Nosocomial Infections

Reid K. Nakamura, DVM, DACVECC, Emily Tompkins, DVM
Compendium, 2012

Nosocomial infections (NIs) are infections acquired by patients during hospitalization. An estimated 5% to 10% of human patients admitted to hospitals develop an NI.1 Among identified pathogens in human intensive care units (ICUs), 70% are resistant to at least one antimicrobial.2 In 2008, 64% of biosecurity experts at veterinary teaching hospitals believed that the risk of NI among their patients had increased in the preceding 10 years.3 Between 2003 and 2008, 82% of veterinary teaching hospitals reported outbreaks of NIs and 45% reported more than one NI outbreak.3 In human medicine, urinary tract infections (UTIs), pneumonia, surgical site infections (SSIs), and bloodstream infections (BSIs) account for approximately 80% of all NIs.4 This article reviews the most common NIs, the human and veterinary literature for each type of infection, and the diagnostic and treatment protocols as well as prevention strategies.

Abdominal and thoracic focused assessment with sonography for trauma, triage, and monitoring in small animals

Gregory R. Lisciandro, DVM, DABVP, DACVECC
Journal of Veterinary Emergency and Critical Care 21(2) 
2011. 

Objectives – To review the nonradiologist use of ultrasound (US) in the setting of emergency and critical care, the development, clinical applications, and standardization of veterinary abdominal and thoracic focused assessment with sonography for trauma (FAST) techniques.

Etiology – Since the 1990s, the 4-point FAST US technique has been used for injury surveillance in people with blunt and penetrating trauma. FAST screens for free fluid in the abdominal, pleural, and pericardial cavities with high sensitivity and specificity. More recently, an extended FAST scan was developed for the rapid detection of pneumothorax. These techniques and newly created scans have been applied to other critically ill, nontraumatized, subsets of human patients. As a result, the terminology related to this field, eg, extended FAST, HHFAST, FFAST, FAFF, BOAST, SLOH, bedside US, ‘$ Approach,’ protocols, and objectives have become convoluted despite having similar goals.

Diagnosis – The importance of US in the setting of emergency medicine is highlighted by the fact that this diagnostic modality has become an integral part of the core curriculum for nonradiologists including the American College of Surgeons, American College of Emergency Physicians, American Board of Emergency Medicine, Society of Academic Emergency Medicine, and all United States Accreditation Council for Graduate Medical Education Emergency Medicine residency programs.

Therapy – Veterinary applications of FAST techniques include an abdominal FAST technique with an abdominal FAST applied fluid scoring system, and a thoracic FAST technique. In an attempt to avoid the creation of numerous acronyms, veterinarians would be well served by making the ‘T’ in ‘FAST’ stand for ‘Trauma,’ ‘Triage,’ and ‘Tracking.’ Prognosis – These veterinary FAST techniques provide an extension of the physical examination for the emergency and critical care veterinarian potentially expediting diagnosis, prompting life-saving maneuvers, and guiding patient management. Further clinical research to determine sensitivity, specificity, and accuracy for specific conditions is warranted.

Enteropathogenic Bacteria in Dogs and Cats: Diagnosis, Epidemiology, Treatment, and Control

S.L. Marks, S.C. Rankin, B.A. Byrne, and J.S. Wee
J Vet Intern Med 2011;25:1195–120. 

2011.

This report offers a consensus opinion on the diagnosis, epidemiology, treatment, and control of the primary enteropathogenic bacteria in dogs and cats, with an emphasis on Clostridium difficile, Clostridium perfringens, Campylobacter spp., Salmonella spp., and Escherichia coli associated with granulomatous colitis in Boxers. Veterinarians are challenged when attempting to diagnose animals with suspected bacterial-associated diarrhea because well-scrutinized practice guidelines that provide objective recommendations for implementing fecal testing are lacking. This problem is compounded by similar isolation rates for putative bacterial enteropathogens in animals with and without diarrhea, and by the lack of consensus among veterinary diagnostic laboratories as to which diagnostic assays should be utilized. Most bacterial enteropathogens are associated with self-limiting diarrhea, and injudicious administration of antimicrobials could be more harmful than beneficial. Salmonella and Campylobacter are well-documented zoonoses, but antimicrobial administration is not routinely advocated in uncomplicated cases and supportive therapy is recommended. Basic practices of isolation, use of appropriate protective equipment, and proper cleaning and disinfection are the mainstays of control. Handwashing with soap and water is preferred over use of alcohol-based hand sanitizers because spores of C. difficile and C. perfringens are alcohol-resistant, but susceptible to bleach (1:10 to 1:20 dilution of regular household bleach) and accelerated hydrogen peroxide. The implementation of practice guidelines in combination with the integration of validated molecular-based testing and conventional testing is pivotal if we are to optimize the identification and management of enteropathogenic bacteria in dogs and cats

Ultrasound of the Gastrointestinal Tract

Martha Moon Larson, DVM, MS,
David S. Biller, DV

Vet Clin Small Anim 39 (2009) 747–759

Familiarity with the normal and abnormal ultrasound appearance of the canine and feline gastrointestinal (GI) tract provides a marked advantage in the diagnosis of GI disease. Although gas may inhibit complete visualization, in many cases, ultrasound is able to confirm or rule out suspected disease. It should be noted that ultrasound of the GI tract does not preclude the need for abdominal radiographs. The two imaging modalities are complementary, and each adds individual information. Ultrasound evaluation of the GI tract provides information about bowel wall thickness and layers, assessment of motility, and visualization of important adjacent structures such as lymph nodes and peritoneum. In the hands of experienced sonographers, abdominal ultrasound has replaced the need for GI contrast studies in many cases, saving time, money, radiation exposure, and stress to the patient.

Managing Acute Spinal Cord Injuries

Stephanie Kube, DVM, DACVIM, Natasha Olby, VetMB, PhD, DACVIMCompendium, September 2008

Acute spinal cord injuries commonly seen in veterinary patients include vascular, compressive, and concussive injuries. Vascular lesions, or infarcts, are usually caused by fibrocartilagenous emboli. Concussive and compressive injuries have a variety of pathologies, including intervertebral disk disease, fractures, and luxations (dislocations) of the vertebral column. Although considerable controversy exists over the most appropriate way to manage acute spinal cord injuries, early surgical intervention or decompression remains the best treatment option in managing acute compressive injuries in veterinary patients. High-dose methylprednisolone sodium succinate, an established treatment in human medicine, is falling out of favor because studies have shown little therapeutic benefit and severe adverse effects.

Fluoroquinolones – Then and Now

Lidia M. Pallo-Zimmerman, DVM, DACVIM, Julie K. Byron, DVM, MS, DACVIM, Thomas K. Graves, DVM, PhD, DACVIM
Compendium, July 2010

Fluoroquinolones were discovered in the 1960s as a derivative of the antimalarial drug chloroquine. Over the past 40 years, many fluoroquinolones have been developed for use in human and veterinary medicine. As with all classes of antibiotics, resistance to fluoroquinolones is a serious concern, and multiple avenues for resistance are being investigated. Resistance-associated point mutations in bacterial DNA and, more recently, plasmid-mediated resistance have been reported in both human and veterinary bacterial isolates. This article reviews the history and most current literature on fluoroquinolones approved for use in dogs and cats and the spectra of activity, mechanisms of action, resistance patterns, and recommendations for appropriate clinical use of these drugs

Ultrasound of the Gastrointestinal Tract

Martha Moon Larson, DVM, MS, David S. Biller, DVM
Vet Clin Small Anim 39 (2009) 747–759

Familiarity with the normal and abnormal ultrasound appearance of the canine and feline gastrointestinal (GI) tract provides a marked advantage in the diagnosis of GI disease. Although gas may inhibit complete visualization, in many cases, ultrasound is able to confirm or rule out suspected disease. It should be noted that ultrasound of the GI tract does not preclude the need for abdominal radiographs. The two imaging modalities are complementary, and each adds individual information. Ultrasound evaluation of the GI tract provides information about bowel wall thickness and layers, assessment of motility, and visualization of important adjacent structures such as lymph nodes and peritoneum. In the hands of experienced sonographers, abdominal ultrasound has replaced the need for GI contrast studies in many cases, saving time, money, radiation exposure, and stress to the patient.

Guidelines for Reducing Pathogens in Veterinary Hospitals - Disinfectant Selection, Cleaning Protocols, and Hand Hygiene

Joshua A. Portner, DVM, DACVECC, 
Justine A. Johnson, DVM, DACVECC
Compendium, 2010

Antibiotic resistance is a growing problem in the hospital setting. Organisms that cause hospital-acquired infections are generally highly resistant, requiring expensive antibiotics and further hospitalization. As a result, many owners of infected pets choose euthanasia. Appropriate hospital disinfection and staff hygiene practices can prevent such infections by reducing the pathogen load in a facility in accordance with the "nosocomial prevention triad"—appropriate antibiotic usage, staff and patient hygiene, and hospital maintenance and disinfection. This review outlines the development and implementation of hospital disinfection protocols and hand hygiene practices in small animal veterinary hospital

Feline Pediatrics - How to Treat the Small and the Sick

Susan Little DVM
Compendium, 2011

Most veterinarians have been presented with kittens that have failed to thrive. These patients are challenging due to their small size, their unfamiliar physiology, and the tendency for their status to deteriorate quickly. The most common general causes of illness and failure to thrive are maternal, gestational, environmental, genetic, and infectious factors. In much of the veterinary literature, the neonatal period is defined as the first 4 weeks of life. However, it is clinically useful to consider defined risk periods: the first 4 days of life (when many problems are related to labor and delivery or the environment); between 21 and 28 days of age (when important changes leading to neurologic and behavioral maturation take place); and weaning (4 to 6 weeks of age).

Dystocia

Sergio Serrano, LV, DVM, DACVECC 
Matthew McMillan, BVM&S, MRCVS
Standars of Care of Compendium 

February of 2009

Dystocia is a relatively common emergency presentation. It occurs in 3.3% to 5.8% of all feline pregnancies; in dogs, the overall rate is around 5%. However, dystocia rates are breed specific: only 0.8% to 2.3% of pregnancies in cats with a normal conformation result in dystocia, whereas in some large-headed and achondroplastic dog breeds, the rate can approach 100%.

Diskospondylitis in Dogs

Alireza A. Gorgi, DVM 
Dennis O’Brien, DVM, PhD, DACVIM (Neurology)
Compendium

June, 2007.

Diskospondylitis is an infection of the intervertebral disk and the end plates of the adjacent vertebrae. This disease is fairly common in dogs and has been seen with many different bacterial infections and some fungal infections. Staphylococcal infections are the most common cause of diskospondylitis in dogs. Other common causes include infections with Streptococcus spp, Escherichia coli, and Brucella canis. Some of the less common organisms isolated include Klebsiella, Pseudomonas, Proteus, Actinomyces, Pasteurella, Candida, and Mycobacterium spp. Fungal diseases such as infection with Aspergillus or Paecilomyces spp as well as unspecified fungal infections have also been reported as causes of diskospondylitis.

Pulmonary tromboembolism

Heidi New, DVM, Christopher G. Byers, 
DVM, DACVECC, DACVIM (SAIM)
Compendium, 2011

Pulmonary thromboembolism (PTE) has been associated with many diseases. Clot formation is a consequence of hypercoagulability, blood stasis, and damage to the endothelium of blood vessels, a set of changes known as the Virchow triad. Diagnosing PTE may be difficult because common clinical signs, including tachypnea, dyspnea, and hypoxemia, are not pathognomonic for the disease. The initial workup for PTE should include arterial blood gas analysis and thoracic radiography. If there is a strong clinical suspicion for PTE, further tests are indicated, such as D-dimer measurement, thromboelastography, and advanced imaging..

Acute respiratory distress syndrome in dogs and cats - a review of clinical findings and pathophysiology

Amy E. DeClue, DVM, MS, DACVIM
Leah A. Cohn, DVM, PhD, DACVIM
Journal of Veterinary Emergency and Critical Care 
17(4) 2007, pp 340–347

Unfortunately, current mortality rates for ARDS in small animals are close to 100%. As our capability to treat patients with advanced life-threatening disease increases, it is vital that we develop a familiarity with the pathogenesis of ARDS. Understanding the complex inflammatory interactions is essential for determining effective preventative and management strategies as well as designing novel therapies for veterinary patients.

Feline Pyothorax

Tonya E. Boyle, DVM 
Eleanor C. Hawkins, DVM, DACVIM
Standars of Care
August 2005

Pyothorax is the presence of a suppurative, septic effusion within the pleural space. It is typically easy to diagnose via cytologic analysis of fluid obtained by thoracentesis. The fluid obtained may be very turbid and can range in color from white to brown or red. Pyothorax is characterized as an exudate with protein above 3.5 g/dl, total nucleated cell count exceeding 7,000/μl of mostly degenerative neutrophils, pH below 6.9, and glucose concentration less than 10 mg/dl. Generally, extracellular and intracellular bacterial organisms are present on cytologic examination if the patient has not received antibiotic therapy before thoracentesis is performed. Because many cats with pyothorax present in respiratory distress, initial thoracentesis can be both a stabilizing, therapeutic measure as well as a definitive diagnostic test.

Causes and management of complications in wound healing

Jackie Demetriou and Silke Stein
In Practice September 2011 
Volume 33 - 392–400.

Although most wound complications are not life-threatening, they can involve prolonged periods of discomfort for the animal and extended veterinary care, as well as increased costs for owners. However, with the appropriate treatment, most wound complications can be managed successfully. This article describes what might be expected of a normal healing wound, and discusses the common causes of complications in small animals and how these can be managed.

Complications of Ovariohysterectomy and Orchiectomy in Companion Animals

Christopher A. Adin, DVM
Vet Clin Small Anim 41 (2011) 1023–1039
September 2011

Ovariohysterectomy (OVH) and orchiectomy are two of the most commonly performed surgeries in companion animal practice. Techniques for accomplishing surgical sterilization vary widely between geographic areas. While a ventral midline OVH is the standard technique in the United States, veterinarians in continental Europe commonly use a ventral midline ovariectomy, and practitioners in the United Kingdom perform flank OVH. Interestingly, retrospective analyses have shown no significant differences in the rate of stump pyometra, urinary incontinence, or other complications when these techniques are compared, so there is no strong rationale to prefer one technique over another.

Complications of Gastrointestinal Surgery in Companion Animals

Gary W. Ellison, DVM, MS
Vet Clin Small Anim 41 (2011) 915–934. 

September 2011

The small animal surgeon routinely creates wounds in the gastrointestinal (GI) tract for biopsy, for foreign body or neoplasm removal for correction of gastric dilatation volvulus, or to relieve intestinal and colonic obstruction. Unlike dehiscence of a skin wound, which is often easily remedied with appropriate local wound treatment, dehiscence of a wound of the GI tract often leads to generalized bacterial peritonitis and potentially death. Consequently, technical failures and factors that negatively affect GI healing are of great clinical significance to the surgeon. Surgery of the GI tract must be considered clean-contaminated at best, and as one progresses aborally down the GI tract, the bacterial population increases. Therefore, intraoperative spillage, wound dehiscence, or perforations that occur in the lower small intestine or colon tend to be associated with a higher mortality rate than those of the stomach or upper small intestine.

Managing cats with cancer: An examination of ethical perspectives

Antony S Moore BVSc MVSc
Journal of Feline Medicine and Surgery 
(2011) 13, 661–67

Caring for cancer patients presents many ethical issues for veterinarians and other veterinary health workers. The issues that most veterinarians think of relate to management of the patient when the owners’ preferences for treatment do not appear to be in the animal’s best interest, as well as concerns about toxicities and about costs of veterinary services (advanced imaging, surgery, radiation therapy and chemotherapy). While not limited to the veterinary profession, we are more often faced with dilemmas about the appropriateness of palliative care and decisions about euthanasia than our medical colleagues. Equally important are the ethics of not treating patients, and the integration of unproven and alternative strategies into conventional care. A separate ethical issue arises from investigational therapies and research. Less often considered, but nonetheless relevant, are the ethics of suboptimal evaluation (staging) of patients prior to treatment, or of not informing owners about all the options available

Causes of pancytopenia y dogs and cats

Shawn Ann Kearns, DVM 
Patty Ewing, DVM, MS, DACVP
Compendium 
February 2006

Pancytopenia (i.e., a decrease in all circulating hematologic cell lines) can result from peripheral destruction of cells or a primary insult to the bone marrow. Many infectious, immunemediated, and neoplastic conditions have been associated with pancytopenia in dogs and cats. Bone marrow aspirates and/or core biopsy samples are generally required to fully characterize the marrow disease, especially in cases of decreased hematopoietic cell production. Understanding the mechanisms by which various disorders alter circulating blood or marrow cells may aid in developing a diagnostic and/or treatment plan.The prognosis in pancytopenic patients is variable and depends on the underlying cause.

Flea control in flea allergic dogs and cats

Marie-Christine Cadiergues
EJCAP - Vol. 19 - Issue 3 
December 2009

Flea allergy dermatitis (FAD) remains the most common allergic skin disease of dogs and cats, although its frequency varies according to geographical location. Despite the availability of safe, effective products, treating FAD remains a challenge. This challenge should be more readily overcome once both practitioner and owner(s) are entirely convinced of the diagnosis. The main diffi culties and pitfalls facing the practitioner are described. Treatment requires appropriate knowledge of the fl ea life cycle and fl ea-related biology, and understanding of the mode of action of the relevant fl ea control products. An integrated approach to treatment should be adopted, involving all the players in the fl ea life cycle - the FAD patient, all in-contact pets, and the environment. Each case must be customised, with effective fl ea control products used in combination with cleaning measures such as steaming, vacuuming and regular grooming.