Background: Surgical site infection (SSI) is a frequent complication following emergency equine laparotomy. It negatively impacts equine welfare, increases treatment costs and is a hospital biosecurity risk justifying investigations of ways to reduce SSI incidence. Objectives: To determine if a sutured-on stent dressing for anaesthetic recovery reduces SSI in horses following emergency laparotomy. Study design: Randomised controlled trial. Methods: Eligible horses undergoing emergency exploratory laparotomy were enrolled. Horses were randomised to have a sutured-on stent dressing (intervention) or standard adhesive textile dressing (control) placed for incisional protection during anaesthetic recovery. Horses were followed up to 90 days postoperatively. Data were analysed according to intention-to-treat principles. Time to SSI (primary outcome) for each group was analysed using a Cox proportional hazard model. Secondary outcomes (SSI during hospitalisation, pyrexia during hospitalisation, days hospitalisation and incisional hernia formation at 90 days) were analysed using Chi-squared tests and a univariable logistic regression model (categorical data) or by comparing means between groups (continuous data). Results: The study included 352 horses (167 intervention group, 185 control group). SSI developed in 101 horses (28.7%) at a mean of 9.7 days (SD 4.6 days). Rate of SSI was not significantly different between intervention and control groups unadjusted (Hazard Ratio [HR] 0.83, 95% CI 0.56 - 1.23, P=0.36) or adjusted for variables significantly associated with rate of SSI (HR 0.88, 95% CI 0.59 – 1.30, P=0.51). There were no significant differences in secondary outcomes between intervention and control groups. Main limitations: This study was performed at a single centre and only evaluated incisional protection for anaesthetic recovery. Conclusions: Use of a sutured-on stent dressing for anaesthetic recovery did not reduce the rate of SSI compared to a textile adhesive dressing. Further RCT are required to investigate efficacy of other interventions on reduction of SSI following emergency laparotomy
Summary The growing problem of antimicrobial resistance affects veterinarians on a daily basis. Antimicrobial stewardship and responsible prescribing are essential for a future with effective antimicrobials, as it is unlikely that new antimicrobials will become available for use in horses in the near future. Extended‐spectrum β‐lactamase (ESBL) producing Enterobacteriaceae , methicillin‐resistant Staphylococcus aureus (MRSA) and Salmonella spp. are pathogens of significant concern but there are also other opportunistic pathogens such as Pseudomonas spp., α‐haemolytic Streptococcu s spp., Enterococcus spp. and Acinetobacter spp. which, due to their high intrinsic resistance, have limited treatment options in adult horses. It is essential that highest priority critically important antimicrobials such as ceftiofur, enrofloxacin, rifampicin and polymyxin B are used prudently in horses and ideally based on culture and antimicrobial susceptibility testing (AST). For example, the use of polymyxin B at a low anti‐endotoxic dose rather than at a higher antimicrobial dose in horses for the treatment of systemic inflammatory response syndrome is a potential driver for resistance to colistin (polymyxin E), an antimicrobial used as a last resort in the treatment of multidrug resistant (MDR) Enterobacteriaceae infections in humans. Serum procalcitonin levels are used in humans to distinguish noninfectious inflammatory conditions from inflammation caused by bacteria and other infectious agents and are also used to guide cessation of antimicrobial treatment. Although no such studies have been performed in horses, this or other markers may prove to be helpful in guiding antimicrobial treatment decisions in the future. Optimising sampling techniques and good communication with the microbiology laboratory are essential for generating the accurate culture and AST results that underpin appropriate antimicrobial use. Additionally, there is clearly a need for national and international harmonisation of laboratory methods in order to improve the reliability and consistency of results reported by different laboratories.
Summary Despite recent developments in advanced imaging, radiography remains the most commonly employed imaging modality for investigating apical infection of cheek teeth in horses. Radiographic technique, knowledge of the normal anatomy and horse compliance are paramount for acquiring good quality dental radiographs. Interpretation of subtle pathology can be difficult for even the most experienced radiologist; however, in more chronic cases, identification of dental abnormalities is easier.
Recurrent exertional rhabdomyolysis (RER) in Thoroughbred and Standardbred racehorses is characterized by episodes of muscle rigidity and cell damage that often recur upon strenuous exercise. The objective was to evaluate the importance of genetic factors in RER by obtaining an unbiased estimate of heritability in cohorts of unrelated Thoroughbred and Standardbred racehorses. Four hundred ninety-one Thoroughbred and 196 Standardbred racehorses were genotyped with the 54K or 74K SNP genotyping arrays. Heritability was calculated from genome-wide SNP data with a mixed linear and Bayesian model, utilizing the standard genetic relationship matrix (GRM). Both the mixed linear and Bayesian models estimated heritability of RER in Thoroughbreds to be approximately 0.34 and in Standardbred racehorses to be approximately 0.45 after adjusting for disease prevalence and sex. To account for potential differences in the genetic architecture of the underlying causal variants, heritability estimates were adjusted based on linkage disequilibrium weighted kinship matrix, minor allele frequency and variant effect size, yielding heritability estimates that ranged between 0.41–0.46 (Thoroughbreds) and 0.39–0.49 (Standardbreds). In conclusion, between 34–46% and 39–49% of the variance in RER susceptibility in Thoroughbred and Standardbred racehorses, respectively, can be explained by the SNPs present on these 2 genotyping arrays, indicating that RER is moderately heritable. These data provide further rationale for the investigation of genetic mutations associated with RER susceptibility.
Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited.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.Retrospective analysis of clinical records.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.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.Retrospective study and incomplete follow-up.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.
Abstract There are few documented cases of facial abscesses due to masseter abscess formation in South American camelids. Facial swellings in South American camelids have been reported and are frequently due to apical tooth root infections. Masseter abscess has been described in people. However, this lesion has not previously been described in South American camelids. This case report describes the clinical signs, diagnostic procedures and pathological findings in adult male Huacaya alpaca suffering from a masseter abscess caused by Fusobacterium necrophorum and Actinomyces spp. The mass was delimited by computed tomography and removed under general anaesthesia. The histopathology of the mass revealed severe focally extensive suppurative inflammation, which infiltrated and effaced the skeletal muscle. Bacterial cultures revealed that the abscess was caused by Fusobacterium necrophorum and Actinomyces spp. Once removed, the alpaca was started on antimicrobial therapy and did fully recover at the farm.
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. 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. 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.
Summary 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 ( SSI s) 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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