RESUMO
OBJECTIVE: To assess viability and safety of preemptive treatment of type II endoleak for abdominal aortic aneurysm (AAA) repairs. METHODS: A 69-year-old man with renal fusion (horseshoe kidney) was referred for treatment of a 5.5 cm AAA. His anatomy was suitable for endovascular repair. The risk for type II endoleak was increased because of multiple infrarenal arterial orifices originating within the aneurysm sac. These included an accessory renal artery that supplied the renal isthmus, a patent inferior mesenteric artery, and a pair of large lumbar arteries originating from a single orifice (8 mm) at L3 spinal level. The lumbar orifice was selectively cannulated and occluded with thrombogenic coils 1 week prior to his endovascular aneurysm repair. RESULTS: Aneurysm repair was uneventful with no signs of early or delayed endoleak and long-term follow-up of 5 years. CONCLUSIONS: Preemptive coil embolization of perianeurysmal arteries may be considered as a safe and effective strategy for management of potential type II endoleak.
RESUMO
OBJECTIVE: To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time. DESIGN: Experimental study. SETTING: Small animal research facility. ANIMALS: Twenty-four purpose-bred research dogs. INTERVENTIONS: Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (T0), at 3 minutes (T3), and at 6 minutes (T6) into BLS. MEASUREMENTS AND MAIN RESULTS: The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pao2, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (P < 0.03). By T6, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous Po2, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from T0 (P < 0.05). CONCLUSIONS: Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical role of POC testing during CPR.
Assuntos
Veias Jugulares , Animais , Cães/sangue , Masculino , Feminino , Sistemas Automatizados de Assistência Junto ao Leito , Reanimação Cardiopulmonar/veterinária , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/veterinária , Parada Cardíaca/terapia , Parada Cardíaca/sangue , Testes ImediatosRESUMO
OBJECTIVE: After the 2012 Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR Guidelines, this is an update of evidence-based consensus guidelines for Basic Life Support (BLS), advanced life support (ALS), and periarrest monitoring. DESIGN: These RECOVER CPR Guidelines were generated using a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system for evidence evaluation and translation of this evidence into clear and actionable clinical instructions. Prioritized clinical questions in the Population, Intervention, Comparator, and Outcome (PICO) format were used as the basis to conduct systematic literature searches by information specialists, to extract information from relevant publications, to assess this evidence for quality, and finally to translate the findings into treatment recommendations. These recommendations were reviewed by the RECOVER writing group and opened for comment by veterinary professionals for 4 weeks. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: A total of 40 worksheets were prepared to evaluate questions across the 3 domains of BLS, ALS and Monitoring, resulting in 90 individual treatment recommendations. High-dose epinephrine is no longer recommended, and atropine, if used, is only administered once. Bag-mask ventilation is prioritized over mouth-to-nose ventilation in nonintubated animals. In addition, an algorithm for initial assessment, an updated CPR algorithm, a rhythm diagnosis tool, and an updated drug dosing table are provided. CONCLUSIONS: While the majority of the BLS and ALS recommendations remain unchanged, some noteworthy changes were made due to new evidence that emerged over the past 10 years. Indirectness of evidence remains the largest impediment to the certainty of guidelines formulation and underscores an urgent need for more studies in the target species of dogs and cats.
Assuntos
Reanimação Cardiopulmonar , Doenças do Gato , Cães , Animais , Gatos , Reanimação Cardiopulmonar/veterinária , Reanimação Cardiopulmonar/normas , Reanimação Cardiopulmonar/métodos , Doenças do Gato/terapia , Doenças do Cão/terapia , Parada Cardíaca/veterinária , Parada Cardíaca/terapiaRESUMO
OBJECTIVE: To systematically review evidence and devise treatment recommendations for basic life support (BLS) in dogs and cats and to identify critical knowledge gaps. DESIGN: Standardized, systematic evaluation of literature pertinent to BLS following Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Prioritized questions were each reviewed by 2 Evidence Evaluators, and findings were reconciled by BLS Domain Chairs and Reassessment Campaign on Veterinary Resuscitation (RECOVER) Co-Chairs to arrive at treatment recommendations commensurate to quality of evidence, risk to benefit relationship, and clinical feasibility. This process was implemented using an Evidence Profile Worksheet for each question that included an introduction, consensus on science, treatment recommendations, justification for these recommendations, and important knowledge gaps. A draft of these worksheets was distributed to veterinary professionals for comment for 4 weeks prior to finalization. SETTING: Transdisciplinary, international collaboration in university, specialty, and emergency practice. RESULTS: Twenty questions regarding animal position, chest compression point and technique, ventilation strategies, as well as the duration of CPR cycles and chest compression pauses were examined, and 32 treatment recommendations were formulated. Out of these, 25 addressed chest compressions and 7 informed ventilation during CPR. The recommendations were founded predominantly on very low quality of evidence and expert opinion. These new treatment recommendations continue to emphasize the critical importance of high-quality, uninterrupted chest compressions, with a modification suggested for the chest compression technique in wide-chested dogs. When intubation is not possible, bag-mask ventilation using a tight-fitting facemask with oxygen supplementation is recommended rather than mouth-to-nose ventilation. CONCLUSIONS: These updated RECOVER BLS treatment recommendations emphasize continuous chest compressions, conformation-specific chest compression techniques, and ventilation for all animals. Very low quality of evidence due to absence of clinical data in dogs and cats consistently compromised the certainty of recommendations, emphasizing the need for more veterinary research in this area.
Assuntos
Reanimação Cardiopulmonar , Animais , Cães , Gatos , Reanimação Cardiopulmonar/veterinária , Reanimação Cardiopulmonar/normas , Reanimação Cardiopulmonar/métodos , Medicina Veterinária/normas , Medicina Veterinária/métodos , Doenças do Gato/terapia , Parada Cardíaca/veterinária , Parada Cardíaca/terapia , Medicina Baseada em Evidências/normas , Doenças do Cão/terapiaRESUMO
OBJECTIVE: To describe the methodology used by the Reassessment Campaign on Veterinary Resuscitation (RECOVER) to re-evaluate the scientific evidence relevant to CPR in small and large animals, to newborn resuscitation, and to first aid and to formulate the respective consensus-based clinical guidelines. DESIGN: This report describes the evidence-to-guidelines process employed by RECOVER that is based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and includes Information Specialist-driven systematic literature search, evidence evaluation conducted by more than 200 veterinary professionals, and provision of clinical guidelines in the domains of Preparedness and Prevention, Basic Life Support, Advanced Life Support, Post-cardiac Arrest Care, Newborn Resuscitation, First Aid, and Large Animal CPR. SETTING: Transdisciplinary, international collaboration in academia, referral practice, and general practice. RESULTS: For this update to the RECOVER 2012 CPR guidelines, we answered 135 Population, Intervention, Comparator, and Outcome (PICO) questions with the help of a team of Domain Chairs, Information Specialists, and more than 200 Evidence Evaluators. Most primary contributors were veterinary specialists or veterinary technician specialists. The RECOVER 2024 Guidelines represent the first veterinary application of the GRADE approach to clinical guideline development. We employed an iterative process that follows a predefined sequence of steps designed to reduce bias of Evidence Evaluators and to increase the repeatability of the quality of evidence assessments and ultimately the treatment recommendations. The process also allowed numerous important knowledge gaps to emerge that form the foundation for prioritizing research efforts in veterinary resuscitation science. CONCLUSIONS: Large collaborative, volunteer-based development of evidence- and consensus-based clinical guidelines is challenging and complex but feasible. The experience gained will help refine the process for future veterinary guidelines initiatives.
Assuntos
Consenso , Medicina Veterinária , Animais , Medicina Veterinária/normas , Medicina Veterinária/métodos , Guias de Prática Clínica como Assunto , Medicina Baseada em Evidências/normas , Reanimação Cardiopulmonar/normas , Reanimação Cardiopulmonar/veterinária , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/veterinária , Parada Cardíaca/terapiaRESUMO
INTRODUCTION: Bronchopulmonary arterial fistulas have been reported following lung transplant, and in association with COPD, trauma, radiation therapy, and infection. They may also arise congenitally. Embolization is the most frequent treatment. CASE PRESENTATION: We present a case of a 58-year-old male with a prior history of pulmonary tuberculosis who initially presented with minimal hemoptysis for several months. Right upper lobe bronchial artery to pulmonary artery fistulas were discovered by angiography. These were excluded by particle and microcoil embolizations. CLINICAL DISCUSSION: Relatively unopacified blood from bronchial artery enters right pulmonary artery and causes ill-defined hypodensities mixing with opacified blood, especially compared to uniformly, brightly enhancing left pulmonary artery. As a result, interpreters will frequently incorrectly conclude that right pulmonary artery embolism exists rather than a bronchopulmonary arterial fistula. CONCLUSION: In most cases, bronchopulmonary arterial fistulas are treated by bronchial artery embolization; however, direct puncture or stent grafting are alternate considerations depending on the patient's anatomy. In all instances, a multidisciplinary approach is a must.
RESUMO
Penetrating injury can cause pseudoaneurysm which can then affect nerve compression. Although rare, penetrating injuries leading to ulnar artery pseudoaneurysm (UAP) are implicated slightly more frequently than other upper extremity arterial segments. Manual compression, thrombin injections, and surgical reconstruction are typically chosen to effect repair. Conversely, peripheral stent-graft implantation has rarely been reported as an option to exclude upper extremity pseudoaneurysm. We describe a case of a 25-year-old male who was stabbed, presented with signs of ulnar nerve compression, and in whom UAP was instead discovered and treated by stent-graft deployment.
RESUMO
Infective endocarditis (IE) is a potentially fatal disease in dogs. Limited information exists regarding the characterization of bacterial isolates from dogs with IE. The objective of this study was to describe bacterial isolates associated with IE and their antimicrobial susceptibility patterns. A retrospective analysis of dogs with IE and bacterial isolates was performed, and antimicrobial susceptibility was interpreted using current veterinary cut points where available. The susceptibility rate was assessed for association with survival and previous antimicrobial administration. Fifty-one bacterial isolates were identified from 45 dogs, and 33 had antimicrobial susceptibility performed. Staphylococcus spp. (14/51; 27.5%) was the most common organism. Antimicrobials with the lowest susceptibility rate were ampicillin (19/26; 73%), doxycycline (16/22; 73%), and enrofloxacin (22/29; 76%) with 12/33 (36%) of isolates exhibiting multidrug resistance (MDR). Individual antimicrobial resistances and the MDR rate were not associated with a difference in survival rate. Bacterial isolates from dogs that had received fluoroquinolone antimicrobials in the month before diagnosis had a higher rate of non-intrinsic fluoroquinolones resistance (5/8;62.5%) compared to those that did not receive fluoroquinolones (2/21; 9.5%) (p = 0.03). Antimicrobial resistance and MDR phenotype were common in this study. Culture and antimicrobial susceptibility testing should be pursued in dogs with IE to help guide antimicrobial therapy.
RESUMO
OBJECTIVE: To report the prevalence of initial shockable cardiac arrest rhythms (I-SHKR), incidence of subsequent shockable cardiac arrest rhythms (S-SHKR), and factors associated with I-SHKRs and S-SHKRs and explore their association with return of spontaneous circulation (ROSC) rates in dogs and cats undergoing CPR. DESIGN: Multi-institutional prospective case series from 2016 to 2021, retrospectively analyzed. SETTING: Eight university and eight private practice veterinary hospitals. ANIMALS: A total of 457 dogs and 170 cats with recorded cardiac arrest rhythm and event outcome reported in the Reassessment Campaign on Veterinary Resuscitation CPR registry. MEASUREMENTS AND MAIN RESULTS: Logistic regression was used to evaluate association of animal, hospital, and arrest variables with I-SHKRs and S-SHKRs and with patient outcomes. Odds ratios (ORs) were generated, and significance was set at P < 0.05. Of 627 animals included, 28 (4%) had I-SHKRs. Odds for I-SHKRs were significantly higher in animals with a metabolic cause of arrest (OR 7.61) and that received lidocaine (OR 17.50) or amiodarone (OR 21.22) and significantly lower in animals experiencing arrest during daytime hours (OR 0.22), in the ICU (OR 0.27), in the emergency room (OR 0.13), and out of hospital (OR 0.18) and that received epinephrine (OR 0.19). Of 599 initial nonshockable rhythms, 74 (12%) developed S-SHKRs. Odds for S-SHKRs were significantly higher in animals with higher body weight (OR 1.03), hemorrhage (OR 2.85), or intracranial cause of arrest (OR 3.73) and that received epinephrine (OR 11.36) or lidocaine (OR 18.72) and significantly decreased in those arresting in ICU (OR 0.27), emergency room (OR 0.29), and out of hospital (OR 0.38). Overall, 171 (27%) animals achieved ROSC, 81 (13%) achieved sustained ROSC, and 15 (2%) survived. Neither I-SHKRs nor S-SHKRs were significantly associated with ROSC. CONCLUSIONS: I-SHKRs and S-SHKRs occur infrequently in dogs and cats undergoing CPR and are not associated with increased ROSC rates.
Assuntos
Reanimação Cardiopulmonar , Doenças do Gato , Doenças do Cão , Serviços Médicos de Emergência , Parada Cardíaca , Humanos , Gatos , Cães , Animais , Reanimação Cardiopulmonar/veterinária , Estudos Retrospectivos , Prevalência , Doenças do Gato/epidemiologia , Doenças do Gato/terapia , Doenças do Cão/epidemiologia , Doenças do Cão/terapia , Epinefrina , Lidocaína , Parada Cardíaca/epidemiologia , Parada Cardíaca/terapia , Parada Cardíaca/veterinária , Sistema de RegistrosRESUMO
INTRODUCTION: Inadvertent subclavian artery puncture during attempted central venous catheterization can be devastating. Percutaneous stent grafting, closure devices and conventional surgery have been described to effect repair. Balloon occlusion has also been described and often recommended. Numerous publications advise use of balloon expanded to no less than the diameter of the punctured artery. CASE PRESENTATION: We describe the case of a 21 year-old male whose right subclavian artery was inadvertently punctured after central-line removal. Our balloon when expanded was purposely slightly smaller than the inner arterial diameter. Balloon occlusion nevertheless alone sufficed to effect closure and repair. CLINICAL DISCUSSION: When the expanded balloon surpasses the diameter of the subclavian artery, it is expected that blood flow to the upper extremity will be cut off. Presently, there is a lack of definitive data concerning the maximum duration for balloon inflation that could lead to upper extremity ischemia. However, in this particular case, there was a temporary reduction in vertebral artery flow, while the flow in the carotid and axillosubclavian arteries remained rapid and uninterrupted. To our understanding, only one other case documents the use of a balloon shorter than the vessel diameter. CONCLUSION: In specific scenarios, it is advisable to consider the use of smaller balloon diameters to effectively stop extravasation while ensuring adequate perfusion to the brain and hand. While alternative approaches such as open repair, and stent graft procedure have been reported for repairing subclavian artery rupture, balloon tamponade provides interventional radiologists with a distinct technical advantage.
RESUMO
A prostate abscess is a rare clinical entity with an incidence of 0.2%-0.5% in males. No case reports exist of Staphylococcus haemolyticus as an etiologic bacterial agent. We report a 59-year-old man with a past medical history of poorly controlled diabetes mellitus and benign prostatic hyperplasia who was hospitalized due to urosepsis and obstruction. A prostatic abscess was discovered and initially treated with intravenous vancomycin and ertapenem. Clinical improvement was apparent within two days following transrectal prostatic abscess drainage. Four weeks of intravenous antibiotics followed. Prostatic abscess cultures grew Staphylococcus haemolyticus and Escherichia coli following tube deployment. To the best of our knowledge, this is the first case reporting Staphylococcus haemolyticus as an organism in a prostate abscess. We regard this as another example of the rising incidence of gram-positive organisms in prostatic abscesses in the post-antibiotic era.
RESUMO
BACKGROUND: Pyothorax, an accumulation of inflammatory fluid in the pleural space, is often caused by foreign body inhalation in dogs, whereas the etiology in cats can be more difficult to discern. OBJECTIVE: Compare clinical, microbiologic findings, and etiology in cats and dogs with pyothorax. ANIMALS: Twenty-nine cats and 60 dogs. METHODS: Medical records of cats and dogs diagnosed with pyothorax from 2010 to 2020 were reviewed. Clinical findings, fluid analysis, and microbiologic results were retrieved. RESULTS: Antimicrobials had been administered to equal proportions of cats and dogs before fluid sampling (45% and 47%). Groups did not differ in age or total protein concentration or percentage neutrophils in pleural fluid, but effusion cell count was significantly higher in cats than in dogs (P = .01). Neutrophils containing intracellular bacteria were identified in more cats (27/29, 93%) than dogs (44/60, 73%; P = .05). Penetrating damage to the thorax was implicated as the cause of pyothorax in equal percentages of cats (76%) and dogs (75%). Etiology could not be determined in 2 cats and 1 dog. Cats had higher numbers of bacterial isolates per patient (median, 3) than dogs (median, 1; P = .01) and anaerobes were isolated more often in cats (23/29, 73%) than in dogs (27/60, 45%; P = .003). CONCLUSIONS AND CLINICAL IMPORTANCE: Pyothorax had similar etiologies in cats and dogs. Cats had higher fluid cell counts, higher numbers of bacterial isolates identified per patient, and intracellular bacteria detected more commonly than did dogs.
Assuntos
Doenças do Gato , Doenças do Cão , Empiema Pleural , Derrame Pleural , Gatos , Cães , Animais , Doenças do Cão/diagnóstico , Empiema Pleural/etiologia , Empiema Pleural/veterinária , Empiema Pleural/tratamento farmacológico , Antibacterianos/uso terapêutico , Estudos Retrospectivos , Doenças do Gato/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/veterináriaRESUMO
OBJECTIVE: To characterize the clinical features of noncardiogenic pulmonary edema (NCPE), etiology, and outcome in dogs and cats. The study also aimed to evaluate associations with mortality. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: Thirty dogs and 1 cat, all client owned. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data collected included animal characteristics, clinical history, evaluation of oxygenation, radiographic features, treatments, and outcomes. Causes of NCPE included upper airway obstruction, electrocution, drowning, neurogenic etiology, and unknown. The etiology was known in 21 of 31 cases (68%), while the etiology of the remaining 10 cases (32%) was classified as unknown. The most common cause for NCPE was upper airway obstruction, found in 14 of 31 cases (45%). The majority of thoracic radiographs showed a mixed interstitial-to-alveolar pulmonary pattern with a diffuse distribution (52%). Oxygen therapy was administered to 27 dogs (90%). Furosemide was administered to 12 dogs (40%). The median duration of hospitalization was 48 hours (range: 1-192). Twenty-three animals (74%) survived to discharge. Six dogs were mechanically ventilated, with only 2 of them (33%) surviving to discharge. The requirement for mechanical ventilation was the only parameter associated with mortality (P = 0.03). CONCLUSIONS: NCPE is a heterogenous disease process that is most common in dogs. There are a variety of causes, but upper airway obstruction appears to be the most common. The overall prognosis is good in animals that do not require mechanical ventilation.
Assuntos
Obstrução das Vias Respiratórias , Doenças do Gato , Doenças do Cão , Edema Pulmonar , Gatos , Cães , Animais , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Edema Pulmonar/veterinária , Estudos Retrospectivos , Doenças do Gato/diagnóstico , Doenças do Gato/terapia , Doenças do Gato/etiologia , Doenças do Cão/diagnóstico , Doenças do Cão/terapia , Doenças do Cão/etiologia , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/terapia , Obstrução das Vias Respiratórias/veterináriaRESUMO
BACKGROUND: Bacterial urinary tract infections have been associated with comorbidities and increased antimicrobial resistance over time. OBJECTIVE: To identify bacterial species, antimicrobial susceptibility patterns and risk factors associated with antimicrobial resistance. ANIMALS: Three hundred sixty-three positive urine cultures from 308 cats. METHODS: Bacterial species and antimicrobial susceptibility data from positive aerobic bacterial urine cultures from cats with growth of ≥103 colony forming units per milliliter (cfu/ml) were included. Medical records were reviewed, and bacteriuria was classified as sporadic bacterial cystitis, recurrent bacterial cystitis or subclinical bacteriuria (SBU). Multivariable logistic regression analysis was used to evaluate antimicrobial resistance risk factors. RESULTS: A total of 444 bacterial isolates from 363 bacteriuric episodes were identified. Escherichia coli (52%) and SBU (59%) were the most common organism and classification, respectively. When compared to other classifications of bacteriuria, Enterococcus spp. were more likely to be isolated from SBU episodes (P < .001), whereas E. coli was more likely to be isolated from sporadic bacterial cystitis episodes (P < .001). Recurrent bacterial cystitis was associated with an increased risk of antimicrobial resistance to amoxicillin/clavulanic acid (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.3-11.3). The percent susceptibilities of all bacterial isolates to commonly prescribed antimicrobials were amoxicillin/clavulanic acid (72%), cefazolin (49%), enrofloxacin (61%), and trimethoprim/sulfamethoxazole (75%). Multidrug resistance was highest for Enterococcus faecium isolates (65%). CONCLUSIONS AND CLINICAL IMPORTANCE: No antimicrobial achieved >90% susceptible designation to all bacteria isolated highlighting the importance of performing urine culture and susceptibility testing, particularly for cats with recurrent bacterial cystitis.
Assuntos
Anti-Infecciosos , Infecções Bacterianas , Bacteriúria , Cistite , Enterococcus faecium , Infecções Urinárias , Animais , Bacteriúria/tratamento farmacológico , Bacteriúria/veterinária , Escherichia coli , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/veterinária , Infecções Urinárias/microbiologia , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/veterinária , Cistite/tratamento farmacológico , Cistite/veterinária , Ácido Clavulânico/farmacologia , Amoxicilina/farmacologia , Testes de Sensibilidade Microbiana/veterináriaRESUMO
The rising prevalence of extended-spectrum ß-lactamase (ESBL)-producing Enterobacterales is a significant threat to animal and human health. This study aims to describe the clinical features, antimicrobial susceptibility patterns, and genotypic features of infections associated with ESBL-producing Enterobacterales in dogs and cats seen at a tertiary referral veterinary teaching hospital. Enterobacterales isolated from dogs and cats that underwent ESBL testing during the study period were identified using a search of the hospital antimicrobial susceptibility test software database. Medical records of confirmed ESBL isolates were reviewed, and the source of infection, clinical findings, and antimicrobial susceptibility were recorded. Genomic DNA from bacterial isolates was evaluated for antimicrobial resistance genes with whole genome sequencing. Thirty ESBL-producing isolates were identified based on phenotypic testing (twenty-nine from dogs, one from a cat); twenty-six were Escherichia coli and the remainder were Klebsiella spp. Bacterial cystitis was the most commonly identified (8/30, 27%) clinical problem associated with infection. Resistance to three or more antimicrobial classes was identified in 90% (27/30) of isolates, and all isolates were susceptible to imipenem. Over 70% of isolates were susceptible to piperacillin-tazobactam, amikacin, and cefoxitin. BlaCTX-M-15 was the most common ESBL gene identified, present in 13/22 (59%) isolate genomes. A wide range of clinical infections were identified. Piperacillin-tazobactam and amikacin may be alternatives to carbapenem therapy. Further, larger-scale studies are needed.
RESUMO
BACKGROUND: Multiple studies have evaluated the breed-specific prevalence of dog erythrocyte antigen (DEA) 1 in various geographic regions. However, few large-scale studies exist that describe breed prevalence of DEA 1 in the United States. KEY FINDINGS: From January 2000 to October 2020, 6469 dogs had their RBC antigen type determined and were included in the study. The overall prevalence of DEA 1 in all dogs was 61.2%. Of 50 breeds with sample sizes ≥20, 8 breeds had a high prevalence (≥90%) of DEA 1-positive blood type: Basset Hound, Bernese Mountain Dog, Brittany, Dachshund, Miniature Pinscher, Miniature Schnauzer, Pug, and Rottweiler. Four breeds had a high prevalence (≥90%) of DEA 1-negative blood type: Boxer, English Bulldog, Flat-Coated Retriever, and French Bulldog. Numerous breeds with a sample size <20 and ≥5 were found to have 100% prevalence of a DEA 1 blood type, although these findings need to be confirmed with a larger sample size. No statistical difference in any breed based on sex was found. The results in this study are consistent with previously reported data in other countries. SIGNIFICANCE: Knowledge of regional breed differences in DEA 1 prevalence can help to improve selection and recruitment of appropriate blood donor dogs.
Assuntos
Antígenos de Grupos Sanguíneos , Doenças do Cão , Cães , Animais , Transfusão de Sangue/veterinária , Incompatibilidade de Grupos Sanguíneos/veterinária , Tipagem e Reações Cruzadas Sanguíneas/veterinária , Prevalência , California/epidemiologia , Eritrócitos , Doenças do Cão/epidemiologiaRESUMO
OBJECTIVE: To investigate the association of point-of-care biochemical variables obtained during CPR or within 24 hours of return of spontaneous circulation (ROSC) with patient outcomes. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: Ninety-four dogs and 27 cats undergoing CPR according to the Reassessment Campaign on Veterinary Resuscitation guidelines. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood gas, acid-base, electrolyte, glucose, and plasma lactate values obtained during CPR or within 24 hours of ROSC were retrospectively evaluated and are described. The blood sample type and collection time with respect to CPR initiation and ROSC were recorded. Measured variables, collection times, and species were included in a multivariable logistic regression model to estimate the odds ratio (OR) and 95% confidence interval of ROSC, sustained ROSC (≥20 min), and survival to hospital discharge. Significance was set at P < 0.05. Seventy-two venous blood samples obtained during CPR and 45 first venous and arterial blood samples obtained after ROSC were included in logistic regression analysis. During CPR, PvO2 (1.09 [1.036-1.148], P = 0.001) and venous standard base excess (SBE) (1.207 [1.094-1.331], P < 0.001) were associated with ROSC. PvO2 (1.075 [1.028-1.124], P = 0.002), SBE (1.171 [1.013-1.353], P = 0.032), and potassium concentration (0.635 [0.426-0.946], P = 0.026) were associated with sustained ROSC. Potassium concentration (0.235 [0.083-0.667], P = 0.007) was associated with survival to hospital discharge. Following ROSC, pH (69.110 [4.393-1087], P = 0.003), potassium concentration (0.222 [0.071-0.700], P = 0.010), and chloride concentration (0.805 [0.694-0.933], P = 0.004) were associated with survival to hospital discharge. CONCLUSIONS: Biochemical variables such as PvO2 , SBE, and potassium concentration during CPR and pH, potassium, and chloride concentration in the postarrest period may help identify dogs and cats with lower odds for ROSC or survival to hospital discharge following CPR.
Assuntos
Reanimação Cardiopulmonar , Doenças do Gato , Doenças do Cão , Parada Cardíaca , Gatos , Cães , Animais , Reanimação Cardiopulmonar/veterinária , Reanimação Cardiopulmonar/métodos , Parada Cardíaca/terapia , Parada Cardíaca/veterinária , Estudos Retrospectivos , Retorno da Circulação Espontânea , Doenças do Gato/terapia , Cloretos , Sistemas Automatizados de Assistência Junto ao Leito , Doenças do Cão/terapiaRESUMO
OBJECTIVES: The aims of this study were: to describe the potassium-lowering treatment strategies used to manage moderate-to-severe hyperkalemia in male cats with urethral obstruction (UO); to determine how much dextrose was required per unit of insulin to prevent hypoglycemia; to determine whether early initiation of a dextrose continuous rate infusion (CRI) prevented hypoglycemia; and to determine whether in-hospital mortality was associated with presenting plasma potassium concentration ([K+]). METHODS: The medical records of male cats presenting with a [K+] ⩾7.0 mEq/l due to UO that had another [K+] measured within 6 h were reviewed retrospectively. All [K+] values within the first 6 h, blood glucose concentrations, treatments for hyperkalemia and survival to discharge were recorded. Analyses were performed to test for associations between dextrose:insulin ratios or method of dextrose administration and the development of hypoglycemia; and for presenting [K+] and mortality. Normally distributed groups of continuous data were compared with a t-test and categorical data were compared with a Fisher's exact test. RESULTS: Fifty cats were included. Mean presenting [K+] was 8.9 ± 1.0 mEq/l, while the mean final [K+] within 6 h was 6.6 ± 1.4 mEq/l. Forty-two (84%) cats were treated with intravenous fluids and 40 (80%) were treated with dextrose and insulin. Median dextrose:insulin ratio was 2 g/u (range 0.4-100). No dextrose:insulin ratio was found to protect against hypoglycemia, and 3/8 cats that became hypoglycemic had received ⩾2 g dextrose per unit of insulin. There was no association between the early initiation of a dextrose-containing CRI and avoidance of hypoglycemia. No association was found between presenting [K+] and mortality. CONCLUSIONS AND RELEVANCE: While no specific dextrose:insulin ratio was found to protect against hypoglycemia, there is evidence that the commonly recommended dextrose:insulin ratio of 2 g/u may be inadequate in preventing hypoglycemia in every cat. Severity of hyperkalemia was not associated with mortality.
Assuntos
Doenças do Gato , Obstrução Uretral , Animais , Gatos , Masculino , Doenças do Gato/tratamento farmacológico , Insulina/uso terapêutico , Potássio , Estudos Retrospectivos , Obstrução Uretral/veterináriaRESUMO
Wildfires pose a major health risk for humans, wildlife, and domestic animals. We previously discovered pathophysiologic parallels between domestic cats with naturally occurring smoke inhalation and thermal burn injuries and human beings with similar injuries; these were characterized by transient myocardial thickening, cardiac troponin I elevation and formation of intracardiac thrombosis. While the underlying mechanisms remain unclear, results from murine models suggest that platelet priming and activation may contribute to a global hypercoagulable state and thrombosis. Herein, we evaluated and compared the degree of platelet activation, platelet response to physiologic agonists and levels of platelet-derived microvesicles (PDMV) in 29 cats with naturally occurring wildfire thermal injuries (WF), 21 clinically healthy cats with subclinical hypertrophic cardiomyopathy (HCM) and 11 healthy cats without HCM (CC). We also quantified and compared circulating PDMVs in WF cats to CC cats. In addition, we examined the association between thrombotic events, severity of burn injuries, myocardial changes, and the degree of platelet activation in cats exposed to wildfires. Flow cytometric detection of platelet surface P-selectin expression showed that WF cats had increased platelet response to adenosine diphosphate (ADP) and thrombin compared to the two control groups indicating the presence of primed platelets in circulation. In addition, cats in the WF group had increased circulating levels of PDMV, characterized by increased phosphatidylserine on the external leaflet. Cats in the WF group with documented intracardiac thrombosis had elevated platelet activation and platelet priming in the presence of ADP. While high dose arachidonic acid (AA) mostly resulted in platelet inhibition, persistent response to AA was noted among cats in the WF group with intracardiac thrombosis. Univariate and multiple logistic regression analyses demonstrated that increased platelet response to AA was independently associated with thrombotic events. This is the first study reporting the significant association between platelet priming and intracardiac thrombosis in domestic cats with naturally occurring wildfire-related injuries and smoke inhalation. Further studies are required to delineate additional mechanisms between inflammation and thrombosis, especially regarding platelet primers and the cyclooxygenase pathway. One Sentence Summary: Platelet activation and shedding of platelet-derived microvesicles due to platelet priming is present following naturally occurring wildfire smoke exposure and thermal burn injuries in a population of domestic cats.
RESUMO
OBJECTIVE: To describe the clinical and clinicopathological characteristics, treatment, and outcome for dogs and cats with a confirmed foxtail. DESIGN: Retrospective study utilizing a medical records database over a 10-year period from January 1, 2009 to December 31, 2018. SETTING: University teaching hospital. ANIMALS: Seven hundred and fifty-four dogs and 37 cats with a diagnosis of foxtail foreign body. Cases with direct visualization by a clinician or on histopathology were included. Information extracted for each case included signalment; anatomical foxtail location; clinicopathological and imaging findings; treatments and interventions provided; and outcome. MEASUREMENTS AND MAIN RESULTS: The prevalence of foxtail associated disease was 0.25% in dogs and 0.07% in cats over this time period. Most animals were young to middle-aged and presented in the summer months. The most common location in dogs was the aural canal, cutaneous/subcutaneous space, and nasal canal. In cats, ocular foxtails were most common (30/37). Blood work changes were nonspecific. Ultrasound supervised by a boarded radiologist was utilized in 114 cases, mainly for subcutaneous, sublumbar, and intracavitary foxtail locations, with successful location of a foxtail in 72.8% of cases scanned. Computed tomography was performed in 78 dogs with suspected intracavitary foxtail migration, and in all cases, structural changes related to the presence of the foxtail were found. Anerobic bacteria were most commonly isolated when a culture was submitted, with Actinomyces spp. rarely isolated. The most common of the 120 anaerobic isolates were Bacteroides/Prevotella spp. (n = 38), Fusobacterium spp. (n = 32), and Peptostreptococcus anaerobius (n = 30). CONCLUSIONS: The short-term outcome for foxtail-associated lesions is good, and most cases can be managed on an outpatient basis. A minority of cases develop life-threatening disease and may require a multidisciplinary approach of multimodal imaging, endoscopy, or surgery.