Antimicrobial susceptibility of Salmonella and Escherichia coli from equids sampled in the NAHMS 2015-16 equine study and association of management factors with resistance.

Several studies have investigated antimicrobial resistance (AMR) in Salmonella spp. and Escherichia coli isolated from hospitalized horses, but studies conducted on community-based populations of equids are limited. The factors associated with AMR in these bacteria in the general horse population are not well understood. The primary objective of our study was to estimate the prevalence of Salmonella and describe antimicrobial susceptibility of Salmonella and E. coli from equids across the United States. The second objective was to identify associations between health management and biosecurity practices and AMR. Fecal samples submitted from 1357 equids on 199 operations were tested for Salmonella, identifying 27 positive samples with 29 isolates belonging to 18 serotypes. Fecal sample and operation-level prevalence of Salmonella was 2.0% (27/1357) and 7.0% (14/199), respectively. Most (25/29) isolates were pan-susceptible while four isolates exhibited resistance, three of which were multidrug resistant. Of the 721 samples cultured for E. coli, 85% (613/721) were positive. Eighty-six percent of the E. coli isolates recovered were pan-susceptible (529/612). Ten isolates were intermediate to one antimicrobial drug and susceptible to all others. Seventy-three E. coli isolates (11.9%, SE=1.3) were resistant to one or more antimicrobials, corresponding to a 33.0% (64/194) operation-level prevalence. Resistance to sulfonamide drugs was most common with 63 isolates (10.3%) resistant to sulfisoxazole, 57 of which (9.3%) were resistant to trimethoprim-sulfamethoxazole. MDR in E. coli was rare (1.8%, SE=0.5). Univariate and multivariable regression were used to evaluate associations between health management and biosecurity questionnaire items and AMR in E. coli. The outcome modeled was resistance to any of the 14 tested antimicrobials. Depending on the operation type, operations with greater than 20 resident equids were significantly associated with resistance. In addition, performance operations were significantly associated with resistance when compared to farm/ranch operations. Operations with feed containers that prevent fecal contamination and those that had treated any equids for illness or injury were associated with a lower AMR. The study results suggest that equids in the general population appear to pose low risk of shedding antimicrobial resistant strains of Salmonella and E. coli, and therefore low transmission potential to other equids, animals, humans, or the environment. However, it is prudent to practice good hand hygiene to prevent spread of Salmonella as well as AMR, and to protect both animal and human health. Despite study limitations, potential management factors that may influence prevalence and prevent spread of AMR shed by equids were identified.

Knowledge base and effectiveness of online continuing education about foreign animal diseases for equine veterinarians.

The purpose of this study was to assess the effectiveness of two different methods of online education using the knowledge base of African horse sickness (AHS) among US equine veterinarians as a model. An e-mail was sent to US veterinary members of the American Association of Equine Practitioners (AAEP), inviting them to participate in a complementary online educational opportunity. We determined participants' baseline knowledge of AHS by their responses in an AHS case scenario. Participants were then randomly assigned to either a Webinar module or a text-formatted module, followed by an educational assessment quiz. Educational effectiveness was measured by considering the difference between the educational assessment quiz score and the baseline knowledge score. Of the 5,394 members from the AAEP list, 309 veterinarians agreed to participate, but only 211 completed the entire study. The median baseline knowledge score from the case scenario was 20 out of a perfect score of 100 points. The median assessment quiz score after the participants had access to the AHS educational material was 90, which was significantly higher than the baseline knowledge score (p=.01). Educational effectiveness in the module formats showed no significant difference (p=.81). Results from this study suggest that online education modules, once accessed, may improve participants' knowledge of veterinary diseases.

Babesia equi-induced anemia in a Quarter Horse and subsequent regulatory response.

CASE DESCRIPTION: A 7-year-old Quarter Horse gelding used for unsanctioned racing was examined because of fever and anorexia. CLINICAL FINDINGS: Physical examination revealed fever, tachycardia, and tachypnea. Results of a CBC indicated anemia and mild thrombocytopenia. Results of microscopic examination of a blood smear indicated piroplasms in erythrocytes, consistent with Babesia spp. Regulatory authorities were contacted, and results of serologic testing at the National Veterinary Services Laboratories confirmed acute Babesia equi infection. TREATMENT AND OUTCOME: Equids on the home premises of the index horse were placed under quarantine. Those equids were tested for piroplasmosis, and 6 of 63 horses had positive results for B equi. Another horse that had previously been housed on the index premises also had positive results for B equi. Competent tick vectors for piroplasmosis organisms were not identified. All 8 horses with piroplasmosis were Quarter Horses that participated in unsanctioned racing and were trained by the same person. Two of the horses were illegally removed from the index premises; these 2 horses and the other horse with piroplasmosis that was previously housed on the index premises could not be found. The other 5 horses with piroplasmosis were euthanized. Investigators concluded that transmission of B equi among horses was most likely iatrogenic. CLINICAL RELEVANCE: The United States has been considered piroplasmosis free. However, veterinarians should consider piroplasmosis in horses with signalments and clinical signs similar to those of the index horse of this report. Regulatory authorities should be contacted regarding horses in which piroplasmosis is suspected.

Re-emergence of the apicomplexan Theileria equi in the United States: elimination of persistent infection and transmission risk.

Arthropod-borne apicomplexan pathogens that cause asymptomatic persistent infections present a significant challenge due to their life-long transmission potential. Although anti-microbials have been used to ameliorate acute disease in animals and humans, chemotherapeutic efficacy for apicomplexan pathogen elimination from a persistently infected host and removal of transmission risk is largely unconfirmed. The recent re-emergence of the apicomplexan Theileria equi in U.S. horses prompted testing whether imidocarb dipropionate was able to eliminate T. equi from naturally infected horses and remove transmission risk. Following imidocarb treatment, levels of T. equi declined from a mean of 10(4.9) organisms/ml of blood to undetectable by nested PCR in 24 of 25 naturally infected horses. Further, blood transfer from treated horses that became nested PCR negative failed to transmit to naïve splenectomized horses. Although these results were consistent with elimination of infection in 24 of 25 horses, T. equi-specific antibodies persisted in the majority of imidocarb treated horses. Imidocarb treatment was unsuccessful in one horse which remained infected as measured by nested PCR and retained the ability to infect a naïve recipient via intravenous blood transfer. However, a second round of treatment eliminated T. equi infection. These results support the utility of imidocarb chemotherapy for assistance in the control and eradication of this tick-borne pathogen. Successful imidocarb dipropionate treatment of persistently infected horses provides a tool to aid the global equine industry by removing transmission risk associated with infection and facilitating international movement of equids between endemic and non-endemic regions.

Outbreak of equine piroplasmosis in Florida.

CASE DESCRIPTION: A 7-year-old Quarter Horse gelding was hospitalized in Ocala, Fla, because of lethargy, fever, anorexia, and swelling of distal aspects of the limbs. A tentative diagnosis of equine piroplasmosis (EP) was made on the basis of examination of a blood smear. The case was reported to the Florida State Veterinarian, and infection with Babesia equi was confirmed. The subsequent investigation included quarantine and testing of potentially exposed horses for B equi and Babesia caballi infections, tick surveillance, and owner-agent interviews. CLINICAL FINDINGS: 210 horses on 25 premises were tested for infection with EP pathogens. Twenty B equi-infected horses on 7 premises were identified; no horses tested positive for B caballi. Seven horses, including the index case, had clinical findings consistent with EP Dermacentor variabilis was considered the only potential tick vector for B equi collected, and all D variabilis specimens tested negative for Babesia organisms via PCR assay. Results of the epidemiological investigation suggested that B equi was spread by use of shared needles and possibly blood transfusions. All horses that tested positive were involved in nonsanctioned Quarter Horse racing, and management practices were thought to pose substantial risk of transmission of blood-borne pathogens. TREATMENT AND OUTCOME: Final outcome of B equi-infected horses was euthanasia, death from undetermined causes, or shipment to a US federal research facility. CLINICAL RELEVANCE: This investigation highlights the importance of collaboration between private veterinary practitioners, state veterinary diagnostic laboratories, and regulatory officials in the recognition, containment, and eradication of foreign animal disease.

Relationship of biosecuriy practices with the use of antibiotics for the treatment of infectious disease on U.S. equine operations.

This study is the first report estimating, on a national basis, the use of various biosecurity practices, singly and in combination, on U.S. equine operations. Use of biosecurity practices is described for operations by risk level, based on reported exposure of resident horses to outside horses during the previous 12 months. In addition, the association between use of various biosecurity practices and use of antibiotics to treat infectious disease in both adult equids and foals is reported. The comparison of these study findings with previously reported data in the literature is limited by the fact that few estimates of biosecurity practice use on equine operations have been reported and none has been published on a national basis beyond those in the National Animal Health Monitoring System (NAHMS) equine reports. A total of 78.5% of operations had some risk of exposure of resident horses to outside horses between summer 2004 and the time of the interview in summer 2005. For the majority of biosecurity practices, there was a significant (p<0.05) difference between different exposure risk levels in the percentage of operations using the practice. A higher percentage of high- and medium-risk operations implemented a combination of 4 or more biosecurity practices compared to low-risk operations. There was less use of antibiotics to treat infectious disease in adult horses on operations that required those who visit the operation to use separate equipment, change clothes/overalls, disinfect boots and equipment, or park vehicles away from animals than on those that did not. None of the other biosecurity practices were associated with use of antibiotics in adult horses and none of the biosecurity practices included in this study was associated with use of antibiotics in foals. For adults the use of antibiotics for infectious disease increased with decreasing herd size; this trend was reversed for antibiotic use in foals. The effect of exposure risk level was different for adults and foals. For adults, antibiotic use was lower for operations at higher risk; for foals, antibiotic use was higher for operations at higher risk.

Development, application, and validation of a survey for infectious disease control practices at equine boarding facilities.

OBJECTIVE: To develop a questionnaire for self-assessment of biosecurity practices at equine boarding facilities and to evaluate infectious disease control practices in these facilities in Colorado. DESIGN: Cross-sectional study. SAMPLE POPULATION: 64 equine boarding facilities in Colorado. PROCEDURES: Survey questions were rated according to importance for prevention and containment of equine infectious diseases. Point values (range, 0 to 20) were assigned for possible responses, with greater values given for optimal infection control methods. Questionnaires were mailed to equine boarding facilities in Colorado advertised on the World Wide Web. Survey responses were compared with assessments made by a member of the research team during visits to 30 randomly selected facilities. Agreement among results was analyzed via a kappa test and rated as poor, fair, moderate, substantial, or nearly perfect. RESULTS: Survey responses were received for 64 of 163 (39%) equine boarding facilities. Scores ranged from 106 to 402 points (maximum possible score, 418). Most facilities received better scores for movement and housing of equids than for other sections of the survey. Respondents at 24 of 48 (50%) facilities that routinely received new equids reported isolation of new arrivals. Agreement between self-assessment by survey respondents and evaluation by a member of the research team was determined to be fair to substantial. CONCLUSIONS AND CLINICAL RELEVANCE: Most equine boarding facilities have opportunities to improve measures for prevention or containment of contagious diseases (eg, isolation of newly arrived equids and use of written health management protocols). Most self-assessments of infection control practices were accurate.

Comparison of temperature readings from a percutaneous thermal sensing microchip with temperature readings from a digital rectal thermometer in equids.

OBJECTIVE: To compare temperature readings from an implantable percutaneous thermal sensing microchip with temperature readings from a digital rectal thermometer, to identify factors that affect microchip readings, and to estimate the sensitivity and specificity of the microchip for fever detection. DESIGN: Prospective study. ANIMALS: 52 Welsh pony foals that were 6 to 10 months old and 30 Quarter Horses that were 2 years old. PROCEDURES: Data were collected in summer, winter, and fall in groups 1 (n = 23 ponies), 2 (29 ponies), and 3 (30 Quarter Horses), respectively. Temperature readings from a digital rectal thermometer and a percutaneous thermal sensing microchip as well as ambient temperature were recorded daily for 17, 23, and 19 days in groups 1 through 3, respectively. Effects of ambient temperature and rectal temperature on thermal sensor readings were estimated. Sensitivity and specificity of the thermal sensor for detection of fever (rectal temperature, >or= 38.9 degrees C [102 degrees F]) were estimated separately for data collection at ambient temperatures 15.6 degrees C. RESULTS: Mean ambient temperatures were 29.0 degrees C (84.2 degrees F), -2.7 degrees C (27.1 degrees F), and 10.4 degrees C (50.8 degrees F) for groups 1 through 3, respectively. Thermal sensor readings varied with ambient temperature and rectal temperature. Rectal temperatures ranged from 36.2 degrees to 41.7 degrees C (97.2 degrees to 107 degrees F), whereas thermal sensor temperature readings ranged from 23.9 degrees (75 degrees F) to 42.2 degrees C (75 degrees to 108 degrees F). Sensitivity for fever detection was 87.4%, 53.3%, and 58.3% in groups 1 to 3, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The thermal sensor appeared to have potential use for initial screening of body temperature in equids at ambient temperatures > 15.6 degrees C.

Lack of correlation between antibody titers to fibrinogen-binding protein of Streptococcus equi and persistent carriers of strangles.

Previously published studies have neither used nor reported the results of an indirect enzyme-linked immunosorbent assay (iELISA) to measure serologic responses in natural outbreaks of strangles. The concept of using serologic responses to identify persistent carriers of Streptococcus equi has been proposed but not scientifically evaluated. The specific aims of the current study were to determine the duration and level of truncated fibrinogen-binding protein-specific (SeM allele 1) antibody production in ponies involved in a natural outbreak of strangles and to determine if test results from this serologic iELISA could predict persistent carrier status. Serologic samples were obtained before and after an outbreak of naturally occurring strangles infection. Persistent carriers of S. equi were identified via culture and polymerase chain reaction (PCR) testing of lavage fluid collected from the guttural pouches and nasopharynx or swabs of the nasopharynx after recovery from acute disease and at postmortem examination. Logistic regression analysis was used to determine if an association existed between serologic response and persistent carrier state. The ELISA reported in the current study definitively confirmed a recent exposure to S. equi. However, the measured serologic response did not predict carrier status in this strangles outbreak. Therefore, a guttural-pouch endoscopy with subsequent culture or PCR testing to detect S. equi remains the most accurate method available for the identification of persistent carriers.

Factors associated with vesicular stomatitis in animals in the western United States.

OBJECTIVE: To identify factors associated with development of vesicular stomatitis (VS). DESIGN: Case-control study. SAMPLE POPULATION: 138 livestock premises and 118 horses suspected of having VS in Texas, New Mexico, and Colorado. PROCEDURES: Premises with >or= 1 animal with clinical signs and laboratory confirmation of infection were classified as case premises. Premises where laboratory confirmation results were negative were control premises. Among equine premises, case and control horses were selected on the basis of premises status. A survey was conducted to identify factors associated with VS for premises and specific horses. RESULTS: Control of insect populations in the 2 weeks before the VS investigation decreased the odds of disease for premises where vegetation coverage was grassland or pasture (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.01 to 0.7). Odds of VS for premises covered with grassland or pasture increased when measures to control insect populations were not used (OR, 11; 95% CI, 0.8 to 156.3) and for premises that had a body of water (OR, 2.3; 95% CI, 1.0 to 5.6). Use of measures to prevent insect bites or harassment by insects (OR, 0.2; 95% CI, 0.1 to 0.8) and spending time in shelters (OR, 0.4; 95% CI, 0.2 to 1.1) in the 2 weeks prior to investigation decreased the odds of being a case horse. CONCLUSIONS AND CLINICAL RELEVANCE: Insect control and spending time in shelters decreased the odds for infection with VS. Premises covered with grassland or pasture or that had a body of water were at a higher risk.

Adsorptive effects of di-tri-octahedral smectite on Clostridium perfringens alpha, beta, and beta-2 exotoxins and equine colostral antibodies.

OBJECTIVE: To determine the adsorptive capability of di-tri-octahedral smectite (DTOS) on Clostridium perfringens alpha, beta, and beta-2 exotoxins and equine colostral antibodies. SAMPLE POPULATION: 3 C perfringens exotoxins and 9 colostral samples. PROCEDURES: Alpha, beta, and beta-2 exotoxins were individually co-incubated with serial dilutions of DTOS or bismuth subsalicylate, and the amount of toxin remaining after incubation was determined via toxin-specific ELISAs. Colostral samples from healthy mares were individually co-incubated with serial dilutions of DTOS, and colostral IgG concentrations were determined via single radial immunodiffusion assay. RESULTS: Di-tri-octahedral smectite decreased the amount of each C perfringens exotoxin in co-incubated samples in a dose-dependent manner and was more effective than bismuth subsalicylate at reducing exotoxins in vitro. Decreases in the concentration of IgG were detected in samples of colostrum that were combined with DTOS at 1:4 through 1:16 dilutions, whereas no significant decrease was evident with DTOS at the 1:32 dilution. CONCLUSIONS AND CLINICAL RELEVANCE: Di-tri-octahedral smectite effectively adsorbed C perfringens exotoxins in vitro and had a dose-dependent effect on the availability of equine colostral antibodies. Results suggested that DTOS may be an appropriate adjunctive treatment in the management of neonatal clostridiosis in horses. In vivo studies are necessary to fully assess the clinical efficacy of DTOS treatment.

Pilot study to evaluate 3 hygiene protocols on the reduction of bacterial load on the hands of veterinary staff performing routine equine physical examinations.

Reduction factors (RFs) for bacterial counts on examiners' hands were compared when performing a standardized equine physical examination, followed by the use of one of 3 hand-hygiene protocols (washing with soap, ethanol gel application, and chlorohexidine-ethanol application). The mean RFs were 1.29 log10 and 1.44 log10 at 2 study sites for the alcohol-gel (62% ethyl alcohol active ingredient) protocols and 1.47 log10 and 1.94 log10 at 2 study sites for the chlorhexidine-alcohol (61% ethyl alcohol plus 1% chlorhexidine active ingredients) protocols, respectively. The RFs were significantly different (P < 0.0001) between the hand-washing group and the other 2 treatment groups (the alcohol-gel and the chlorhexidine-alcohol lotion). The use of alcohol-based gels or chlorhexidine-alcohol hand hygiene protocols must still be proven effective in equine practice settings, but in this study, these protocols were equivalent or superior to hand washing for reduction in bacterial load on the hands of people after they perform routine physical examinations.

Impact of heat stress on the fecal shedding patterns of Salmonella enterica Typhimurium DT104 and Salmonella enterica infantis by 5-week-old male broilers.

The objective of this study was to determine if there is an impact of heat stress of broiler chickens on number and survival of two types of Salmonella shed in the chicken's feces after an oral challenge. The data from this study indicate that heat stress did not result in higher levels or longer survival of Salmonella spp. shed in feces. It is possible that the duration or intensity of the heat stress employed was not sufficient or that heat stress does not alter the number or survivability for these particular strains of Salmonella spp. Feces stored at room temperature after collection, resulted in the numbers of both strains of Salmonella increasing by one to three logs in the first week. This finding indicates that there could be an increase in environmental contamination under certain conditions.

Impact of hospitalization and antimicrobial drug administration on antimicrobial susceptibility patterns of commensal Escherichia coli isolated from the feces of horses.

Objective-To evaluate antimicrobial susceptibility of commensal Escherichia coli strains isolated from the feces of horses and investigate relationships with hospitalization and antimicrobial drug (AMD) administration. Design-Observational study. Animals-68 hospitalized horses that had been treated with AMDs for at least 3 days (HOSP-AMD group), 63 hospitalized horses that had not received AMDs for at least 4 days (HOSP-NOAMD group), and 85 healthy horses that had not been hospitalized or treated with AMDs (community group). Procedures-Fecal samples were submitted for bacterial culture, and up to 3 E coli colonies were recovered from each sample. Antimicrobial susceptibility of 724 isolates was evaluated. Prevalence of resistance was compared among groups by use of log-linear modeling. Results-For 12 of the 15 AMDs evaluated, prevalence of antimicrobial resistance differed significantly among groups, with prevalence being highest among isolates from the HOSP-AMD group and lowest among isolates from the community group. Isolates recovered from the HOSP-AMD and HOSP-NOAMD groups were also significantly more likely to be resistant to multiple AMDs. Resistance to sulfamethoxazole and resistance to trimethoprim-sulfamethoxazole were most common, followed by resistance to gentamicin and resistance to tetracycline. Use of a potentiated sulfonamide, aminoglycosides, cephalosporins, or metronidazole was positively associated with resistance to 1 or more AMDs, but use of penicillins was not associated with increased risk of resistance to AMDs. Conclusion and Clinical Relevance-Results suggest that both hospitalization and AMD administration were associated with prevalence of antimicrobial resistance among E coli strains isolated from the feces of horses.

Indirect fluorescent antibody testing of cerebrospinal fluid for diagnosis of equine protozoal myeloencephalitis.

OBJECTIVE: To assess the use of CSF testing with an indirect fluorescent antibody test (IFAT) for diagnosis of equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona. SAMPLE POPULATION: Test results of 428 serum and 355 CSF samples from 182 naturally exposed, experimentally infected, or vaccinated horses. PROCEDURE: EPM was diagnosed on the basis of histologic examination of the CNS. Probability distributions were fitted to serum IFAT results in the EPM+ and EPM-horses, and correlation between serum and CSF results was modeled. Pairs of serum-CSF titers were generated by simulation, and titer-specific likelihood ratios and post-test probabilities of EPM at various pretest probability values were estimated. Post-test probabilities were compared for use of a serum-CSF test combination, a serum test only, and a CSF test only. RESULTS: Post-test probabilities of EPM increased as IFAT serum and CSF titers increased. Post-test probability differences for use of a serum-CSF combination and a serum test only were < or = 19% in 95% of simulations. The largest increases occurred when serum titers were from 40 to 160 and pre-test probabilities were from 5% to 60%. In all simulations, the difference between pre- and post-test probabilities was greater for a CSF test only, compared with a serum test only. CONCLUSIONS AND CLINICAL RELEVANCE: CSF testing after a serum test has limited usefulness in the diagnosis of EPM. A CSF test alone might be used when CSF is required for other procedures. Ruling out other causes of neurologic disease reduces the necessity of additional EPM testing.

Evaluation of factors associated with positive IgM capture ELISA results in equids with clinical signs compatible with West Nile virus infection: 1,017 cases (2003).

OBJECTIVE: To describe the prevalence of West Nile virus (WNV) infection and evaluate factors associated with positive IgM capture ELISA results in equids with clinical signs compatible with WNV infection. DESIGN: Retrospective case series. SAMPLE POPULATION: Laboratory submission forms from 1,104 equids tested for WNV in Colorado in 2003. PROCEDURES: Submission forms accompanying samples submitted for detection of WNV via IgM capture ELISA were obtained from the Colorado state veterinarian and diagnostic laboratories performing the tests. Data on signalment, clinical signs, history of vaccination against WNV, and assay results were collected from laboratory submission forms. Equids with clinical signs compatible with WNV infection in which IgM capture ELISA results were positive were considered as case equids. RESULTS: 1,104 equids were tested for WNV; 1,017 (92.1%) had clinical signs compatible with WNV infection. Among equids with clinical signs compatible with WNV infection, the odds of testing positive for WNV via IgM capture ELISA were lower in males and in vaccinated equids and higher in equids with moderate and severe illness, compared with females, unvaccinated equids, and equids with mild illness. CONCLUSIONS AND CLINICAL RELEVANCE: Among equids with clinical signs compatible with WNV infection, vaccination against WNV, severity of clinical signs, duration of illness, and region in Colorado were associated with increased risk of having a positive IgM capture ELISA result.

Investigation of falsely reported resistance of Streptococcus equi subsp. zooepidemicus isolates from horses to trimethoprim-sulfamethoxazole.

The objective of this study was to investigate the perceived increase in resistance of Streptococcus equi subsp. zooepidemicus (S. zooepidemicus) isolated from the lower respiratory tract of horses to trimethoprim-sulfamethoxazole (SXT). The recorded SXT-susceptibility results of 50 S. zooepidemicus isolates from the tracheal wash fluid of equine patients examined at Colorado State University Veterinary Teaching Hospital from each of 2 time periods (1987-1990 and 1997-2001) were compared and statistically analyzed using a cross-sectional study design. There was a statistically significant difference between the documented resistance of S. zooepidemicus isolated in the 1987-1990 time period (8%), using quantitative microbroth dilution, and the resistance reported for isolates from the 1997-2001 time period (42%), using Kirby-Bauer agar disk diffusion. Laboratory investigation revealed inadequate quality control of media and subsequent falsely reported resistance of S. zooepidemicus from 1997 to 2001 time period. This study demonstrates how minor deviations from prescribed laboratory-testing guidelines can have a major effect on antimicrobial susceptibility test results. The study also underscores the need for regular surveillance and monitoring of trends in antimicrobial susceptibility to detect and correct such problems. In addition, epidemiologists and others collecting data from laboratories should be cautioned to interact with the laboratory regarding interpretation of results of various testing methods to ensure accurate analysis and conclusions.

Antimicrobial drug use in veterinary medicine.

Recognizing the importance of antimicrobial resistance and the need for veterinarians to aid in efforts for maintaining the usefulness of antimicrobial drugs in animals and humans, the Board of Regents of the American College of Veterinary Internal Medicine charged a special committee with responsibility for drafting this position statement regarding antimicrobial drug use in veterinary medicine. The Committee believes that veterinarians are obligated to balance the well-being of animals under their care with the protection of other animals and public health. Therefore, if an animal's medical condition can be reasonably expected to improve as a result of treatment with antimicrobial drugs, and the animal is under a veterinarian's care with an appropriate veterinarian-client-patient relationship, veterinarians have an obligation to offer antimicrobial treatment as a therapeutic option. Veterinarians also have an obligation to actively promote disease prevention efforts, to treat as conservatively as possible, and to explain the potential consequences associated with antimicrobial treatment to animal owners and managers, including the possibility of promoting selection of resistant bacteria. However, the consequences of losing usefulness of an antimicrobial drug that is used as a last resort in humans or animals with resistant bacterial infections might be unacceptable from a public or population health perspective. Veterinarians could therefore face the difficult choice of treating animals with a drug that is less likely to be successful, possibly resulting in prolonged or exacerbated morbidity, to protect the good of society. The Committee recommends that voluntary actions be taken by the veterinary profession to promote conservative use of antimicrobial drugs to minimize the potential adverse effects on animal or human health. The veterinary profession must work to educate all veterinarians about issues related to conservative antimicrobial drug use and antimicrobial resistance so that each individual is better able to balance ethical obligations regarding the perceived benefit to their patients versus the perceived risk to public health. Specific means by which the veterinary profession can promote stewardship of this valuable resource are presented and discussed in this document.

Community-associated methicillin-resistant Staphylococcus aureus in horses and humans who work with horses.

OBJECTIVE: To evaluate the prevalence of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) in horses and horse personnel. DESIGN: Prospective prevalence study. SAMPLE POPULATION: 972 horses and 107 personnel from equine farms in Ontario, Canada and New York state. PROCEDURE: Nasal swab specimens were collected from horses and humans on farms with (targeted surveillance) and without (nontargeted surveillance) a history of MRSA colonization or infection in horses during the preceding year. Selective culture for MRSA was performed. Isolates were typed via pulsed-field gel electrophoresis, and antibiograms were determined. RESULTS: MRSA was isolated from 46 of 972 (4.7%) horses (0/581 via nontargeted surveillance and 46/391 [12%] via targeted surveillance). Similarly, MRSA was isolated from 14 of 107 (13%) humans (2/41 [5%] from nontargeted surveillance and 12/66 [18%] from targeted surveillance). All isolates were subtypes of Canadian epidemic MRSA-5, an uncommon strain in humans. All isolates were resistant to at least 1 antimicrobial class in addition to beta-lactams. On all farms with colonized horses, at least 1 human was colonized with an indistinguishable subtype. For horses, residing on a farm that housed > 20 horses was the only factor significantly associated with MRSA colonization. For humans, regular contact with > 20 horses was the only identified risk factor. CONCLUSIONS AND CLINICAL RELEVANCE: Results confirm a reservoir of colonized horses on a variety of farms in Ontario and New York and provide evidence that 1 MRSA strain is predominantly involved in MRSA colonization in horses and humans that work with horses.

Immunologic responses to West Nile virus in vaccinated and clinically affected horses.

OBJECTIVE: To compare neutralizing antibody response between horses vaccinated against West Nile virus (WNV) and horses that survived naturally occurring infection. DESIGN: Cross-sectional observational study. ANIMALS: 187 horses vaccinated with a killed WNV vaccine and 37 horses with confirmed clinical WNV infection. PROCEDURE: Serum was collected from vaccinated horses prior to and 4 to 6 weeks after completion of an initial vaccination series (2 doses) and 5 to 7 months later. Serum was collected from affected horses 4 to 6 weeks after laboratory diagnosis of infection and 5 to 7 months after the first sample was obtained. The IgM capture ELISA, plaque reduction neutralization test (PRNT), and microtiter virus neutralization test were used. RESULTS: All affected horses had PRNT titers > or = 1:100 at 4 to 6 weeks after onset of disease, and 90% (18/20) maintained this titer for 5 to 7 months. After the second vaccination, 67% of vaccinated horses had PRNT titers > or = 1:100 and 14% had titers < 1:10. Five to 7 months later, 33% (28/84) of vaccinated horses had PRNT titers > or = 1:100, whereas 29% (24/84) had titers < 1:10. Vaccinated and clinically affected horses' end point titers had decreased by 5 to 7 months after vaccination. CONCLUSIONS AND CLINICAL RELEVANCE: A portion of horses vaccinated against WNV may respond poorly. Vaccination every 6 months may be indicated in certain horses and in areas of high vector activity. Other preventative methods such as mosquito control are warranted to prevent WNV infection in horses.