Anaerobic bacterial pneumonia with septicemia in two racehorses

Anaerobic bacterial pneumonia with septicemia was diagnosed in 2 Thoroughbred racehorses referred with respiratory tract disease that had failed to respond to initial treatment with various antibiotics including penicillin and trimethoprim-sulfamethoxazole. Multiple anaerobic organisms, including Bacteroides spp and Fusobacterium spp, were isolated from blood and transtracheal aspirates obtained from both horses and from aspirates of cutaneous nodules obtained from 1 horse. The latter horse responded to metronidazole treatment followed by procaine penicillin G administration and regained its health over the following 6 months. The other horse did not respond as favorably to a similar antibiotic regimen and died following an acute episode of pulmonary hemorrhage after remaining intermittently febrile for 7 weeks. Although in vitro antimicrobial susceptibility tests indicated that all anaerobic organisms isolated from both horses were susceptible to penicillin, the infection in these horses responded poorly to initial treatments with this drug. We speculated that adequate penicillin concentration was not attained in the deep foci of infection in the lungs. Animals with anaerobic bacterial infections that fail to respond to penicillin or from which penicillin-resistant anaerobes are isolated may benefit from treatment with metronidazole.     

Anaerobic bacterial infections and response to treatment in dogs and cats: 36 cases (1983-1985)

Anaerobic bacteria have been increasingly implicated as important pathogens in animals. To determine the prevalence of anaerobic bacterial infection, the results of anaerobic bacteriologic culture of 599 specimens obtained from dogs and cats hospitalized at the Colorado State University Veterinary Teaching Hospital were reviewed. Obligate anaerobic bacteria were isolated from 35% of properly submitted specimens; Bacteroides spp and Fusobacterium spp were the organisms most commonly isolated. Infections most often containing anaerobes were abscesses, pleuropulmonary infections, and abdominal infections. A complication rate of 28% was observed with anaerobic bacterial infections; failure to initially treat with an effective antibiotic increased the rate of recurrence of infection.     

Occurrence of anaerobic bacteria in diseases of the dog and cat.

A survey for anaerobic bacteria was conducted in 314 clinical specimens from dogs and cats. A total of 187 anaerobic isolates in pure and mixed culture were isolated from 111 of the specimens that contained anaerobic bacteria. Common isolated included Actinomyces (9.1%), Clostridium perfringens (19.3%), other Clostridium spp (11.2%), Peptostreptococcus anaerobius (7.5%), Bacteroides melaninogenicus (13.4%), other Bacteroides spp (17.6%), and Fusobacterium necrophorum (5.3%). Anaerobic bacteria were involved in serious lesions that often were life threatening to the animals. Antibiotic susceptibility data indicated that the lincomycin family, the penicillin family, chloramphenicol, and cephaloridine are preferred drugs for treatment of anaerobic infections. Data from the survey were used in formulation of a table to aid practitioners in clinical diagnosis of disease caused by anaerobes. Clostridium perfringens was isolated in large numbers from five of six dogs with a clinical diagnosis of canine hemorrhagic gastroenteritis and from one cat with hemorrhagic diarrhea. Experimental infections were induced in rats, using caine feces as inoculum. Induced lesions contained aerobic and anaerobic bacteria similar to those bacteria isolated in the clinical survey, indicating that feces may serve as a major source of these bacteria in clinical infections of the dog.     

Aerobic and anaerobic bacterial isolates from horses with pneumonia or pleuropneumonia and antimicrobial susceptibility patterns of the aerobes

Frequency of aerobic and anaerobic isolates in 327 aspirates and in 123 pleural fluid samples from 327 horses with pneumonia or pleuropneumonia and antimicrobial susceptibility patterns of the aerobes were reported. Of the 327 horses, 75% survived, 20% were euthanatized, and 5% died. Tracheobronchial aspirates or pleural fluid specimens from 25 of the horses did not yield growth. Of the remaining 302 horses, 221 had only aerobic organisms isolated, whereas only anaerobes were isolated from 6 of the 302 horses. The remaining 75 horses had mixed aerobic and anaerobic bacterial infections. The survival rates for horses with aerobic only isolates was twice that of horses with anaerobic isolates. The aerobic bacteria most frequently isolated were beta-Streptococcus spp, Pasteurella spp, Escherichia coli, and Enterobacter spp. The anaerobic species most frequently isolated were Bacteroides spp and Clostridium spp.     

BSAVA EDUCATION COMMITTEE COMMISSIONED ARTICLE: Anaerobic bacteria: a cause of infection?

This review article considers the evidence available for a significant role of obligate anaerobes in infections of small animals. The presence of anaerobes in the normal flora and the meaning of the terms aerobe and anaerobe both in relation to the bacterial metabolism and laboratory culture is discussed. The reported findings of anaerobes in clinical veterinary conditions are reviewed. The particular importance of the non-sporing (non-clostridial) anaerobes in traumatic and endogenous infections and the mixed nature, both in terms of different anaerobes and mixed aerobes and anaerobes of such infection are considered. Some experimental evidence for the pathogenicity of obligate anaerobes and their complex role in mixed infections is given. Observations on the use of antibiotics for treatment of suspected anaerobic infections are discussed and the possible implications to laboratory procedures for antibiotic sensitivity testing.     

2008 American Association of Feline Practitioners' feline retrovirus management guidelines

Feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) are among the most common infectious diseases of cats. Although vaccines are available for both viruses, identification and segregation of infected cats form the cornerstone for preventing new infections. Guidelines in this report have been developed for diagnosis, prevention, treatment, and management of FeLV and FIV infections. All cats should be tested for FeLV and FIV infections at appropriate intervals based on individual risk assessments. This includes testing at the time of acquisition, following exposure to an infected cat or a cat of unknown infection status, prior to vaccination against FeLV or FIV, prior to entering group housing, and when cats become sick. No test is 100% accurate at all times under all conditions; results should be interpreted along with the patient's health and risk factors. Retroviral tests can diagnose only infection, not clinical disease, and cats infected with FeLV or FIV may live for many years. A decision for euthanasia should never be based solely on whether or not the cat is infected. Vaccination against FeLV is highly recommended in kittens. In adult cats, antiretroviral vaccines are considered non-core and should be administered only if a risk assessment indicates they are appropriate. Few large controlled studies have been performed using antiviral or immunomodulating drugs for the treatment of naturally infected cats. More research is needed to identify best practices to improve long-term outcomes following retroviral infections in cats.     

Anaerobic bacteria in 21 horses with pleuropneumonia

Anaerobic bacteria are important and overlooked bacterial pathogens of the lower respiratory tract in horses. Twenty-one of 46 horses with pleuropneumonia had anaerobic bacteria isolated from pleural fluid or from tracheobronchial aspirate. Bacteroides oralis and B melaninogenicus were the anaerobes most frequently isolated. Survival was significantly less for horses from which anaerobes were isolated than for horses from which anaerobes were not isolated. Putrid odor was associated with the pleural fluid and/or breath in 62% of the horses from which anaerobes were isolated. In these horses, the survival rate was significantly less than for horses from which odoriferous specimens were not isolated.     

Clinical use of metronidazole in horses: 200 cases (1984-1989)

Case records of 200 horses treated with metronidazole were reviewed. Horses were treated for respiratory tract infections (90 cases), peritonitis or abdominal abscess (39 cases), celiotomy (49 cases), orthopedic infections (6 cases), and miscellaneous soft tissue infections (16 cases). Bacteria of the genus Bacteroides were most prevalent (55 of 167 anaerobic isolates). Metronidazole was always used in combination with other antimicrobial drugs. Only 4 of the 200 horses had signs of adverse effects associated with metronidazole treatment. Those 4 horses had poor appetite that resolved when metronidazole treatment was discontinued.     

Changes in prevalence and susceptibility of obligate anaerobes in clinical veterinary practice

Of 3,133 clinical specimens obtained from domestic animals, 26% contained species of bacteria that were obligate anaerobes. Members of the genera Bacteroides, Fusobacterium, and Peptostreptococcus accounted for 77% of the isolates. On the average, 2 species of obligate anaerobes were found in each specimen, usually admixed with facultatively anaerobic bacteria. Of those specimens containing an obligate anaerobe, 20% contained one isolate that was resistant to penicillin, ampicillin, and cephalothin. These resistant isolates belonged to the genus Bacteroides, the most common being Bacteroides fragilis. Approximately one third of these penicillin-resistant isolates was resistant to tetracycline as well. All isolates were susceptible to chloramphenicol, tetracycline (excluding penicillin-resistant Bacteroides), metronidazole, and clindamycin.     

In vitro antimicrobial susceptibility of anaerobic bacteria isolated from caprine footrot

The in vitro antimicrobial susceptibility of Gram-negative anaerobic bacilli commonly isolated from footrot in goats was studied. A total of 97 isolates belonging to the genera Dichelobacter, Fusobacterium, Prevotella, Porphyromonas and Bacteroides, obtained from clinical cases of footrot in south-western Spain between March 2000 and May 2001, were tested against 25 antimicrobial agents comprising beta-lactams, aminoglycosides, macrolides, chloramphenicol, quinolones, lincosamides, sulphonamides and tetracyclines in order to optimise antibiotic treatment of this disease in goats. beta-lactams, tetracyclines and metronidazole displayed the highest in vitro efficacy against the species involved in the pathogenesis of footrot.     

Antibiotics in the treatment of wounds

In selecting an antibiotic, considerations include the sensitivity of the pathogen, drug distribution to the site of infection, bacteriostatic or bactericidal action under the existing tissue conditions, safety, and cost. Ideally, in vitro susceptibility of the pathogen can be obtained. In addition, cytologic evaluation, including a Gram stain, may be helpful in directing the initial course of therapy. Antibiotic sensitivity does not by itself guarantee satisfactory results. The terms "sensitive" and "resistant" are relative terms based on achievable blood levels of antimicrobial agents. The term "sensitive" implies that the level necessary to inhibit bacterial growth is achieved when an adequate dose is given at appropriate intervals. The distribution of the drug and, in turn, the level achieved at the site of infection depends on a number of factors, including molecular size, protein binding, and lipid solubility. Because, in most cases, specific tissue concentrations are not known, serum concentrations are used to represent the levels in the extracellular fluid space, which is the site of most bacterial infections. The local environment can further enhance or hinder antimicrobial penetration and activity. The antibiotic concentration achieved in the blood affects the concentration at the site of infection because simple passive diffusion appears to be the method of transport for most antibiotics. The antibiotic activity after reaching the site of infection is influenced by environmental conditions. Local production of enzymes, purulent and fibrinous exudate, and pH changes can adversely affect drug action. With many of these variables being difficult to predict, knowledge of etiologic agents is the cornerstone of rational use of the antimicrobial drugs. A reasonable suspicion based on clinical signs and knowledge of likely pathogens can guide the initial choice of antimicrobial therapy. Since both aerobic and anaerobic organisms may be involved in wound infections, and because antibiotic sensitivity of many of these pathogens is unpredictable, broad-spectrum antimicrobial therapy is often warranted initially.     

A review of the characteristics and treatment of methicillin‐resistant Staphylococcus aureus (MRSA) in the horse and a case series of MRSA infection in four horses

Methicillin‐resistant Staphylococcus aureus (MRSA) is an emerging cause of serious bacterial infection in the horse, with an increasing number of cases reported over the last decade. MRSA, along with other commensal staphylococcal species, can reside on the mucosa of several sites in the horse, particularly the nose. Nasal carriage of MRSA appears rare amongst horses in the community, although a higher prevalence has been found in hospitalised horses. MRSA infections can involve a variety of body sites, but most commonly encountered are soft tissue infections of either traumatic or surgical wounds. MRSA strain types isolated from horses are typically multidrug‐resistant and usually differ from those recovered from humans and other small animal species. Treatment of infection can be prolonged and is dependent on timely, accurate diagnosis and on appropriate therapy; often guided by antimicrobial susceptibility testing. The purpose of this review is to provide clinically relevant information for the equine practitioner and, for illustration, the diagnosis, treatment and outcome of 4 clinical cases of MRSA infection in horses is discussed.     

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.     

Campylobacteriosis in dogs and cats: a review

Campylobacter species are commonly isolated from faecal samples collected from dogs and cats, with the most prevalent species being C. upsaliensis, C. helveticus, and C. jejuni. Although the majority of dogs and cats are subclinically infected, some will develop mild to moderate enteritis. Immature animals, animals from intensive housing backgrounds, and animals with concurrent disease are especially predisposed to infection and the development of clinical signs. Bacterial culture methods applied in diagnostic laboratories remain biased to C. jejuni and C. coli detection, but molecular methods to diagnose Campylobacter spp. infections in dogs and cats have become widely available and can aid rapid and accurate diagnosis. Multilocus sequence typing has also been developed for subtyping different strains and has been used in epidemiological investigations. In the majority of cases, clinical signs are self-limiting and antimicrobial treatment is not warranted. Campylobacter spp. isolated from dogs and cats have shown resistance to commonly used antimicrobials, so antimicrobial therapy should only be administered where this is justified. Contact with dogs and cats is a recognised risk factor for human campylobacteriosis, thus people living or working in close contact with cats and dogs should be made aware of the zoonotic organisms these animals can shed.     

Tissues and exudates contain sufficient thymidine for growth of anaerobic bacteria in the presence of inhibitory levels of trimethoprim-sulfamethoxazole.

Obligate anaerobes are susceptible in vitro to trimethoprim-sulfonamides. Clinical efficacy of this drug combination for treatment of infectious processes in which anaerobes are involved is uncertain. We hypothesize that this uncertainty is a result of thymidine in tissues and exudates which abrogates the inhibitory effect of trimethoprim-sulfonamides. We shown herein that species of anaerobic bacteria commonly encountered in infectious processes grew on thymidine-containing medium despite the presence of levels of trimethoprim-sulfamethoxazole (S x T) previously shown to be inhibitory. Biologic fluids and tissues, where anaerobic bacteria are commonly encountered in diseased states, were shown to contain thymidine levels that were sufficient to reverse the inhibitory effect of S x T upon these species of bacteria. These observations suggest that the use of trimethoprim-sulfonamides is not a rational choice for treatment of infectious processes in which an obligate anaerobe is a component.     

Evaluation of subgingival bacteria in the dog and susceptibility to commonly used antibiotics

The aim of the present investigation was to evaluate the subgingival aerobic and anaerobic flora of 13 dogs with periodontal disease and the susceptibility of these bacteria to antibiotics currently approved in Italy for treatment of canine infections. Of the anaerobic bacteria, Bacteroides fragilis was most frequently isolated, followed by Peptostreptococcus + Porphyromonas gingivalis and Prevotella intermedia. Of the aerobic bacteria, alpha-hemolytic Streptococcus was most frequently isolated, often associated with Escherichia coli or Pasteurella multocida. Resistance of anaerobic and aerobic bacteria to various antibiotics was generally high. Anaerobic bacteria appeared to be susceptible to amoxicillin + clavulanic acid, doxycycline, and erythromycin; aerobic bacteria appeared to be susceptible to amoxicillin + clavulanic acid, erythromycin, gentamycin, and sulfa-trimethoprim. Bacteroides fragilis was resistant to all of the antibiotics tested. The emerging worldwide problem of bacterial resistance to antibiotics resulting from overuse and misuse of antibiotics is discussed.     

Fluoroquinolones in animal health

The fluoroquinolones are a series of synthetic antibacterial agents that are undergoing extensive investigation for both human and veterinary use in the treatment of a variety of bacterial infections. These agents work through the inhibition of DNA gyrase, interfering with the supercoiling of bacterial chromosomal material. As a result, these agents are rapidly bactericidal primarily against gram-negative bacteria, mycoplasma, and some grampositive bacteria, with most having little to no activity against group D streptococci and obligate anaerobic bacteria. Resistance develops slowly and is almost always chromosomal and not plasmid-mediated. However, development of resistance to the fluoroquinolones and transfer of that resistance among animal and human pathogens have become a hotly debated issue among microbiologists. The fluoroquinolones are a current antimicrobial class whose use in veterinary medicine is being scrutinized. From a pharmacokinetic perspective, these agents are variably but well absorbed from the gastrointestinal tract and almost completely absorbed from parenteral injection sites, and they are well distributed to various tissues in the body. The fluoroquinolones are metabolized and renally excreted, with many of them having approximately equal excretion by the hepatic and the renal excretory systems. The primary toxicity observed at therapeutic doses involves the gastrointestinal system and phototoxicity, although at higher doses central nervous system toxicity and ocular cataracts are observed. Administration to immature animals may result in erosive arthropathies at weight-bearing joints, and administration of high doses to pregnant animals results in maternotoxicity and occasionally embryonic death. The fluoroquinolones are approved for indications such as urinary tract infections and soft tissue infections in dogs and cats and colibacillosis in poultry. Approval for bovine respiratory disease in the United States is being sought. Other indications for which the fluoroquinolones have been used in animal health include deep-seated infections, prostatitis, and other bacterial infections resistant to standard antimicrobial therapy.     

Treatment for bovine Escherichia coli mastitis – an evidence‐based approach

Bovine mastitis caused by Escherichia coli can range from being a subclinical infection of the mammary gland to a severe systemic disease. Cow‐dependent factors such as lactation stage and age affect the severity of coliform mastitis. Evidence for the efficacy of antimicrobial treatment for E. coli mastitis is very limited. Antimicrobial resistance is generally not a limiting factor for treatment, but it should be monitored to detect changes in resistance profiles. The only antimicrobials for which there is some scientific evidence of beneficial effects in the treatment for E. coli mastitis are fluoroquinolones and cephalosporins. Both are critically important drugs, the use of which in animals destined for food should be limited to specific indications and should be based on bacteriological diagnosis. The suggested routine protocol in dairy herds could target the primary antimicrobial treatment for mastitis, specifically infections caused by gram‐positive bacteria. In E. coli mastitis with mild to moderate clinical signs, a non‐antimicrobial approach (anti‐inflammatory treatment, frequent milking and fluid therapy) should be the first option. In cases of severe E. coli mastitis, parenteral administration of fluoroquinolones, or third‐ or fourth‐generation cephalosporins, is recommended due to the risk of unlimited growth of bacteria in the mammary gland and ensuing bacteremia. Evidence for the efficacy of intramammary‐administered antimicrobial treatment for E. coli mastitis is so limited that it cannot be recommended. Nonsteroidal anti‐inflammatory drugs have documented the efficacy in the treatment for E. coli mastitis and are recommended for supportive treatment for clinical mastitis.     

Susceptibility of Bacteroides from swine abscesses to 13 antibiotics

The minimal inhibitory concentrations (MIC) of 129 strains of genus Bacteroides, isolated from abscesses in pigs, for 13 different antimicrobial agents were determined by an agar-dilution method under anaerobic conditions. Clindamycin, the most active antibiotic tested, had a median MIC of 0.8 micrograms/ml. Penicillin G, talampicillin, minocycline, chloramphenicol, and cefoxitin also inhibited all isolates at lower concentrations. Some isolates of B pyogenes were susceptible to gentamicin (MIC, 0.4 micrograms/ml), erythromycin (MIC, 0.8 micrograms/ml), cephalexin (MIC, 0.8 micrograms/ml), and cefoxitin (MIC, 3.2 micrograms/ml). Erythromycin, at a concentration of 3.2 micrograms/ml, was active against 70% of B suis tested, but it was less active against the other Bacteroides species. Some strains tested were resistant to streptomycin and neomycin.     

Oral associated bacterial infection in horses: studies on the normal anaerobic flora from the pharyngeal tonsillar surface and its association with lower respiratory tract and paraoral infections

Two hundred and seventy bacterial isolates were obtained from the pharyngeal tonsillar surface of 12 normal horses and 98 obligatory anaerobic bacteria were characterised. Of these, 57 isolates belonging to 7 genera (Peptostreptococcus (1); Eubacterium (9); Clostridium (6); Veillonella (6); Megasphera (1); Bacteroides (28); Fusobacterium (6)) were identified, and 16 of these were identified to species level (P. anaerobius (1); E. fossor (9); C. villosum (1); B. fragilis (1); B. tectum (2); B. heparinolyticus (2)). Three hundred and twenty isolates were obtained from 23 samples from horses with lower respiratory tract (LRT) or paraoral (PO) bacterial infections. Of the 143 bacteria selected for detailed characterisation, obligate anaerobes accounted for 100 isolates, facultative anaerobes for 42 isolates and obligate aerobes for one isolate. Phenotypic characterisation separated 99 of the isolates into 14 genera. Among the obligately anaerobic species, Gram-positive cocci including P. anaerobius comprised 25% of isolates, E. fossor 11% and other Gram-positive rods (excluding Clostridium sp.) 18% of isolates. The Gram-negative rods comprised B. fragilis 5%, B. heparinolyticus 5%, asaccharolytic pigmented Bacteroides 3% and other Bacteroides 13%, while a so-far unnamed species of Fusobacterium (7%), and Gram-negative corroding rods (3%) were isolated. Among the facultatively anaerobic isolates, S. equi subsp. zooepidemicus accounted for 31% of isolates, followed by Pasteurella spp. 19%, Escherichia coli 17%, Actinomyces spp. 9%, Streptococcus spp. 9%. Incidental facultative isolates were Enterococcus spp. 2%, Enterobacter cloaceae 2%, Actinobacillus spp. 2% and Gram-negative corroding rods 5%. On the basis of the similarities (as determined by DNA hybridization data and/or phenotypic characteristics) of some of the bacterial species (e.g. E. fossor and B. heparinolyticus) isolated from both the normal pharyngeal tonsillar surfaces and LRT and PO diseases of horses, it is considered that the most likely source of bacteria involved in these disease processes is flora from the oral cavity.