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Giancola S, Hart KA. Equine blood cultures: Can we do better? Equine Vet J 2022. [PMID: 36210694 DOI: 10.1111/evj.13891] [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: 04/22/2022] [Accepted: 10/02/2022] [Indexed: 11/30/2022]
Abstract
Blood culture is considered the gold standard test for documenting bacteraemia in patients with suspected bacterial sepsis in veterinary and human medicine. However, blood culture often fails to yield bacterial growth even though the clinical picture is strongly suggestive of bacterial sepsis, or contaminating organisms can overgrow the true pathogen, making accurate diagnosis and appropriate management of this life-threatening condition very challenging. Methodology for collecting blood cultures in equine medicine, and even in human hospitals, is not standardised, and many variables can affect the yield and type of microorganisms cultured. Microbiological culture techniques used in the laboratory and specific sample collection techniques, including volume of blood collected, aseptic technique utilised, and the site, timing and frequency of sample collection, all have substantial impact on the accuracy of blood culture results. In addition, patient-specific factors such as husbandry factors, the anatomical site of the primary infection, and changing microflora in different geographic locations, also can impact blood cultures. Thus, blood cultures obtained in practice may not always accurately define the presence or absence of, or specific organisms causing, bacteraemia in horses and foals with suspected sepsis. Erroneous blood culture results can lead to inappropriate antimicrobial use, which can result in poor outcomes for individual patients and contribute to the development of antimicrobial resistance in the patient's microflora and the environmental microcosm. This review summarises current indications and methodology, and specific factors that may be optimised, for equine blood culture, with particular focus on available literature from neonatal foals with suspected bacterial sepsis. To standardise and optimise blood culture techniques in horses and foals, future research in this area should be aimed at determining the optimal volume of blood that should be collected for culture, and the ideal site, timing, and frequency of sample collection.
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Affiliation(s)
- Shyla Giancola
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | - Kelsey A Hart
- Department of Large Animal Medicine, University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
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Durie I, Galen GV. Can the use of antimicrobials in adult equine patients with acute colitis be justified in the era of antimicrobial stewardship? EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Inge Durie
- Evidensia Specialisthästsjukhuset Strömsholm Strömsholm Sweden
| | - Gaby van Galen
- University of Sydney School of Veterinary Science University of Sydney Sydney New South Wales Australia
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Gustafsson K, Tatz AJ, Slavin RA, Sutton GA, Dahan R, Ahmad WA, Kelmer G. Intraincisional medical grade honey decreases the prevalence of incisional infection in horses undergoing colic surgery: A prospective randomised controlled study. Equine Vet J 2020; 53:1112-1118. [PMID: 33340154 DOI: 10.1111/evj.13407] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 10/20/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical grade honey has previously been described as a prophylactic treatment for wounds. Local prophylactic treatment may be valuable in preventing post-operative incisional infections in horses undergoing colic surgery but has not been evaluated. OBJECTIVES To establish whether medical grade honey gel, applied on the linea alba intraoperatively, decreases the prevalence of incisional infections in horses undergoing colic surgery with no associated adverse effects. STUDY DESIGN Prospective blinded randomised controlled clinical study. METHODS Horses older than 4 months that underwent colic surgery between May 2017 and December 2018 and survived for >2 weeks were included in the study. Horses were allocated 1:1 to treatment or control by block randomisation. In the treatment group, following closure of the linea alba, medical grade honey gel (L-Mesitran Soft® ) was placed in the incision followed by apposition of subcutaneous tissue and skin. Information regarding the incision and post-operative complications was obtained at five time points (24 hours, 48 hours, 5 days, 14 days and 3 months). RESULTS Eighty-nine horses were included in the study. No adverse effects associated with treatment were observed. Horses in the treatment group had a lower rate of incisional infection compared with the control group (8.2% vs. 32.5%, P = .02). The protective effect of MGH had a calculated adjusted odds ratio (OR) of 0.2 (95% CI:0.07-0.8, P = .03). The number of patients required to receive treatment to prevent one case of incisional infection (NNEB) was 4.7. Risk factors associated with infection included: younger age (OR = 27, 95% CI: 2.3 to 306, P = .008) and diarrhoea 48 hours post-operatively (OR = 20, 95% CI: 1.5 to 277, P = .02). MAIN LIMITATIONS Follow-up was performed by different veterinary surgeons, hence not completely uniform. CONCLUSION Local prophylactic treatment with medical grade honey gel in the abdominal incision during surgery is safe and may significantly decrease the prevalence of incisional infections in horses undergoing colic surgery.
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Affiliation(s)
- Kajsa Gustafsson
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Amos J Tatz
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Roni A Slavin
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Gila A Sutton
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Roee Dahan
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
| | - Wiessam A Ahmad
- Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Gal Kelmer
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot, Israel
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Affiliation(s)
- B. Dunkel
- RVC EquineClinical Science and ServicesRoyal Veterinary College North Mymms, Hatfield, Hertfordshire UK
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Byrne CA, Lumsden JM, Lang HM, O'Sullivan CB. Synovial sepsis of unknown origin in the adult Thoroughbred racehorse. Equine Vet J 2019; 52:91-97. [PMID: 31006125 DOI: 10.1111/evj.13127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Synovial sepsis of unknown origin is a rare cause of lameness in the adult horse, and a haematogenous pathogenesis has been proposed in previous cases. OBJECTIVES To describe the features and outcome of synovial sepsis of unknown origin in adult Thoroughbred racehorses. STUDY DESIGN Retrospective case series. METHODS Hospital records for admissions between 2005 and 2015 were reviewed to identify adult horses diagnosed with synovial sepsis of unknown origin. Presentation, clinicopathological, microbiological and diagnostic imaging findings were recorded. Treatment methods, surgical findings, complications and long-term outcome were evaluated. RESULTS Eleven cases were identified over the study period. Diagnosis was established from clinical examination and clinicopathologic findings, which were comparable to other aetiologies of synovial sepsis. Affected structures included synovial joints, tendon sheaths and bursae. Concurrent osteochondritis dissecans or articular cartilage lesions were evident during arthroscopic surgery in three cases. Significant intrasynovial haemorrhage was not identified. Microbial culture of synovial fluid or synovial biopsy was positive in 6/11 of cases, with all isolates being Gram-positive cocci. Of the 6 positive microbial cultures, all isolates demonstrated in vitro sensitivity to a cephalosporin antimicrobial agent. A concurrent remote wound was present in a single case. No other potential origins of bacteraemia were identified. Treatment methods included endoscopic surgery, standing multineedle lavage, intravenous regional limb perfusion, intrasynovial medication and/or systemic antimicrobial administration. All horses survived to hospital discharge. For the 6/11 cases that raced following synovial sepsis, the median period for return to racing was 221 days. MAIN LIMITATIONS A small study population, which was retrospectively reviewed. CONCLUSIONS Synovial sepsis of unknown origin is rare in the adult Thoroughbred racehorse and can affect a range of synovial structures. A concurrent potential source of bacteraemia is rarely identified. With appropriate management, the prognosis to return to racing is fair.
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Affiliation(s)
- C A Byrne
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - J M Lumsden
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - H M Lang
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - C B O'Sullivan
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
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Sheats MK. A Comparative Review of Equine SIRS, Sepsis, and Neutrophils. Front Vet Sci 2019; 6:69. [PMID: 30931316 PMCID: PMC6424004 DOI: 10.3389/fvets.2019.00069] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
The most recent definition of sepsis in human medicine can be summarized as organ dysfunction caused by a dysregulated host response to infection. In equine medicine, although no consensus definition is available, sepsis is commonly described as a dysregulated host systemic inflammatory response to infection. Defense against host infection is the primary role of innate immune cells known as neutrophils. Neutrophils also contribute to host injury during sepsis, making them important potential targets for sepsis prevention, diagnosis, and treatment. This review will present both historical and updated perspectives on the systemic inflammatory response (SIRS) and sepsis; it will also discuss the impact of sepsis on neutrophils, and the impact of neutrophils during sepsis. Future identification of clinically relevant sepsis diagnosis and therapy depends on a more thorough understanding of disease pathogenesis across species. To gain this understanding, there is a critical need for research that utilizes a clearly defined, and consistently applied, classification system for patients diagnosed with, and at risk of developing, sepsis.
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Affiliation(s)
- M. Katie Sheats
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
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Wilkins PA. What's in a word? The need for SIRS and sepsis definitions in equine medicine and surgery. Equine Vet J 2018; 50:7-9. [PMID: 29193295 DOI: 10.1111/evj.12780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P A Wilkins
- University of Illinois - Veterinary Clinical Sciences, Champain-Urbana, Illinois, USA
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Isgren CM, Salem SE, Townsend NB, Timofte D, Maddox TW, Archer DC. Sequential bacterial sampling of the midline incision in horses undergoing exploratory laparotomy. Equine Vet J 2018; 51:38-44. [PMID: 29679416 PMCID: PMC6585715 DOI: 10.1111/evj.12958] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 03/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is limited information about bacterial isolates that are present on the equine midline incision during and following exploratory laparotomy. OBJECTIVES To investigate the bacterial species cultured from the ventral midline pre-, intra- and post- laparotomy, whether particular bacterial isolates are associated with the development of surgical site infections (SSIs) and to report the antimicrobial resistance phenotypes of these isolates. STUDY DESIGN Prospective cohort study. METHODS The ventral midline of 31 horses undergoing exploratory laparotomy was sampled for bacterial culture at set time-points pre, intra and post-operatively. Inclusion criteria were that horses must have undergone exploratory laparotomy within 90 min of the initial colic examination upon hospital admission and must not have been placed in a stable prior to surgery. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration. RESULTS Seven horses (22.6%) developed a SSI. None of the variables tested were associated with the altered risk of SSI. The prevalence of a positive bacterial culture from the incision increased progressively over time and a variety of bacteria were isolated. A positive intra-operative culture was not a predictor of SSI; and when a SSI did occur, it was due to a different bacterial isolate. MRSA and ESBL-producers were identified in the post-operative period in one and four different horses respectively, but none of these developed a SSI. MAIN LIMITATIONS Sampling was limited to hospitalisation and no culture results were available for horses developing SSI following hospital discharge. CONCLUSIONS A variety of bacterial species may be isolated from equine laparotomy incisions peri-operatively without development of SSI. SSI does not appear to be solely related to bacterial contamination of the incision peri-operatively and other mechanisms such as bacteraemia merit further investigation.
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Affiliation(s)
- C M Isgren
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst, UK.,Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Leahurst, UK
| | - S E Salem
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst, UK.,Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zakazik, Egypt
| | - N B Townsend
- Three Counties Equine Hospital, Stratford Bridge, Ripple, Tewkesbury, UK
| | - D Timofte
- Institute of Veterinary Science, University of Liverpool, Leahurst, UK.,Institute of Infection and Global Health, University of Liverpool, Leahurst, UK
| | - T W Maddox
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Leahurst, UK
| | - D C Archer
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst, UK.,Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Leahurst, UK
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Practical Fluid Therapy and Treatment Modalities for Field Conditions for Horses and Foals with Gastrointestinal Problems. Vet Clin North Am Equine Pract 2018. [PMID: 29534809 PMCID: PMC7126773 DOI: 10.1016/j.cveq.2017.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kovač M, Huskamp B, Scheidemann W, Toth J, Tambur Z. Survival and Evaluation of Clinical and Laboratory Variables as Prognostic Indicators in Horses Hospitilized with Acute Diarrhea: 342 Cases (1995-2015). ACTA VET-BEOGRAD 2017. [DOI: 10.1515/acve-2017-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
A retrospective study was performed on 342 horses with acute diarrhea (equine colitis). Clinical and laboratory data were obtained upon arrival at the equine hospital. The main focus of this study was to find the difference between the clinical and laboratory variables of surviving and deceased acute colitis horses before the beginning of medical treatment, with the aim to provide a better guideline for determining the prognosis of survival. According to this retrospective study the lethality rate of acute equine colitis was 41.93 %. The time interval from the onset of acute diarrhea to the horse being taken to the clinic was significantly longer in the case of horses which had not survived. The heart rate, hematocrit, blood pH, blood hydrogen carbonate concentration, base excess and HCT/TPP ratio were shown to be significantly related to the survival of horses with colitis. Thus, the hematocrit, appeared to be the most relevant predictor of the outcome of acute equine colitis. Body temperature, respiration rate, total plasma protein and white blood cell count, did not show any prognostic significance.
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Affiliation(s)
- Milomir Kovač
- Veterinary Clinic – New Century, Skryabin Moscow State Veterinary Academy; Moskow, Krasnogorsky district, Nikolo-Uryupino , 143421, Russian Federation
| | | | | | - Joseph Toth
- Veterinary Clinic – Gescher-Hochmoor, Gescher , Germany
| | - Zoran Tambur
- Instittute of Hygiene, Military Medical Academy, Belgrade, Serbia and Faculty of Stomatology in Pančevo, Pančevo , Serbia
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Bauquier JR, Tennent-Brown BS, Tudor E, Bailey SR. Effects of polymyxin-B on TNF-α production in equine whole blood stimulated with three different bacterial toxins. J Vet Pharmacol Ther 2017; 41:e35-e39. [DOI: 10.1111/jvp.12445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Affiliation(s)
- J. R. Bauquier
- Faculty of Veterinary and Agricultural Sciences; Department of Veterinary Clinical Sciences; Melbourne Veterinary School; University of Melbourne; Werribee Vic. Australia
| | - B. S. Tennent-Brown
- Faculty of Veterinary and Agricultural Sciences; Department of Veterinary Clinical Sciences; Melbourne Veterinary School; University of Melbourne; Werribee Vic. Australia
| | - E. Tudor
- Faculty of Veterinary and Agricultural Sciences; Department of Veterinary Biosciences; Melbourne Veterinary School; University of Melbourne; Parkville Vic. Australia
| | - S. R. Bailey
- Faculty of Veterinary and Agricultural Sciences; Department of Veterinary Biosciences; Melbourne Veterinary School; University of Melbourne; Parkville Vic. Australia
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12
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Diseases of the Alimentary Tract. Vet Med (Auckl) 2017. [PMCID: PMC7167529 DOI: 10.1016/b978-0-7020-5246-0.00007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Werners AH. Treatment of endotoxaemia and septicaemia in the equine patient. J Vet Pharmacol Ther 2016; 40:1-15. [PMID: 27452161 DOI: 10.1111/jvp.12329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/02/2016] [Indexed: 12/27/2022]
Abstract
Endotoxins, constituents of the cell wall of gram-positive and gram-negative bacteria, regularly result in severe illness and death in horses. In endotoxaemia, these constituents are present in the systemic circulation; in septicaemia, whole microbes invade normally sterile parts of the body. Interaction of these endotoxins with pathogen recognition receptors leads to an inflammatory response that cannot always be sufficiently contained and hence needs direct treatment. Over the last decennia, our understanding of the pathophysiology of endotoxaemia and septicaemia has significantly increased. Based on improved understanding of the interaction between receptors and endotoxins as well as the subsequent downstream signalling pathways, new therapeutic targets have been identified in laboratory animal species and humans. Important species differences in the recognition of endotoxins and pathogens by their receptors as well as the inflammatory response to receptor activation hamper extrapolation of this information to the horse (and other species). Historically, horses with endotoxaemia and septicaemia have been treated mainly symptomatically and supportively. Based on the identified therapeutic targets, this review describes the current knowledge of the treatment for endotoxaemia and septicaemia in the horse with reference to the findings in other animal species and humans.
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Affiliation(s)
- A H Werners
- Department of Anatomy, Physiology and Pharmacology, School of Veterinary Medicine, St. George's University, True Blue Campus, St. George's, Grenada, West-Indies
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McConachie E, Giguère S, Barton MH. Scoring System for Multiple Organ Dysfunction in Adult Horses with Acute Surgical Gastrointestinal Disease. J Vet Intern Med 2016; 30:1276-83. [PMID: 27296454 PMCID: PMC5094519 DOI: 10.1111/jvim.14321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 03/04/2016] [Accepted: 05/09/2016] [Indexed: 01/28/2023] Open
Abstract
Background The prevalence of multiple organ dysfunction syndrome (MODS) in horses with acute surgical gastrointestinal (GI) disease is unknown. Currently, there are no validated criteria to confirm MODS in adult horses. Objectives To develop criteria for a MODS score for horses with acute surgical colic (MODS SGI) and evaluate the association with 6‐month survival. To compare the MODS SGI score with a MODS score extrapolated from criteria used in people (MODS EQ). Animals Adult horses that required exploratory laparotomy (n = 62) for colic. Healthy adult horses undergoing elective surgical procedures (n = 12) established the reference range of some variables. Methods Prospectively, a MODS SGI score was developed based on organ‐specific criteria established from a literature review, data collection, and clinical judgment. Data for scoring each horse were collected on Days 1 and 2 postoperatively. Horses were scored retrospectively using both scoring criteria. The prognostic performance of the MODS SGI score and its overall performance compared with the MODS EQ score were assessed with receiver operating characteristic (ROC) curve analysis. Results The MODS SGI score had excellent performance for predicting 6‐month survival with an area under the ROC curve (AUC) of 0.95 (95% CI: 0.87–0.99). The AUC for the MODS SGI score was significantly higher than the MODS EQ (AUC: 0.76; 0.63–0.86). Conclusions and Clinical Importance The MODS SGI score predicts 6‐month survival from discharge in horses with acute surgical colic. The MODS SGI score performed better than a score extrapolated from human scoring systems.
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Affiliation(s)
- E McConachie
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - S Giguère
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - M H Barton
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA
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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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Credille BC, Woolums AR, Giguère S, Robertson T, Overton MW, Hurley DJ. Prevalence of bacteremia in dairy cattle with acute puerperal metritis. J Vet Intern Med 2014; 28:1606-12. [PMID: 25103694 PMCID: PMC4895591 DOI: 10.1111/jvim.12418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/21/2014] [Accepted: 06/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background Acute puerperal metritis (APM) affects 30% of postpartum dairy cattle. Bacteremia negatively impacts survival in cattle with coliform mastitis. However, the prevalence of bacteremia in dairy cattle with APM is unknown. Hypothesis Bacteremia is detectable in a large proportion of cattle with APM. Animals Seventeen dairy cows with APM and 17 healthy dairy cattle. Methods Prospective case‐control study. Cases were identified by daily monitoring of cattle in the first 10 days after calving. Controls were matched to cases by parity and days in milk. Cows were examined at the time of identification of APM. A complete blood count, serum biochemical analysis, and bacteriologic culture of blood and lochial fluid were performed on each animal at the time of diagnosis. The same samples were collected from healthy herdmates of a similar parity and days in milk. Blood culture results and clinicopathologic variables were compared between groups. Conditional logistic regression was used to evaluate factors associated with APM, whereas multivariate logistic regression was used to evaluate factors associated with bacteremia. Results Bacteremia occurred in 53% (9/17) of cattle with APM and 53% (8/15) controls. Bacillus spp. was the organism most commonly isolated from the bloodstream in cattle of both groups. Bacteremic cattle in both groups were significantly less likely to have basophils in the peripheral circulation (P = .02) and more likely to have higher serum globulin concentrations (P = .02). Conclusions and Clinical Importance Bacteremia is a common occurrence in postpartum dairy cattle. Further study is warranted to investigate the modes by which bacteria colonize the bloodstream in this population of animals and the importance of bacteremia on health and productivity of affected animals.
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Affiliation(s)
- B C Credille
- Department of Population Health, College of Veterinary Medicine, University of Georgia, Athens, GA
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Kullmann A, Holcombe SJ, Hurcombe SD, Roessner HA, Hauptman JG, Geor RJ, Belknap J. Prophylactic digital cryotherapy is associated with decreased incidence of laminitis in horses diagnosed with colitis. Equine Vet J 2013; 46:554-9. [DOI: 10.1111/evj.12156] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/27/2013] [Indexed: 01/19/2023]
Affiliation(s)
- A. Kullmann
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; USA
| | - S. J. Holcombe
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; USA
| | - S. D. Hurcombe
- Department of Clinical Sciences; College of Veterinary Medicine; The Ohio State University; USA
| | - H. A. Roessner
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; USA
| | - J. G. Hauptman
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; USA
| | - R. J. Geor
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; USA
| | - J. Belknap
- Department of Clinical Sciences; College of Veterinary Medicine; The Ohio State University; USA
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Hurcombe SD, Mudge MC, Daniels JB. Presumptive bacterial translocation in horses with strangulating small intestinal lesions requiring resection and anastomosis. J Vet Emerg Crit Care (San Antonio) 2012; 22:653-60. [DOI: 10.1111/j.1476-4431.2012.00803.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/02/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Samuel D. Hurcombe
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
| | - Margaret C. Mudge
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
| | - Joshua B. Daniels
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus; OH; 43210
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Abstract
Pattern recognition receptors (PRRs) on host cells detect pathogens to activate innate immunity which, in turn, initiates inflammatory and adaptive immune responses. Successful activation of PRRs is, therefore, critical to controlling infections and driving pathogen‐specific adaptive immunity, but overactivity of PRRs causes systemic inflammation, which is detrimental to the host. Here we review the PRR literature as it relates to horses and speculate on the role PRRs may play in sepsis and endotoxaemia.
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Affiliation(s)
- A H Werners
- Anatomy, Physiology and Pharmacology Academic Programme, School of Veterinary Medicine, St George's University, True Blue, Grenada, West Indies
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Declue AE, Johnson PJ, Day JL, Amorim JR, Honaker AR. Pathogen associated molecular pattern motifs from Gram-positive and Gram-negative bacteria induce different inflammatory mediator profiles in equine blood. Vet J 2011; 192:455-60. [PMID: 21974971 DOI: 10.1016/j.tvjl.2011.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 08/30/2011] [Accepted: 09/02/2011] [Indexed: 01/09/2023]
Abstract
Although the incidence of Gram-positive infection in horses is increasing, little is known about differences in inflammatory response between Gram-positive and Gram-negative organisms in this species. Equine blood was stimulated with components of both Gram-negative and Gram-positive organisms: lipopolysaccharide (LPS); lipoteichoic acid (LTA); peptidoglycan (PG); with combinations of LPS, LTA and PG; and with phosphate buffered saline (control). LPS, LTA and PG stimulated tumor necrosis factor (TNF) and interleukin (IL)-6 production but only LTA and PG stimulated IL-1β production from whole blood. LPS was a more potent inducer of TNF than either LTA or PG and both LPS and LTA were more potent inducers of IL-6 than PG. Generally, combinations of pathogen associated molecular patterns (PAMPs) did not elicit greater inflammatory mediator responses when compared to LPS, LTA or PG alone, although there was some synergism between the effects of LPS and LTA. The repertoire of inflammatory mediators provoked by Gram-positive vs. Gram-negative motifs is thus distinctly different. As novel immunomodulatory therapies are developed for use in the horse, care should be exercised when applying treatments for endotoxemia to animals with Gram-positive infections given the different cytokine response profiles.
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Affiliation(s)
- A E Declue
- Comparative Internal Medicine Laboratory, College of Veterinary Medicine, University of Missouri, 900 East Campus Drive, Columbia, MO 65211, USA.
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