Microbiologic changes during antimicrobial treatment and rate of relapse of distal respiratory tract infections in foals

Abstract

Summary Despite the high incidence of distal respiratory tract infection of undetermined cause on farms, to our knowledge, the microbiologic effects of conventional antimicrobial treatment for this condition have not been studied. We evaluated the possible pathogenic role of bacterial isolates from the distal airways of foals with clinical respiratory tract disease, by correlating changes in their numbers (increase or decrease) with clinical, endoscopic, and pulmonary cytologic signs of disease resolution during treatment with antimicrobial drugs. We also determined qualitative changes in in vitro antimicrobial susceptibility of bacterial isolates after 7 days of treatment and relapse rate of foals. Significant (P < 0.05) decrease in the numbers of an isolate in the airways was considered strong evidence of a pathogenic role in this disease syndrome. Foals with endoscopically confirmed distal respiratory tract infection (drti; n = 65) were selected at random for treatment (n = 56) or nontreatment (n = 9), and bronchial lavage specimens were cultured and evaluated cytologically before and after 7 days of treatment with trimethoprim-sulfamethoxazole (tms) and a β-lactam drug (penicillin, ampicillin, or sulbactam-ampicillin), the standard treatment in all foals. The effect of treatment was to abruptly reduce the clinical (nasal discharge, cough, adventitious lung sounds) and cytologic signs of airway infection. Severity of disease in nontreated foals, however, did not change or did worsen over time. Reduction in the frequency and numbers of Streptococcus zooepidemicus isolated during treatment supported a causal role for this organism in the clinical syndrome observed. On the other hand, the frequency of non-Str zooepidemicus isolates (eg, Staphylococcus epidermidis, Streptomyces spp, α-hemolytic streptococci) actually increased during treatment, compatible with a commensal or competitive role for these organisms. Significantly (P < 0.001) more pretreatment isolates were susceptible in vitro to either tms or β-lactam drugs than to β-lactam drugs alone; more posttreatment isolates were susceptible to either tms or β-lactam than to either drug alone. These data indicate that there may be some benefit to combined use of tms plus β-lactam drugs in foals with drti. Mean ± sem relapse rate was 31 ± 6% (range 0 to 57%); risk factors (clinical signs of disease, laboratory variables) for relapse could not be identified. In conclusion, treatment resulted in significant (P < 0.001) reduction in airway inflammation in foals with clinical drti. The high reinfection rate indicates that a predisposing factor, possibly age-related immunodeficiency, may predispose foals to illness and persists after treatment.