BackgroundUrinary tract infections (UTIs) are common in dogs. The responsible bacterial populations have evolved with increasing resistance to many antimicrobials.ObjectiveTo characterize the antimicrobial susceptibility patterns of canine urinary tract isolates over a 51‐month period.AnimalsOne thousand six hundred and thirty‐six bacterial isolates from 1,028 dogs.MethodsAerobic bacterial isolate growth and susceptibility data from urine cultures of dogs were identified, retrospectively. Medical records were reviewed to obtain signalment, comorbidities, and antimicrobial use in the previous 30 days. The UTIs were further categorized as uncomplicated, complicated, or pyelonephritis.ResultsCommon bacterial isolates identified were Escherichia coli (52.5%), Staphylococcus spp. (13.6%), and Enterococcus spp. (13.3%). In vitro susceptibility among all isolates varied for commonly prescribed antimicrobials (amoxicillin [59%], amoxicillin/clavulanic acid [76%], cephalexin [66%], enrofloxacin [74%] and trimethoprim‐sulfamethoxazole [86%]). For all antimicrobials tested (except aminoglycosides), in vitro susceptibility was higher in uncomplicated versus complicated infections (P < .05). Uncomplicated infection isolate susceptibility rates remained ≤90% for PO administered antimicrobials. Administration of amoxicillin, doxycycline, and enrofloxacin, but not amoxicillin/clavulanic acid in the previous 30 days was associated with resistance to that antimicrobial. Multidrug resistant isolates of E. coli and Staphylococcus spp. were more common in dogs with complicated than uncomplicated UTIs (36% versus 21%, P < .0001).Conclusions and Clinical ImportanceIn vitro susceptibility was highly variable and no PO administered antimicrobial had >90% efficacy among isolates tested. Multidrug resistance was frequent among isolates tested suggesting that routine culture and susceptibility testing is indicated. Previously prescribed antimicrobials may affect empirical choices made pending susceptibility testing.
Early CPR interventions were associated with a greater likelihood of ROSC, emphasizing the importance of prompt recognition, and initiation of CPR efforts. Although ROSC rates in this study were comparable or higher than previous human and veterinary studies, the rate of "survived events" was lower than that reported in human patients. This may suggest that advances in post CPR care could have benefits to the veterinary CPR patient in the future.
Objective -To systematically examine the evidence on basic life support (BLS) in veterinary CPR and to determine knowledge gaps. Design -Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. Relevant questions were answered on a worksheet template and reviewed by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) BLS domain members, by the RECOVER committee and opened for comments by veterinary professionals for 30 days. Setting -Academia, referral practice, and general practice. Results -Sixteen worksheets were prepared to evaluate techniques for chest compression and ventilation strategies as well as identification of cardiopulmonary arrest (CPA). Major recommendations arising from this evidence review include performing chest compressions at a rate of at least 100/min at a compression depth of one-third to half the width of the chest with minimal pauses, and early instigation of ventilation at a rate of 8-10 breaths/min in intubated patients, or using a 30:2 compression/ventilation ratio in nonintubated patients. Conclusions -Although veterinary clinical trials are lacking, much of the experimental literature on BLS utilized canine models. The major conclusions from this analysis of the literature are the importance of early identification of CPA, and immediate initiation of BLS in these patients. Many knowledge gaps exist, most importantly in our understanding of the optimal hand placement and technique for chest compressions, warranting coordinated future studies targeted at questions of relevance to differences between veterinary species and humans. (J Vet Emerg Crit Care 2012; 22(S1): 26-43)
The physicochemical approaches diagnosed more acid-base abnormalities in this population than the traditional approach although many of the abnormalities identified were small and of unknown clinical relevance. The physicochemical approaches may provide greater insight as to the underlying etiology of abnormalities, which maybe of particular relevance to cases with changes in albumin and/or phosphorus concentration.
Cardiopulmonary resuscitation (CPR) outcomes have not been prospectively described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) guidelines. This study aimed to prospectively describe CPR outcomes and document arrest variables in dogs and cats at a U.S. veterinary teaching hospital since implementation of the RECOVER guidelines using the 2016 veterinary Utstein-style CPR reporting guidelines. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) underwent CPR following implementation of the RECOVER guidelines and were prospectively included. Supervising clinicians completed a data form for CPR events immediately following completion of CPR from December 2013 to June 2018. Seventy-five (44%) dogs and 26 (55%) cats attained return of spontaneous circulation (ROSC), 45 dogs (26%) and 16 cats (34%) had ROSC ≥ 20 min, 13 dogs (8%) and 10 cats (21%) were alive 24 h after CPR, and 12 dogs (7%) and 9 cats (19%) survived to hospital discharge. The most common cause of death in animals with ROSC ≥ 20 min was euthanasia. Patient outcomes were not significantly different since publication of the RECOVER guidelines except for a higher feline survival to hospital discharge rate. Dogs (p = 0.02) but not cats with initial shockable rhythms had increased rates of ROSC while the development of a shockable rhythm during CPR efforts was not associated with ROSC (p = 0.30). In closed chest CPR an end-tidal carbon dioxide (EtCO 2) value of >16.5 mmHg was associated with a 75% sensitivity and 64% specificity for achieving ROSC. Since publication of the RECOVER guidelines, CPR practice did not clinically significantly change at our institution and no improvement of already high ROSC rates was noted. The percentage of cats surviving to hospital discharge was higher than previously reported and the reason for this improvement is not evident with these results. Euthanasia remains a major confounding factor in assessing intermediate and long-term CPR outcomes in dogs and cats.
Ivermectin toxicity occurs in dogs with apparent blindness being a common clinical sign. This is the first case report of ivermectin-induced blindness evaluated with ERG before and after treatment with IVL in a dog unaffected by the multidrug resistance gene mutation. Treatment with an infusion of IVL therapy appeared to shorten the clinical course of disease in this patient without affecting ERG results.
Canine and feline patients with respiratory failure severe enough to require PPV exhibit a different pattern of bacterial isolates cultured from their airways when compared with isolates from patients with respiratory disease that has not resulted in ventilator dependence. These isolates are more likely to be resistant to commonly used antimicrobials/antimicrobial combinations than patients in the respiratory disease group. These findings suggest that in canine and feline patients with infectious lower respiratory tract disease, consideration of the severity of the pulmonary insult may allow for better prediction of likely isolates and their antimicrobial susceptibilities. Further prospective studies with a standardized collection technique are warranted.
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