Nosocomial infections and antimicrobial resistance in critical care medicine

Objective: To review the human and companion animal veterinary literature on nosocomial infections and antimicrobial drug resistance as they pertain to the critically ill patient. Data sources: Data from human and veterinary sources were reviewed using PubMed and CAB. Human data synthesis: There is a large amount of published data on nosocomially‐acquired bloodstream infections, pneumonia, urinary tract infections and surgical site infections, and strategies to minimize the frequency of these infections, in human medicine. Nosocomial infections caused by multi‐drug‐resistant (MDR) pathogens are a leading cause of increased patient morbidity and mortality, medical treatment costs, and prolonged hospital stay. Epidemiology and risk factor analyses have shown that the major risk factor for the development of antimicrobial resistance in critically ill human patients is heavy antibiotic usage. Veterinary data synthesis: There is a paucity of information on the development of antimicrobial drug resistance and nosocomially‐acquired infections in critically ill small animal veterinary patients. Mechanisms of antimicrobial drug resistance are universal, although the selection effects created by antibiotic usage may be less significant in veterinary patients. Future studies on the development of antimicrobial drug resistance in critically ill animals may benefit from research that has been conducted in humans. Conclusions: Antimicrobial use in critically ill patients selects for antimicrobial drug resistance and MDR nosocomial pathogens. The choice of antimicrobials should be prudent and based on regular surveillance studies and accurate microbiological diagnostics. Antimicrobial drug resistance is becoming an increasing problem in veterinary medicine, particularly in the critical care setting, and institution‐specific strategies should be developed to prevent the emergence of MDR infections. The collation of data from tertiary‐care veterinary hospitals may identify trends in antimicrobial drug resistance patterns in nosocomial pathogens and aid in formulating guidelines for antimicrobial use.     

Interactions between viral infection and immune mechanisms

Viruses differ from other infectious agents mainly in two respects: (a) they may be generated in the genome of normal cells and, in other instances, reinserted into the genome as proviruses, (b) they may participate in all pathologic processes that form the main subject of immune surveillance and immunity such as infectious diseases, tumourous growth, and, auto-aggressive processes.

Due to intracellular and cell modifying character of virus infection, the immune mechanisms are often unsuccessful in elimination of the agent from the vertebrate organism and may show disturbances contributing to development of a persistent viral disease. As exemplified by two forms of leprosy, intracellular bacteria may also cause ‘slow’ diseases. Their course, in analogy with viral slow diseases, seems to reflect the changed immunological potential of the infected host.     

Imaging suppurative infections of the central nervous system in horses

Suppurative infections are typically caused by pyogenic bacteria, and are characterised by the formation of purulent exudates (pus). These infections may occur anywhere in the body and are particularly life‐threatening when pertaining to the central nervous system (CNS). Suppurative infections of the CNS may be due to trauma, local extension of disease, and haematogenous spread. In horses, suppurative infections are an important cause of morbidity and mortality, but only infrequently involve the CNS. The gross morphology of suppurative inflammation is described as phlegmon, abscess and empyema, with each form having characteristic morphological features that may be identified during advanced imaging of the CNS. In horses with known or suspected suppurative infection of the CNS, imaging may be performed to reduce diagnostic uncertainty, determine prognosis, or to describe the character and extent of the disease to guide case management.     

A Serological Study on The Prevalence of Toxoplasma Gondii in Meat-Producing Animals in Sweden

Sera from 200 sheep, swine and cattle, respectively, collected at slaughter at each of 3 abattoirs situated in the north, middle and south of Sweden were examined for the presence of antibodies to Toxoplasma gondii by the indirect fluorescent antibody test. Seropositive animals (titre ≥ 1:20) were found at the following rates from north to south: sheep 60%, 66% and 68.5%, swine 9%, 2.5% and 37%, and cattle 10%, 6 % and 35%. The significance of the serological findings is discussed, and it is concluded that T. gondii infection is common in Swedish farm animals. Thus the meat from particularly swine and sheep may provide a potential source of human toxoplasmosis.     

Intranasal vaccination against upper respiratory tract disease (U.R.D.) in the cat—I. Virological and serological observations in cats suffering from U.R.D.

A number of cat colonies in The Netherlands, in which upper respiratory tract disease (U.R.D.) was endemic, were examined for the presence of feline herpes virus (H) and feline calici virus (C) infections. In total 108 cats were examined. In 59% of the cases feline calici virus was isolated and feline herpes virus in 39% of the cases. Mixed infections were found in 26% of the cats. The virus isolates were all neutralised by anti-sera against attenuated strains of feline herpes virus and feline calici virus which are incorporated in a newly developed combined C-H vaccine against U.R.D. in cats. Intranasal application of this vaccine induced a distinct increase in resistance against experimental challenge with virulent C and H, as soon as 24 hours after vaccination.     

Pathological studies of cheek teeth apical infections in the horse: 5. Aetiopathological findings in 57 apically infected maxillary cheek teeth and histological and ultrastructural findings

Examination of 57 apically infected maxillary cheek teeth (CT) showed one or more viable pulps and minimal apical calcified tissue changes present in recently infected CT. With chronic infections, pulps were necrotic or absent, pulp horns were filled with food if occlusal pulpar exposure was present, and gross caries of dentine was occasionally present. With chronic infections, the apical changes varied from gross destructive changes in some teeth, to extensive proliferative calcified apical changes in others. Infundibular caries was believed to cause apical infection in just 16% of infected (maxillary) CT, anachoretic infection in 51%, periodontal spread in 12%, fractures and fissures in 9%, dysplasia in 5% and miscellaneous or undiagnosed causes in 7%.Histology showed viable pulp and absence of circumpulpar dentinal changes in some recently infected CT, but chronically infected teeth had loss of predentine and progressive destruction of the circumpulpar secondary, and even primary dentine, with bacteria identified within the dentinal tubules surrounding infected pulps. Tertiary dentine deposition was rarely detected. Scanning and transmission electron microscopy confirmed these histological findings and showed extensive destructive changes, especially to the dentinal architecture surrounding the pulp chambers of some infected teeth.     

ANTIMICROBIAL SUSCEPTIBILITY PATTERNS OF BIOFILM FORMING STAPHYLOCOCCUS AUREUS ISOLATED FROM PIGEON EXTERNAL OCULAR INFECTIONS

Pathogenic microorganisms are commonly associated with external ocular infections in birds. Pathogen virulence factors as well as reduced host defenses resulting from poor living conditions, nutrition, genetics, physiology, hygiene, fever, and age may increase host susceptibility. Staphylococcus species are bacteria known to serve as opportunistic pathogens in eye infections. The changing profile of microorganisms involved in ocular infections and the emergence of acquired microbial resistance dictate the need for investigative studies regarding bacterial profiles and antimicrobial susceptibility patterns for external ocular infections. The aim of this study was to determine the prevalence of Staphylococcus aureus ocular infections in pigeons and to evaluate their biofilm production ability and antibiotic resistance patterns. Twenty pigeons with confirmed eye infections were included in this project. Conjunctival specimens were collected with swabs presoaked in sterile normal saline. Bacterial growth was identified by standard laboratory procedures and susceptibility testing of the isolates was performed by the Kirby-Bauer method. The ability of the isolates to form a biofilm was also assessed using the microtiter plate method. Of the 20 specimens processed, 20% of the pigeons had staphylococcal eye infections. The resistance pattern of these isolates showed that Staphylococcus spp. from pigeon samples were resistant to tetracycline (100%), erythromycin (100%), azithromycin (100%), nalidixic acid (100%), and cefazolin (50%). All of the Staphylococcus spp. isolated from the pigeons were susceptible to gentamycin and furazolidone. The results of the biofilm detection test showed that 75% of the isolates were biofilm producers. In conclusion, biofilm forming S. aureus with multidrug resistance patterns were the most prevalent bacteria isolated from the pigeons examined in this research study.