Antimicrobial discontinuation in dogs with acute aspiration pneumonia based on clinical improvement and normalization of C‐reactive protein concentration

The Use of Biomarkers to Track and Treat Critical Illness

Biomarkers are objectively measurable parameters that provide clinicians with timely information to guide diagnosis and patient management beyond that which can be obtained from routinely available data. The literature contains thousands of articles on biomarkers in veterinary medicine. Specifically reviewed are the acute kidney injury markers neutrophil gelatinase-associated lipocalin, cystatin, clusterin, and kidney-injury molecule-1; the cardiac troponins and natriuretic peptides as biomarkers of heart disease; the acute phase protein C-reactive protein; procalcitonin; inflammatory cytokines; the markers of neutrophil extracellular trap formation cell-free DNA and nucleosomes; and markers of injury to the endothelium and endothelial glycocalyx including hyaluronan.

Diagnostic value of serum survivin, Ki-67 and thymidine kinase in dogs with nasal cavity disease

Background

The most common nasal cavity disease (ND) in dogs is the malignant nasal cavity tumor. Prognosis and survival after radiation therapy are reported to correlate with tumor size, and therefore indirectly with the time to diagnosis. Diagnosis of a nasal tumor requires imaging procedures under anesthesia. Thus, diagnostic serum markers are urgently needed for early detection and for therapeutic monitoring.

Materials and methods

This prospective, blinded study included dogs with nasal discharge that completed a comprehensive diagnostic workup for ND. Dogs were evaluated by blood testing and whole-body CT and those with concomitant diseases or with steroid pre-treatment were excluded. Serum survivin, Ki-67, and thymidine kinase 1 (TK1) concentrations were determined, and the survivin-lymphocyte ratio (SLR) calculated. Results were compared between groups of dogs with different NDs and to ten healthy controls.

Results

A total of 55 dogs were included, consisting of 25 with malignant ND (12 sarcomas, 13 carcinomas) and 30 with benign ND (7 benign tumors, 13 dogs with idiopathic rhinitis (IR), 10 others including dogs with dental diseases and sinonasal aspergillosis). Survivin and SLR were significantly increased in dogs with malignant ND and in subgroup comparison in sarcomas compared to controls. In addition, the SLR was significantly increased in carcinomas and IR compared to controls. In dogs with IR, no differences were observed in survivin concentrations or SLR based on microbiological or histopathological findings. Survivin concentrations or SLR in dogs with nasal tumors were not significantly different between T-categories. No significant differences were detected in TK1 concentrations among the groups, nor in Ki-67, except for significantly lower Ki-67 concentrations in benign tumors compared to carcinomas and the group others including, e.g., dental diseases.

Conclusion

Although not diagnostic for ND, increased survivin serum concentrations or SLR can be detected in dogs with malignant nasal tumors and IR. In malignant nasal tumors, survivin and SLR did not correlate with tumor size and therefore may be useful in the detection of even small nasal tumors. Therefore, in dogs with nasal tumors and IR, survivin and SLR could serve as a target for disease monitoring or as therapeutic target.

Transthoracic fine-needle aspiration of the lungs, and bacterial culture with antimicrobial susceptibility testing used in diagnosing bacterial pneumonia in dogs and cats: 14 dogs and 2 cats (2009-2021)

Transthoracic fine-needle aspiration of the lungs (TFNA) combined with positive bacterial culture is used less frequently than airway lavage in diagnosing bacterial pneumonia in dogs and cats. This retrospective study evaluated TFNA results and bacterial culture findings in 14 dogs (1 dog twice) and two cats with bacterial pneumonia. Bacterial culture yielded positive results in 9/16 (56.3%) of samples. Only 1/11 (9.1%) of isolated bacterial species showed resistance to empiric treatment (amoxicillin with clavulanate). Six patients without prior antimicrobial treatment had negative bacterial cultures, despite the presence of intracellular bacteria on cytology samples. For patients with suspected bacterial pneumonia, we should consider performing both cytological examination and bacterial culture of lung aspirates, with careful interpretation of the results. Bacterial culture should be considered regardless of ongoing or previous antibiotic treatment, and even in cases where intracellular bacteria are not identified on cytology. Based on our antimicrobial susceptibility findings, first-line empirical treatment with amoxicillin with clavulanate might be an appropriate choice in most of cases regardless of the previous treatment.

In-hospital mortality in dogs with protein-losing enteropathy and associated risk factors

BACKGROUND

Risk factors associated with negative outcomes in dogs with protein-losing enteropathy (PLE) are well documented. However, mortality before hospital discharge and associated risk factors are not well described.

HYPOTHESIS/OBJECTIVES

Report the percentage of dogs with PLE that do not survive to hospital discharge and identify associated risk factors.

ANIMALS

One-hundred and seven dogs presented to a referral hospital and diagnosed with PLE caused by inflammatory enteritis, intestinal lymphangiectasia or both.

METHODS

Retrospective cross-sectional study assessing hospital records. Data on in-hospital mortality and cause were assessed, and presenting signs, treatments prescribed, neutrophil count, lymphocyte count, serum albumin, globulin, and C-reactive protein (CRP) concentrations, and histopathologic findings were compared between survivors and non-survivors.

RESULTS

In-hospital mortality was 21.5% with the most common causes including financial limitations, failure to improve and aspiration pneumonia. Factors associated with mortality during hospitalization included longer duration of hospitalization (P = .04), longer duration of clinical signs (P = .02) and an increase in serum CRP concentration after 1-3 days of in-hospital treatment (P = .02). Higher mortality was identified in Pugs (odds ratio [OR], 4.93; 95% confidence interval [CI], 1.41-17.2; P = .01) and was a result of presumptive aspiration pneumonia in 5/6 of these dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

Protein-losing enteropathy in dogs has substantial mortality during hospitalization. Monitoring for improvement in CRP concentration after treatment during hospitalization may help predict survival to discharge. Pugs have increased in-hospital mortality because of aspiration pneumonia; measures to prevent, recognize, and promptly treat this complication may improve outcomes in this breed.

Recognition and Diagnosis of Underlying Disease Processes in Bacterial Pneumonia

Bacterial pneumonia can present in both dogs and cats as either acute or chronic disease, and clinical signs may suggest respiratory or systemic impairment. Aspiration pneumonia, a common form of disease, can be caused by esophageal or laryngeal disease, vomiting, or altered mentation, such as with CNS disease or general anesthesia. Bacterial pneumonia can also develop due to inhaled airway foreign bodies, reduced local immune function, or impaired clearance of respiratory secretions. Rapid identification of the etiology and associated risk factors for pneumonia can help veterinarians develop a targeted therapeutic plan and prevent recurrence of disease.

Decision making on antimicrobial use: Cat and dog owners' knowledge and preferences for veterinary communication

BACKGROUND

Veterinarians' understanding of cat and dog owners' perceptions about antimicrobial use will enhance their ability to communicate with clients to uphold antimicrobial stewardship guidelines.

METHODS

A total of 571 cat and dog owners were surveyed via an online platform to understand their antimicrobial knowledge and preferences for veterinary communication in antimicrobial use decision making. Data were analysed descriptively and inferentially to determine relationships between variables.

RESULTS

Cat and dog owners' backgrounds had an impact their antimicrobial knowledge. Women, individuals with a university degree, those with a health/science background and those identifying as white had a higher level of knowledge of antibiotics and antibiotic resistance. Owners' trust in veterinarians positively impacts adherence to recommendations. Where there was a strong preference for one type of messaging regarding antimicrobial use and stewardship, the owner's background was not predictive of a difference in response.

LIMITATIONS

The study population was mostly white, which reflects the US population and the reported distribution of pet owners who own dogs and cats. Respondents may have been susceptible to recall bias and/or social desirability bias.

CONCLUSION

Veterinarians should tailor their communication to meet clients' level of knowledge and rely on competent communication to enhance understanding and facilitate adherence to antimicrobial stewardship guidelines.

Nursing strategies for the mechanically ventilated patient

The goal of this manuscript is to provide a comprehensive and multi-disciplinary review of the best nursing practices of caring for mechanically ventilated patients. By reviewing human medicine literature, the authors will extrapolate procedures that have been found to be most effective in reducing the risk of mechanical ventilation (MV) complications. Paired with review of the current standards in veterinary medicine, the authors will compile the best practice information on mechanically ventilated patient care, which will serve as a detailed resource for the veterinary nursing staff. Written from a nursing standpoint, this manuscript aims to consolidate the nursing assessment of a mechanically ventilated patient, addressing both systemic and physical changes that may be encountered during hospitalization. The goal of this review article is to present information that encourages a proactive approach to nursing care by focusing on understanding the effects of polypharmacy, hemodynamic changes associated with MV, complications of recumbent patient care, and sources of hospital acquired infections. When applied in conjunction with the more technical aspects of MV, this manuscript will allow veterinary technicians involved in these cases to understand the dynamic challenges that mechanically ventilated patients present, provide guidance to mitigate risk, address issues quickly and effectively, and create an up-to date standard of practice that can be implemented.

Change over time and agreement between clinical markers of disease resolution in dogs with aspiration-induced lung injury

BACKGROUND

There is a lack of consensus regarding which markers of disease resolution to prioritise when assessing treatment response in client-owned dogs with aspiration-induced lung injury. This study describes the change over time and the agreement between the clinical markers used to determine disease resolution.

METHODS

Physical examination (PE), owner-reported clinical signs (CS-O), thoracic radiographs (TXR) scores and C-reactive protein (CRP) concentrations were determined at enrolment, after 24, 48 and 72 hours, and after 7, 14 and 28 days.

RESULTS

PE scores were significantly improved at 48 hours, while CRP initially increased (24 hours) and then decreased (48 hours). PE, CS-O and CRP significantly improved earlier (7 days) than TXR (14 days). The median number of days to marker normalisation was 7, 9 and 14 for PE, CRP and CS-O, respectively. Marker agreement was excellent/very good at enrolment and fair/poor during disease recovery.

LIMITATIONS

Analysis did not control for differences aetiology of aspiration or the lack of standardisation in treatment approach.

CONCLUSIONS

PE was the earliest and most consistent marker indicating disease resolution. Serial CRP monitoring (72 hours) may provide an objective marker of early treatment response. Alongside PE normalisation, improvement in CS-O, CRP and TRX may assist in determining disease resolution and guide treatments, including limiting antibiotic exposure in dogs with aspiration-induced lung injury.