Factors associated with outcome and gradual improvement in survival over time in 1065 equine neonates admitted to an intensive care unit

BackgroundThe original equine sepsis score provided a method of identifying foals with sepsis. New variables associated with sepsis have been evaluated, but the sepsis score has not been updated.ObjectivesTo evaluate the sensitivity and specificity of 2 updated sepsis scores and the systemic inflammatory response syndrome (SIRS) criteria in regard to detecting sepsis in foals.AnimalsTwo‐hundred and seventy‐three ill foals and 25 healthy control foals.MethodsHistorical, physical examination, and clinicopathologic findings were used to calculate the original sepsis score and 2 updated sepsis scores. SIRS criteria were also evaluated. Sepsis scores and positive SIRS scores were statistically compared to foals with sepsis.ResultsOne‐hundred and twenty‐six foals were septic and 147 sick‐nonseptic. The original and updated sepsis scores were significantly higher in septic foals as compared to sick‐nonseptic and healthy foals. The sensitivity and specificity of the updated sepsis scores to predict sepsis were not significantly better than those of the original sepsis score. One‐hundred and twenty‐seven of 273 (46.5%) foals met the original SIRS criteria and 88/273 (32%) foals met the equine neonatal SIRS criteria. The original SIRS criteria had similar sensitivity and specificity for predicting sepsis as did the 3 sepsis scores in our study.Conclusions and Clinical ImportanceThe updated sepsis scores did not provide improved ability in predicting sepsis. Fulfilling the original SIRS criteria provided similar sensitivity and specificity in predicting sepsis as the modified sepsis score and might serve as a diagnostic aid in identifying foals at risk for sepsis.

Section: Discussioncontrasting

confidence: 46%

Section: Methodsmentioning

confidence: 99%

Evaluation of updated sepsis scoring systems and systemic inflammatory response syndrome criteria and their association with sepsis in equine neonates

Wong

Ruby

Dembek

et al. 2018

“…Up to 60% of foals admitted to an intensive care unit in Florida were considered septic at hospital admission . Escherichia coli is the bacterium most commonly isolated from foals with sepsis in most studies .…”

Section: Introductionmentioning

confidence: 99%

Differences in isolation rate and antimicrobial susceptibility of bacteria isolated from foals with sepsis at admission and after ≥48 hours of hospitalization

Theelen

Wilson

Byrne

et al. 2020

Background Antimicrobial treatment protocols for foals with sepsis that do not improve clinically often are adjusted based on bacteriological and antimicrobial susceptibility testing results from samples collected at hospital admission. Objectives To evaluate whether hospitalization for ≥48 hours affects bacteriological and antimicrobial susceptibility testing results. Animals Two‐hundred sixty‐seven foals <30 days of age admitted to a neonatal intensive care unit and diagnosed with sepsis. Methods Medical records were reviewed retrospectively to identify foals with sepsis and positive bacteriological cultures. Results from samples collected at hospital admission were compared to those collected ≥48 hours after admission. Logistic regression for clustered data and exact logistic regression were used for statistical analysis. Results Three‐hundred fifty‐three unique bacterial isolates were obtained from 231 foals at hospital admission and 92 unique bacterial isolates were obtained from 57 foals after ≥48 hours of hospitalization. Relative isolation frequency after ≥48 hours of hospitalization increased for Acinetobacter spp., 0.6% versus 3.3% (odds ratio [OR], 7.63; 95% confidence interval [CI], 1.28‐45.45); Enterococcus spp., 4.8% versus 19.6% (OR, 5.37; 95% CI, 2.64‐10.90); Klebsiella spp., 5.1% versus 10.9% (OR, 2.27; 95% CI, 1.05‐4.89); Pseudomonas spp., 3.0% versus 7.6% (OR, 3.49; 95% CI, 3.49‐240.50); and Serratia spp., 3.0% versus 5.4% (OR, 20.23; 95% CI, 2.20‐186.14). Bacteria isolated after ≥48 hours of hospitalization were less susceptible to all tested antimicrobial drugs, except for imipenem. Conclusions and Clinical Importance Decreased antimicrobial susceptibility of bacteria isolated after ≥48 hours of hospitalization provides a rationale for repeated bacteriological culture and susceptibility testing in hospitalized foals with sepsis.

“…For mixed populations of critically ill equine neonates, several models for predicting survival have been developed using historical, clinical, and laboratory variables . Two predictive equations for estimating survival have been published previously.…”

Section: Introductionmentioning

confidence: 99%

“…However, both of these studies have limitations because of small study size (<100 foals), resulting in few statistically significant variables in the final models. A more recent model was developed using 1065 foals, but it included variables that cannot be assessed on admission (eg, blood culture results). Another model was developed on a large population of foals (n = 577) ≤7 days of age and included variables obtained shortly after admission.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the foal survival score in a Danish‐Swedish population of neonatal foals upon hospital admission

Bohlin

Saegerman

Hoeberg

et al. 2019

Background It is highly desirable to assess the probability of survival in sick neonatal foals upon admission. The foal survival score (FSS) is a published scoring system used to estimate the probability of survival in hospitalized neonatal foals <4 days old. Hypothesis/Objectives To evaluate the ability of the FSS to predict survival in older foals from a geographically different area compared to the original study. Animals Five‐hundred ninety hospitalized neonatal foals ≤14 days of age. Methods Retrospective Danish‐Swedish multicenter study that included details of signalment, history, clinical examination, laboratory results, necropsy findings, and outcome. Scores and score variables were compared between survivors and nonsurvivors using logistic regression. The optimal cutoff and its test parameters were calculated using a receiver operator characteristic curve. Results Prematurity, cold extremities, ≥2 infectious or inflammatory sites, blood glucose concentration, and total white blood cell counts were significantly associated with nonsurvival ( P ≤ .02). The optimal cutoff to predict survival was ≥6, resulting in sensitivity 78%, specificity 58%, 92% positive predictive value, and 31% negative predictive value. The test performed equally well in foals <4 days old compared to those 4‐14 days old. Conclusions and Clinical Importance Using the suggested optimal cutoff of ≥6, the FSS performed moderately well and may aid in early determination of prognosis for survival. However, the FSS did perform differently in another population and therefore should be assessed under local conditions so that its diagnostic potential is not overestimated.