Demonstrating the importance of local culture and susceptibility data: antibiograms from dogs at a veterinary tertiary care center.

OBJECTIVE: To create antibiograms for commonly cultured organisms in a small animal tertiary care hospital following Clinical and Laboratory Standards Institute guidelines and to compare these local resistance patterns to published first-tier antimicrobial recommendations. SAMPLE: Urine (n = 429), respiratory (41), and skin (75) isolates cultured from dogs between January 1, 2019, and December 31, 2020, at the Tufts University Foster Hospital for Small Animals. PROCEDURES: MIC and susceptibility interpretations were recorded for multiple sites for 2 years. Sites with greater than 30 isolates for at least 1 organism were included. Urinary, respiratory, and skin antibiograms were created using Clinical and Laboratory Standards Institute breakpoints and guidelines. RESULTS: Urinary Escherichia coli had a higher susceptibility percentage for amoxicillin-clavulanate (80% [221/275]) than amoxicillin alone (64% [175/275]). Respiratory E coli were greater than 80% susceptible to only 2 antimicrobials (imipenem, amikacin). Of skin Staphylococcus pseudintermedius isolates, 40% (30/75) were methicillin-resistant and frequently also displayed resistance to non-beta lactam antimicrobials. Susceptibility to recommended first-line antimicrobials varied and was greatest for gram-negative urinary isolates and lowest for methicillin-resistant S pseudintermedius skin isolates and respiratory E coli. CLINICAL RELEVANCE: Local antibiogram creation identified frequent resistance that may preclude the use of guideline-recommended first-line therapy. High levels of resistance identified in methicillin-resistant S pseudintermedius isolates supports growing concern for methicillin-resistant staphylococci in veterinary patients. This project highlights the need for population-specific resistance profiles to be used in conjunction with national guidelines.

Impact of antimicrobial use in dogs on antimicrobial resistance and shared flora with human owners.

Transmission of bacteria between animals and humans in domestic households is increasingly recognized. We evaluated the presence of antimicrobial-resistant fecal bacteria in 8 dog-owner-dog pairs before and after the dog received amoxicillin-clavulanate. The study identified shared flora in the humans and dogs that were affected by antimicrobial administration.

Successful treatment of suspect Babesia-induced ARDS in a dog using lung-protective positive-pressure ventilation and neuromuscular blockade.

A mixed breed dog was treated for severe hemolytic anemia secondary to Babesia canis infection. Within 14 hours of hospitalization, the dog developed respiratory distress and hypoxemia. The patient improved with lung-protective mechanical ventilation and neuromuscular blockade. The dog survived to discharge and was reportedly healthy at three-month follow-up.

Prazosin administration increases the rate of recurrent urethral obstruction in cats: 388 cases.

OBJECTIVE: To determine if prazosin administration decreased the rate of recurrent urethral obstruction (rUO) before hospital discharge and within 14 days. ANIMALS: 388 cats with urethral obstruction. PROCEDURES: Veterinarians who either always or never prescribed prazosin (generally, 0.5 to 1 mg, PO, q 12 h for 14 days) were recruited to complete observational surveys. Patient data and characteristics of relieving the obstruction, including perception of a gritty feel within urethra or difficulty unobstructing the cat, were recorded. The rate of development of rUO before hospital discharge and by day 14 was compared between cats that received or did not receive prazosin with the Fisher exact test. Other variables were similarly compared between cats with and without rUO. RESULTS: 302 (78%) cats received prazosin, while 86 (22%) did not. There was no association between prazosin administration and risk of rUO prior to discharge, with 34 of 302 (11.3%) cats receiving prazosin and 5 or 86 (5.8%) not receiving prazosin developing rUO. Within 14 days, a significantly higher proportion of prazosin-treated cats (73/302 [24%]) developed an rUO, compared with the proportion of non-prazosin-treated cats (and 11/86 [13%]). The perception of a "gritty feeling urethra" or difficulty of performing the catheterization was associated with increased risk of rUO. CLINICAL RELEVANCE: Prazosin administration increased the likelihood of rUO by 14 days; ongoing investigation of other therapies to decrease rUO in cats is warranted. Without specific indications, the use of prazosin for the prevention of rUO should be discouraged.

The use of caffeine as a respiratory stimulant in a cat.

OBJECTIVE: To report the use of caffeine as a respiratory stimulant in a cat with hypoventilation. CASE SUMMARY: A cat was mechanically ventilated due to persistent hypercapnia (Pet co2  > 75 mm Hg) following median sternotomy and thymectomy. After 3 days of mechanical ventilatory support, the cat would initiate breaths but failed weaning due to persistent hypercapnia. Following administration of intravenous caffeine (total 12 mg/kg over 24 h), respiratory and mental status rapidly improved. The cat was subsequently extubated and able to maintain Pvco2  < 50 mm Hg. The cat was later diagnosed with myasthenia gravis. Quality of life 13 months after discharge was reported as excellent by her owner. NEW OR UNIQUE INFORMATION PROVIDED: Caffeine may be considered as a respiratory stimulant in cats with hypoventilation.

Patterns of bacterial culture and antimicrobial susceptibility test results for dogs with retrobulbar abscesses: 133 cases (2002-2019).

OBJECTIVE: To evaluate patterns of bacterial culture and antimicrobial susceptibility test results for dogs with retrobulbar abscesses and generate recommendations for empirical antimicrobial selection. ANIMALS: 133 dogs examined between 2002 and 2019. PROCEDURES: Records were retrospectively reviewed to determine type of bacterial culture, number and type of bacterial isolates, antimicrobial susceptibility test results, concurrent and recent antimicrobial exposure, effect of culture results on antimicrobial regimen, and outcome. RESULTS: Aerobic culture alone was performed in 37 dogs, and aerobic and anaerobic culture was performed in 96 dogs. Isolates were recovered from 96 dogs, with multiple isolates recovered from 54 (56%) of those dogs. Of the 69 dogs for which both aerobic and anaerobic culture was performed and at least 1 isolate was obtained, 34 (49%) had purely aerobic infections, 15 (22%) had mixed aerobic and anaerobic infections, and 20 (29%) had purely anaerobic infections. Pasteurella spp (n = 26), Streptococcus spp (20), and Escherichia coli (12) were the most common aerobic isolates. Bacteroides spp (n = 22), Actinomyces spp (10), and Fusobacterium (10) spp were the most common anaerobic isolates. Susceptibility test results led to changes in the antimicrobial regimen in 37 of 80 (46%) dogs. Of the 76 dogs for which outcome information was available, 78 (97%) recovered. CLINICAL RELEVANCE: Multipathogen and anaerobic infections were common in dogs with retrobulbar abscesses. Susceptibility data supported the use of amoxicillin-clavulanate or a combination of clindamycin and enrofloxacin as first-line treatments. Additional study is needed to characterize anaerobic antimicrobial susceptibilities and to compare results of susceptibility testing with in vivo responses to antimicrobial administration.

Diagnostic utility of abdominal ultrasonography for evaluation of dogs with nontraumatic hemoabdomen: 94 cases (2014-2017).

OBJECTIVE: To evaluate the utility of abdominal ultrasonography (AUS) to detect grossly evident masses in dogs with nontraumatic hemoabdomen. ANIMALS: 94 client-owned dogs. PROCEDURES: Electronic medical records from 2014 to 2017 were searched to identify dogs with nontraumatic hemoabdomen that had an AUS performed by a radiologist and subsequently underwent gross evaluation by surgery or necropsy. Ultrasonography, surgery, and histology reports were reviewed, and descriptive statistics were performed. Sensitivity of ultrasonography to detect grossly identifiable masses was calculated. RESULTS: Differences were identified between AUS and surgical or necropsy findings for 51 of 94 (54%) dogs. Splenic masses were most commonly identified as the cause of hemoabdomen. Sensitivity of AUS was 87.4%, 37.3%, and 31.3% for masses in the spleen, liver, and mesentery, respectively. Five dogs had more lesions identified with AUS than were found on gross evaluation; 0 of 6 dogs with peritoneal diffuse nodular metastasis had lesions detected by AUS. CONCLUSIONS AND CLINICAL RELEVANCE: In this sample of dogs, the utility of AUS to detect grossly identifiable lesions in dogs with nontraumatic hemoabdomen was limited, with the highest and lowest sensitivity found for splenic masses and diffuse nodular metastasis, respectively.

Cataloguing the response by emergency veterinary hospitals during the COVID-19 pandemic via weekly surveys.

BACKGROUND: The COVID-19 pandemic has presented veterinary emergency hospitals with unique challenges. Rapid online surveys represent an efficient way of collating responses to rapidly shifting circumstances. METHODS: Fifty, 24-h small animal emergency veterinary hospital representatives were recruited to participate in weekly surveys in April 2020 to catalog changes due to COVID-19 pandemic. KEY FINDINGS: The majority of emergency veterinary hospitals surveyed reported significant changes to day-to-day operations as a result of the COVID-19 pandemic. SIGNIFICANCE: Reporting of weekly survey results provides useful information on how emergency veterinary hospitals with similar challenges are responding to the COVID-19 pandemic.

Perceptions of Maternal Discrimination and Pregnancy/Postpartum Experiences Among Veterinary Mothers.

Objective: To describe perceptions of maternal discrimination and to begin to understand patterns around timing of starting families, infertility, and post-partum depression among veterinary mothers. Design: Cross-sectional questionnaire with closed and open-ended questions posted to a social media platform "Moms with a DVM." Sample: 1,082 veterinary mothers in the United States. Procedures: An online questionnaire was administered regarding perceived discrimination, inequities in the work-place due to pregnant or maternal status, desired accommodations, timing of pregnancy(ies), fertility issues, and postpartum experiences. Results: At least one form of perceived discrimination was reported by 819 (75.7%) respondents (M = 2.6, SD = 2.1, range 0-10). Specifically, 789 (72.9%) reported maternal discrimination. Over half of the sample (n = 632, 58.4%) reported at least one instance of perceived inequity in the workplace due to status as a mother (M = 1.23, SD = 1.4, range 0-5). A majority (906, 83.7%) reported that their career had "definitely" or "maybe" affected the timing of their children. One hundred eighty-nine respondents (17.5%) experienced at least one miscarriage, and 192 (17.6%) used fertility treatment due to difficulty conceiving. Postpartum depression was diagnosed in 181 respondents (16.7%), and 353 (32.6%) reported symptoms consistent with postpartum depression but did not seek medical care. Of 953 participants who needed accommodations for breastfeeding and/or pumping while at work, 130 (13.6%) reported excellent accommodations, 454 (47.6%) adequate, 258 (27.1%) inadequate, and 111 (11.6%) had no accommodations provided. Conclusions and Clinical Relevance: Participants reported experiences of perceived maternal discrimination, as well as inequities and lack of support services due to status as a mother. These results highlight the need for attention and changes to ensure veterinarians have supportive and sustainable career options.

Usage patterns of carbapenem antimicrobials in dogs and cats at a veterinary tertiary care hospital.

BACKGROUND: Carbapenems are a class of antimicrobials reserved for resistant infections or systemically ill people, yet the extent and context in which they are prescribed in the small animals is understudied. HYPOTHESIS/OBJECTIVE: To describe cases in dogs and cats treated with carbapenems to establish baseline data regarding the types of infections, outcomes, and resistance profiles of target infections. We hypothesize that prescribing practices for carbapenems at a veterinary tertiary care hospital would not comply with the recommended use guidelines in human medicine. METHODS: Retrospective study of veterinary medical records from all dogs and cats prescribed carbapenems between May 1, 2016, and April 30, 2017. RESULTS: A total of 81 infections (71 in dogs and 10 in cats) representing 68 animals (58 dogs and 10 cats) involving carbapenem use were identified. Cultures were performed in 65/81 (80%) infections, and antimicrobial use was de-escalated or discontinued in 10/81 (12%) infections. The average duration of treatment was 27.5 days and ranged from 1 to 196 days. Resistance to more than 3 antimicrobial classes was present in 57/115 (50%) isolates. Resistance to carbapenems was found in 2/64 (3%) of the bacterial isolates with reported carbapenem susceptibility. CONCLUSIONS AND CLINICAL IMPORTANCE: The majority of carbapenem use at a veterinary tertiary care hospital was prescribed in conjunction with culture and sensitivity determination, with de-escalation performed in a minority of cases, and treatment durations longer than typically recommended in human medicine.

Parenterally administered vancomycin in 29 dogs and 7 cats (2003-2017).

BACKGROUND: Vancomycin is commonly used to treat resistant bacterial infections in people. Reported adverse effects of vancomycin in people include acute kidney injury (AKI), neutropenia, and systemic allergic reaction. Given the increased incidence of vancomycin-resistant bacterial infections in people, support is growing for restriction of vancomycin. OBJECTIVES: To evaluate the use of intravenous (IV) vancomycin in a university teaching hospital and to describe potential adverse effects. ANIMALS: Twenty-nine dogs and 7 cats. METHODS: Medical records of dogs and cats treated with IV vancomycin at the Foster Hospital for Small Animals between January 2003 and October 2017 were reviewed. Information recorded included signalment, infection source, vancomycin dosing, potential adverse effects, and outcome. RESULTS: Vancomycin was used to treat infections from a range of sources with a variety of dosing intervals. The most common bacterial isolates susceptible to vancomycin included Enterococcus sp. (11/36, 30.6%), methicillin-resistant Staphylococcus aureus (8/36, 22.2%), and methicillin-resistant Staphylococcus pseudintermedius (2/36, 5.6%). AKI occurred in 6 of 36 patients (16.7%) during vancomycin treatment but could not definitively be attributed to vancomycin treatment in any patients because of illness severity, additional nephrotoxic treatments, or both. Neutropenia or allergic reaction was not documented in any animal. In 2 of 36 patients (5.6%), susceptibility data documented an infection that was only susceptible to vancomycin. Most patients survived to discharge (25/36, 69.4%). CONCLUSIONS AND CLINICAL IMPORTANCE: Adverse effects attributable to vancomycin were infrequent in dogs and cats. In most cases, there were potential alternative effective antimicrobials or lack of susceptibility data to support vancomycin treatment.

Perceptions of support and policies regarding pregnancy, parenting, and family planning during veterinary training at United States veterinary medical training institutions.

OBJECTIVE To gather information about issues associated with pregnancy, lactation, and parenting for US veterinary students and house officers (trainees) and their perception of pregnancy and parenting support services available at US veterinary training institutions. DESIGN Cross-sectional mixed-method survey. SAMPLE 2,088 veterinary students and 312 house officers from 27 US veterinary training institutions. PROCEDURES An email with a link to an online survey was sent to the associate dean for academic affairs at each of the 30 AVMA-accredited US veterinary training institutions with a request that it be forwarded to all veterinary students and house officers (interns and residents). RESULTS Among the 2,400 respondents, 185 (7.7%) reported that they were a parent, were pregnant, or had a significant other who was pregnant. Several significant differences in attitudes and perceptions of pregnancy and parenting support services provided by veterinary training institutions were identified between males and females, veterinary students and house officers, and respondents who were and were not parents. CONCLUSIONS AND CLINICAL RELEVANCE Results provided crucial information about an important facet of well-being for veterinary trainees and suggested that veterinary students and house officers face substantial challenges in becoming parents during their training programs and that perceptions of those challenges differ between males and females.