An outbreak of salmonellosis among horses at a veterinary teaching hospital

Between May 1996 and February 1997, 27 horses and a veterinary student at a veterinary teaching hospital developed apparent nosocomial Salmonella Typhimurium infection. The source of the multiple-drug resistant Salmonella Typhimurium was a neonatal foal admitted for treatment of septicemia. A high infection rate (approx 13% of hospitalized horses) coupled with a high case fatality rate (44%) for the initial 18 horses affected led to a decision to close the hospital for extensive cleaning and disinfection. Despite this effort and modification of hospital policies for infection control, 9 additional horses developed nosocomial Salmonella Typhimurium infection during the 6 months after the hospital reopened. Polymerase chain reaction testing of environmental samples was useful in identifying a potential reservoir of the organism in drains in the isolation facility. Coupled with clinical data, comparison of antimicrobial resistance patterns of Salmonella Typhimurium isolates provided a rapid initial means to support or refute nosocomial infection. Although minor changes in the genome of these isolates developed over the course of the outbreak, pulsed-field gel electrophoresis testing further supported that salmonellosis was nosocomial in all 27 horses.     

Quality of computerized medical record abstract data at a veterinary teaching hospital

This study was designed to evaluate the quality of data from computerized medical record abstracts at the Veterinary Teaching Hospital, Ontario Veterinary College. Information in the paper medical record (registration, physical exam, daily progress, laboratory, radiology, anaesthesia and surgery forms), the summary sheet, and the computerized record were compared. A random sample of 100 patient visits from a subset of visits that were identified as all possible dog or cat elective-surgery visits in the computerized records from 1983 through 1991 were used. Clinicians were responsible for summarizing the medical record on the summary sheet and health record technicians entered the information from the summary sheet into the computer record. Most of the discrepancies (n = 33) noted for diagnoses, procedures or complications were due to the lack of transfer of information from the paper forms to the summary sheet. Although the medical record technicians detected and entered some of these (n = 10), most were not entered into the computerized records. The next most-common discrepancies (n = 5) were due to the clinician writing a different entry on the summary sheet than was present on the other paper record forms. Only one record had a miscoded diagnosis and three had miscoded procedures. Misfiled forms in the medical record folders of two patients resulted in one incorrect diagnosis and one incorrect procedure recorded in the computer record. When any discrepancy between the paper and computer record for diagnoses, procedures or complications was considered, 41% of the visits had discrepancies (46% dogs; 36% cats). The percentage varied by surgery status: non-elective surgeries 82%, elective surgeries 37% and non-surgical visits 29%. There was no obvious time trend. The completeness and accuracy of information in the database was inadequate for the intended research on post-operative complications following elective surgeries.     

Characteristics of Salmonella isolated from animals at a veterinary medical teaching hospital

Salmonella belonging to 47 serotypes was isolated from animals at the University of California Veterinary Medical Teaching Hospital during the years 1974 to 1983. Salmonella belonging to 12 serotypes accounted for 89% of the 725 isolates. Salmonella typhimurium (including var copenhagen) was the most commonly isolated serotype, but during 1981 to 1983, S krefeld and S saint-paul were predominant. Certain serotypes seemed to be isolated more frequently from extraintestinal sources (S typhi-suis, S dublin). Although resistance to ampicillin, kanamycin, neomycin, streptomycin, and sulfonamides was common (greater than 60% of the isolates were resistant), resistance to chloramphenicol, gentamicin, and trimethoprim-sulfonamides was infrequent, except for isolates of S krefeld and S saint-paul.     

Transmission of opportunistic pathogens in a veterinary teaching hospital

Acinetobacter baumannii, Enterococcus faecalis, Enterococcus faecium, and Staphylococcus intermedius isolates from infected surgical wounds and other types of infections in a veterinary teaching hospital were typed by pulsed field gel electrophoresis. A first cluster of infections with a multiresistant A. baumannii strain was observed in dogs and cats in 1998-1999. This strain disappeared after cleaning and disinfection of the companion animals intensive care unit. It was followed in 2000 by a second multiresistant strain, which caused another cluster of infections and was also transmitted to a patient in the nearby horse clinic. Transmission of a multiresistant E. faecium strain between two cats with surgical wound infections was also observed during the same period. No multiresistant S. intermedius strain was observed during this time and transmission of this organism between patients did not seem to occur. The present study demonstrates the potential for hospital nosocomial resistance problems in veterinary medicine similar to those encountered in human medicine. The results suggest that the epidemiology of nosocomial infections with A. baumannii and E. faecium may differ from that of S. intermedius infections and that preventive measures may have to be adapted to the problem organism.     

Complications observed during and after ovariohysterectomy of 142 bitches at a veterinary teaching hospital

The clinical, anaesthetic and surgical records of 142 bitches admitted into the primary care clinic at the Small Animal Hospital, University of Liverpool, between January 2002 and August 2004 for routine ovariohysterectomy by final-year students were analysed for complications during and after the surgery. The time taken to perform the surgical procedure was recorded, to allow assessment of the time involved in one-to-one surgical teaching during live-recovery surgeries of client-owned pets. The types of complications were similar to those reported in earlier studies: nine bitches suffered haemorrhage of the ovarian arteries during surgery, and there were four cases of haemorrhage after surgery, 12 cases of wound inflammation and four other types of complication. The rates of intraoperative, postoperative and total complications were 6.3, 14.1 and 20.6 per cent, respectively.     

Prevalence and characteristics of pain in dogs and cats examined as outpatients at a veterinary teaching hospital

OBJECTIVE: To determine prevalence of pain among dogs and cats examined as outpatients at a veterinary teaching hospital and characteristics of pain in dogs and cats with evidence of pain. DESIGN: Cross-sectional study. ANIMALS: 1,153 dogs and 652 cats examined as outpatients at The Ohio State University during 2002. PROCEDURE: A questionnaire was administered to owners of all dogs and cats. For dogs and cats with evidence of pain, the cause, signs, anatomic location, type (superficial somatic, deep somatic, or visceral), duration, and severity of the pain and the principle mechanism (inflammatory, neuropathic, both, or unknown) responsible for the pain were determined on the basis of questionnaire responses and results of physical examination. The presence of primary hyperalgesia, secondary hyperalgesia, allodynia, and hyposensitivity was recorded. RESULTS: 231 (20%) dogs and 92 (14%) cats had evidence of pain. Dogs with evidence of pain were significantly older and heavier than dogs without. Cats with evidence of pain were significantly older than cats without. In most dogs and cats with evidence of pain, the pain was determined to be of short duration (< 7 days), of mild or moderate severity, somatic, associated with primary hyperalgesia, and inflammatory. Analgesic drugs were frequently administered to dogs with chronic pain, but were not always considered effective. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that mild or moderate pain associated with inflammation may be seen in dogs and cats examined as outpatients. Older, heavier dogs and older cats were more likely to have evidence of pain.     

A quantitative summary of nutrition support services in a veterinary teaching hospital

A full-time nutrition support service provided 1,133 consultations in a small animal teaching hospital from July 1986 to June 1988, consisting of 840 dogs, 260 cats, 23 exotic species, and 10 consultations with incomplete information. The dog and cat consultations represented 2.1 and 3.7% of canine and feline admissions, respectively. Consultations involved the determination of nutritional goals which led to recommendations of specific dietary regimens. Most frequent requests were for diet evaluation and diet formulation to meet estimated calorie and protein needs during illness and stress (23%), for specific calorie or nutrient modification given a working diagnosis (23%), and for avoidance of tissue utilization or weight loss (23%). Frequently involved single organ systems were gastrointestinal (16%), liver (12%), kidney (9%), and pancreas (4%), but multiple system involvement was more common (19%). Most frequent diagnostic categories were metabolic disorders (17%), chronic organ failure (17%), and neoplasia (12%). Enteral nutrition was preferred for 98% of consultations. Voluntary consumption was deemed adequate in 81% of consultations, and highly palatable balanced homemade diets and specialty products were recommended in 74% of these. Human hospital liquid enteral products were used in 95% of consultations recommending involuntary feeding, either fed alone, blended with petfoods, or supplemented with modules of protein or fat. The service demonstrated that full-time nutrition support can be utilized effectively in a small animal teaching hospital. Further development of such services will depend on research focused especially on determination of case-specific nutritional goals, patient responses, and cost effectiveness.     

Outbreak of Clostridium difficile-associated disease in a small animal veterinary teaching hospital

An apparent outbreak of enteric disease occurred in dogs and cats at a veterinary teaching hospital. Clostridium difficile Toxin A or B or both were identified in 1 or more fecal samples from 48 of 93 (52%) dogs over a 5-month period, 30 of which were identified in the 1st 26 days, after which strict infection control measures, including closure to elective cases, were implemented. Affected animals included in-patients, out-patients that were housed temporarily in the wards, and resident blood donor dogs. Infection control measures, including partial depopulation, isolation, hospital and yard cleaning, and barrier precautions, were instituted, after which, the incidence of nosocomial diarrhea decreased from 19 cases per 1,000 admissions to 2.5 cases per 1,000 admissions (P < 0.001).     

Retrospective study of perioperative antimicrobial use practices in horses undergoing elective arthroscopic surgery at a veterinary teaching hospital

Perioperative antimicrobial administration practices were evaluated retrospectively in 97 horses undergoing elective arthroscopy, and antimicrobial use was compared with standard recommendations for perioperative prophylaxis. Parenteral antimicrobials were administered perioperatively to 95/97 (98%) horses, 88 of which received intravenous sodium penicillin. Time from 1st dose until 1st incision ranged from 30 to 390 min [142 ± 55.6 min, mean ± standard deviation (s), median 135 min], and the first incision was performed greater than 2 half-lives after administration of sodium penicillin in 86/95 (91%) cases. Overall duration of therapy was 30.8 ± 24.2 h (mean ± s). Six (6.3%) horses received only a single preoperative dose, while 63 (66%) horses were treated for 24 h or less. While objective data regarding optimal perioperative antimicrobial prophylaxis are limited, the antimicrobial use practices observed here commonly deviated from standard recommendations for perioperative prophylaxis.     

Analysis of Staphylococcus infections in a veterinary teaching hospital from 2012 to 2015

Records of all Diagnostic laboratory submissions from 2012 to 2015 were examined and subjected to analysis according to species, location of infection, species of bacteria, and antibiotic resistance/susceptibility. A total of 23.8% of all culture isolates were Staphylococcus sp. Of those Staphylococcus, 43% were isolated from surgical site infections.Staphylococcus pseudintermedius accounted for approximately 28% of all staphylococcus cultures, while methicillin-resistant (MR) S. pseudintermedius accounted for 8% of all staphylococcus cultures. Environmental samples were also collected by swabbing surfaces in the intensive care unit (ICU) and anesthesia prep room at the OSU VTH. Isolated bacterial colonies were subjected to PCR for species identification and for the presence of the mecA gene. Ability of horizontal transfer in vitro of the mecA gene was evaluated by incubating the mecA positive bacterium, with the mecA negative bacterium, and then plated onto agar plates infused with known concentration of oxacillin. Colonies were then subjected to PCR for species and mecA identification. Horizontal transfer of the mecA gene was demonstrated and confirmed via PCR from MR S. epidermidis to MS S. pseudintermedius in an in vitro model that mimicked the veterinary hospital environment. Biofilms were established using four Staphylococcus species isolated from swabbing the Intensive Care Unit (ICU) and anesthesia prep room and were resistant when exposed to the current cleaning agent.Staphylococcus species makeup nearly ¼ of all infections at OSU VDL during the four years of the study, and MS S. pseudintermedius was shown to acquire the mecA gene from an environmental strain.     

Isolation of methicillin-resistant Staphylococcus aureus from the environment in a veterinary teaching hospital

After recognition of a cluster of methicillin-resistant Staphylococcus aureus (MRSA) infection in horses and humans at the Ontario Veterinary College Veterinary Teaching Hospital, environmental contamination with MRSA was evaluated. A total of 260 environmental surfaces were sampled during periods when MRSA-infected horses were hospitalized, and MRSA was isolated from 25/260 sites (9.6%). The most commonly contaminated sites were stalls housing MRSA-positive horses, but other stalls, medical equipment, personal items, and equine restraint devices also were contaminated. The role of the environment in the transmission of MRSA infection to horses or humans is unclear. However, relatively widespread contamination of the hospital environment, as apparently occurs when infected horses are hospitalized, suggests that the environment may be an important source of MRSA infection. This possibility must be taken into consideration when designing infection control and disinfection protocols.     

Detection of Salmonella organisms and assessment of a protocol for removal of contamination in horse stalls at a veterinary teaching hospital

OBJECTIVES: To assess methods of detecting environmental contamination with Salmonella organisms and evaluate a cleaning and disinfection protocol for horse stalls in a veterinary teaching hospital. DESIGN: Original study. SAMPLE POPULATION: 37 horses with diarrhea likely to be caused by Salmonella infection and their stall environments. PROCEDURES: Fecal samples were collected from horses daily during hospitalization; samples were obtained from stall sites after cleaning and application of disinfectants. Fecal and environmental samples were cultured for Salmonella spp and tested via polymerase chain reaction (PCR) assay to detect Salmonella DNA. RESULTS: 1 horse died and 2 were discharged prior to sample collection. Fecal samples from 9 of 34 horses yielded growth of Salmonella organisms on bacteriologic culture, and 23 yielded positive results via PCR assay on > or = 1 occasion. Among environmental samples from 21 stalls, salmonellae were detected at > or = 1 stall site on 6 of 78 occasions, and > or = 1 stall site yielded positive results via PCR assay on 69 of 77 occasions. Salmonella DNA was detected more frequently in samples of stall drains, cracks, and corners. Salmonella spp were cultured from samples of 3 stalls after both initial and second cleaning and disinfection cycles, but no organisms were detected in samples obtained after use of a peroxygen disinfectant. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that stalls in which horses with salmonellosis were housed should only be used to accommodate newly hospitalized horses after samples (collected after 2 cycles of cleaning and disinfection) from drains, cracks, and corners yield negative results on bacteriologic culture.     

Risk factors for fecal shedding of Salmonella from horses in a veterinary teaching hospital

Identification of risk factors for horses shedding Salmonella in their feces helps identify patients at-risk of infection and protect the overall population through heightened biosecurity. Fecal samples from 230 hospitalized horses were cultured for Salmonella spp. Historical data were collected on 21 putative risk factors and assessed for association with the risk of a horse being culture positive using forwards stepwise logistic regression. Salmonella was isolated from 13 horses—most commonly from either the first (n=5) or second (n=4) sample collected. Only presenting complaint (confounded by age, breed and gender) was significantly (P≤0.05) associated with positive Salmonella-culture results. Analysis of residuals showed that the model was robust, but individual risk-factor estimates were changed by removal of outliers. Overall, presenting complaint (for example, lower-respiratory-tract disease) was the most important indicator of culture status.