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Affiliation(s)
- C. M. Isgren
- Department of Equine Clinical Science Faculty of Health & Life Sciences Institute of Infection, Veterinary and Ecological Sciences University of Liverpool Leahurst UK
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Isgren CM, Maddox TW, Blundell R, Sinovich M, Rubio‐Martinez LM. Advanced imaging of an incomplete fracture and exostosis of the third metacarpal bone in a young Warmblood horse. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.12952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. M. Isgren
- Department of Equine Clinical Science Institute of Veterinary Science University of Liverpool Leahurst Wirral UK
- Department of Epidemiology and Population Health Institute of Infection and Global Health University of Liverpool Leahurst Wirral UK
| | - T. W. Maddox
- Department of Musculoskeletal Biology Institute of Ageing and Chronic Disease University of Liverpool Leahurst Wirral UK
| | - R. Blundell
- Department of Veterinary Pathology, Infection and Public Health Institute of Veterinary Science University of Liverpool Leahurst Wirral UK
| | - M. Sinovich
- Department of Equine Clinical Science Institute of Veterinary Science University of Liverpool Leahurst Wirral UK
| | - L. M. Rubio‐Martinez
- Department of Equine Clinical Science Institute of Veterinary Science University of Liverpool Leahurst Wirral UK
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Isgren CM, Salem SE, Singer ER, Wylie CE, Lipreri G, Graham RJTY, Bladon B, Boswell JC, Fiske-Jackson AR, Mair TS, Rubio-Martínez LM. A multi-centre cohort study investigating the outcome of synovial contamination or sepsis of the calcaneal bursae in horses treated by endoscopic lavage and debridement. Equine Vet J 2019; 52:404-410. [PMID: 31502700 PMCID: PMC7186813 DOI: 10.1111/evj.13180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
Abstract
Background Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited. Objectives To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections. Study design Retrospective analysis of clinical records. Methods Medical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow‐up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival. Results Horses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (hazard ratio, [HR] 0.41, 95% CI 0.18–0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12–5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95% CI 1.78–8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95% CI 1.00–1.02, P = 0.04), post‐operative synoviocentesis (HR 3.18, 95% CI 1.36–7.43, P = 0.006) and post‐operative wound dehiscence (HR 2.5, 95% CI 1.08–5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95% CI 0.11–0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross‐sectional area) (HR 7.92, 95% CI 3.31–19.92, P<0.001). At follow‐up (median 30 months, range 0.25–13 years, n = 70) 87.1% horses were alive, 7.1% had been euthanised due to the calcaneal injury and 5.7% had been euthanised for unrelated reasons. From 57 horses with athletic performance follow‐up, 91.2% returned to the same/higher level of exercise, 5.3% to a lower level and 3.5% were retired due to persistent lameness of the affected limb. Main limitations Retrospective study and incomplete follow‐up. Conclusion Endoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.
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Affiliation(s)
- C M Isgren
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.,Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Wirral, UK
| | - S E Salem
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Wirral, UK.,Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - E R Singer
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - C E Wylie
- Rossdales Equine Hospital, Exning, Newmarket, Suffolk, UK
| | - G Lipreri
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - R J T Y Graham
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - B Bladon
- Donnington Grove Veterinary Group, Newbury, Oxfordshire, UK
| | - J C Boswell
- The Liphook Equine Hospital, Forest Mere, Liphook, Hampshire, UK
| | - A R Fiske-Jackson
- Equine Referral Hospital, Royal Veterinary College, North Mymms, Hertfordshire, UK
| | - T S Mair
- Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent, UK
| | - L M Rubio-Martínez
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.,Sussex Equine Hospital, West Sussex, UK
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Isgren CM, Edwards T, Pinchbeck GL, Winward E, Adams ER, Norton P, Timofte D, Maddox TW, Clegg PD, Williams NJ. Emergence of carriage of CTX-M-15 in faecal Escherichia coli in horses at an equine hospital in the UK; increasing prevalence over a decade (2008-2017). BMC Vet Res 2019; 15:268. [PMID: 31357996 PMCID: PMC6664770 DOI: 10.1186/s12917-019-2011-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/16/2019] [Indexed: 11/23/2022] Open
Abstract
Background This study investigated changes over time in the epidemiology of extended-spectrum β-lactamase (ESBL) producing Escherichia coli within a single equine referral hospital in the UK. Faecal samples were collected from hospitalised horses in 2008 and 2017, processed using selective media and standard susceptibility laboratory methods. A novel real-time PCR with high resolution melt analysis was used to distinguish blaCTX-M-1 and blaCTX-M-15 within CTX-M-1 group. Results In 2008, 457 faecal samples from 103 horses were collected, with ESBL-producing E. coli identified in 131 samples (28.7, 95% CI 24.6–33.1). In 2017, 314 faecal samples were collected from 74 horses with ESBL-producing E. coli identified in 157 samples (50.0, 95% CI 44.5–55.5). There were 135 and 187 non-duplicate ESBL-producing isolates from 2008 and 2017, respectively. In 2008, 12.6% of isolates belonged to CTX-M-1 group, all carrying blaCTX-M-1, whilst in 2017, 94.1% of isolates were CTX-M-1 group positive and of these 39.2 and 60.8% of isolates carried blaCTX-M-1 and blaCTX-M-15, respectively. In addition, the prevalence of doxycycline, gentamicin and 3rd generation cephalosporin resistance increased significantly from 2008 to 2017 while a decreased prevalence of phenotypic resistance to potentiated sulphonamides was observed. Conclusions The real-time PCR proved a reliable and high throughput method to distinguish between blaCTX-M-1 and blaCTX-M-15. Furthermore, its use in this study demonstrated the emergence of faecal carriage of CTX-M-15 in hospitalised horses, with an increase in prevalence of ESBL-producing E. coli as well as increased antimicrobial resistance to frequently used antimicrobials.
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Affiliation(s)
- C M Isgren
- Institute of Infection and Global Health, University of Liverpool, Neston, England.
| | - T Edwards
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, England
| | - G L Pinchbeck
- Institute of Infection and Global Health, University of Liverpool, Neston, England
| | - E Winward
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, England
| | - E R Adams
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, England
| | - P Norton
- Research Centre for Drugs and Diagnostics, Liverpool School of Tropical Medicine, Liverpool, England
| | - D Timofte
- Institute of Infection and Global Health, University of Liverpool, Neston, England.,Institute of Veterinary Science, University of Liverpool, Neston, England
| | - T W Maddox
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, England
| | - P D Clegg
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, England
| | - N J Williams
- Institute of Infection and Global Health, University of Liverpool, Neston, England
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- C. M. Isgren
- Philip Leverhulme Equine Hospital; School of Veterinary Science; University of Liverpool; Neston UK
| | - P. I. Milner
- Department of Musculoskeletal Biology; Institute of Ageing and Chronic Disease; University of Liverpool; Neston UK
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Isgren CM, Salem SE, Archer DC, Worsman FCF, Townsend NB. Risk factors for surgical site infection following laparotomy: Effect of season and perioperative variables and reporting of bacterial isolates in 287 horses. Equine Vet J 2016; 49:39-44. [PMID: 26713622 DOI: 10.1111/evj.12564] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/17/2015] [Indexed: 12/14/2022]
Abstract
REASONS FOR PERFORMING STUDY Surgical site infection (SSI) is an important cause of post operative morbidity following laparotomy. OBJECTIVES To investigate risk factors for SSI, including effect of season and surgery performed outside normal working hours, and to report bacterial isolates and antimicrobial resistance patterns. STUDY DESIGN Retrospective cohort study. METHODS Data were obtained from horses that had undergone exploratory laparotomy over a 3-year period (2010-2013) in a UK hospital population. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration that developed during hospitalisation. Multivariable logistic regression was used to identify associations between pre-, intra- and post operative variables and altered likelihood of SSI. RESULTS Surgical site infection developed in 73/287 (25.4%) horses during hospitalisation. Horses of greater bodyweight (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.0002-1.005, P = 0.03), increased packed cell volume (≥48%) on admission (OR 3.03, 95% CI 1.32-6.94, P = 0.01), small intestinal resection (OR 2.27, 95% CI 1.15-4.46, P = 0.02) and post operative colic (OR 2.86, 95% CI 1.41-5.79, P = 0.003) were significantly associated with increased likelihood of SSI in a multivariable model. SSI was also significantly more likely to occur during winter (OR 3.84, 95% CI 1.38-10.70, P = 0.01) and summer (OR 5.63, 95% CI 2.07-15.3, P = 0.001) months in the model. Three-layer closure of the incision was protective (OR 0.31, 95% CI 0.16-0.58, P<0.001) compared to 2-layer closure. There was no effect of surgery being performed outside normal working hours (P = 0.5). The most common bacterial isolates were Escherichia coli (59.5%), Enterococcus spp. (42.4%) and Staphylococcus spp. (25.4%). Penicillin resistant isolates accounted for 92% (96/104) of isolates while 18% (21/119) of isolates were gentamicin resistant. CONCLUSIONS Laparotomy during winter and summer months was associated with increased likelihood of SSI but there was no effect of surgery performed outside normal working hours. This information assists in identifying horses at high risk of SSI and informing development of preventive strategies.
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Affiliation(s)
- C M Isgren
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
| | - S E Salem
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK.,Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zakazik, Egypt
| | - D C Archer
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
| | - F C F Worsman
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
| | - N B Townsend
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
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Affiliation(s)
- C. M. Isgren
- Philip Leverhulme Equine Hospital; University of Liverpool; Neston Cheshire UK
| | - N. B. Townsend
- Philip Leverhulme Equine Hospital; University of Liverpool; Neston Cheshire UK
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