoo Michigan USA
| | - D. A. Merritt
- Metabolism and Safety; Zoetis; Kalamazoo Michigan USA
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McConachie EL, Hart KA, Whelchel DD, Schroeder EL, Schott HC, Sanchez S. Pulmonary disease potentially associated with Nicoletella semolina in 3 young horses. J Vet Intern Med 2014; 28:939-43. [PMID: 24689696 PMCID: PMC4895471 DOI: 10.1111/jvim.12349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 01/11/2014] [Accepted: 02/19/2014] [Indexed: 12/23/2022] Open
Affiliation(s)
- E L McConachie
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, GA
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HART SK, BARRETT JG, BROWN JA, PAPICH MG, POWERS BE, SULLINS KE. Elution of antimicrobials from a cross-linked dextran gel:In vivoQuantification. Equine Vet J 2012; 45:148-53. [DOI: 10.1111/j.2042-3306.2012.00633.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Winther L. Antimicrobial drug concentrations and sampling techniques in the equine lung. Vet J 2012; 193:326-35. [DOI: 10.1016/j.tvjl.2012.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
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Kirinus J, Pötter L, Gressler L, Leite F, Vargas A. Perfil fenotípico e susceptibilidade antimicrobiana de Streptococcus equi isolados de equinos da região Sul do Brasil. PESQUISA VETERINARIA BRASILEIRA 2011. [DOI: 10.1590/s0100-736x2011000300008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As características fenotípicas [morfológicas, bioquímicas, susceptibilidade aos antimicrobianos, índice de resistência múltipla aos antimicrobianos (IRMA), concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM) da benzilpenicilina] de 38 isolados de Streptococcus equi oriundos de amostras clínicas de animais com adenite equina foram alvo deste estudo. A fenotipia demonstrou três padrões de colônias, três biotipos de fermentação de carboidratos e variação de 0 a 0,4 no IRMA. Todos os isolados de S. equi demonstraram sensibilidade à penicilina, tanto pelo método de disco difusão quanto pelo método de microdiluição. A CIM e CBM média de benzilpenicilina foi de 0,0095μg/mL e 0,0267μg/mL para S. equi subesp. equi e de 0,0128μg/mL e 0,0380μg/mL para S. equi subesp. zooepidemicus. Os valores de CIM e CBM diferiram entre as subespécies (p<0,05). O diâmetro do halo de inibição de penicilina demonstrou relação com a CIM (ì=0,03638 - 0,00072x) para S. equi subesp. equi. Também foi demonstrada relação entre o diâmetro do halo de inibição de penicilina com a CBM para S. equi subesp. equi (ì=0,10931- 0,00223x). Entretanto para as amostras de S. equi subesp. zooepidemicus esta relação somente foi verificada para a CBM (ì=0,1322 - 0,00271x). A CIM de benzilpenicilina frente às amostras isoladas da região Central, Planalto e Sul do estado do Rio Grande do Sul foram estatisticamente semelhantes, mas diferiram do isolado do estado do Paraná, sugerindo o caráter atípico desta cepa. Todos os isolados de S. equi são sensíveis à penicilina e sulfazotrim, confirmando a eleição destes antimicrobianos para o tratamento das infecções por este agente na clínica veterinária. Os resultados obtidos não dispensam a utilização prudente dos antimicrobianos.
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Affiliation(s)
| | - L. Pötter
- Universidade Federal de Santa Maria, Brasil
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Art T, Ramery E, Fraipont A, Lekeux P. Pulmonary function, airway cytology and bronchoalveolar lavage fluid drug concentration after aerosol administration of cefquinome to horses. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2010.00116.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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