Sepsis In Foals Research Articles

Listeria monocytogenes meningoencephalomyelitis most likely due to septic spread as a rare cause of neurological disease and fever in an adult horse

A 14-year-old warmblood mare developed progressive neurological signs including ataxia, nystagmus, impaired mental status as well as decreased cranial nerve reflexes, and finally went recumbent. Postmortem examination and histology revealed...

Peripheral blood markers of sepsis in foals born from mares with experimentally induced ascending placentitis

BackgroundNeonatal sepsis is a leading cause of neonatal death during the first-week postfoaling. Despite recent advancements in the diagnosis and treatment of sepsis in the newborn foal, the non-specific clinical...

Evaluation of updated sepsis scoring systems and systemic inflammatory response syndrome criteria and their association with sepsis in equine neonates.

BackgroundThe original equine sepsis score provided a method of identifying foals with sepsis. New variables associated with sepsis have been evaluated, but the sepsis score has not been updated.ObjectivesTo evaluate the sensitivity and specificity of 2 updated sepsis scores and the systemic inflammatory response syndrome (SIRS) criteria in regard to detecting sepsis in foals.AnimalsTwo‐hundred and seventy‐three ill foals and 25 healthy control foals.MethodsHistorical, physical examination, and clinicopathologic findings were used to calculate the original sepsis score and 2 updated sepsis scores. SIRS criteria were also evaluated. Sepsis scores and positive SIRS scores were statistically compared to foals with sepsis.ResultsOne‐hundred and twenty‐six foals were septic and 147 sick‐nonseptic. The original and updated sepsis scores were significantly higher in septic foals as compared to sick‐nonseptic and healthy foals. The sensitivity and specificity of the updated sepsis scores to predict sepsis were not significantly better than those of the original sepsis score. One‐hundred and twenty‐seven of 273 (46.5%) foals met the original SIRS criteria and 88/273 (32%) foals met the equine neonatal SIRS criteria. The original SIRS criteria had similar sensitivity and specificity for predicting sepsis as did the 3 sepsis scores in our study.Conclusions and Clinical ImportanceThe updated sepsis scores did not provide improved ability in predicting sepsis. Fulfilling the original SIRS criteria provided similar sensitivity and specificity in predicting sepsis as the modified sepsis score and might serve as a diagnostic aid in identifying foals at risk for sepsis.

Plasma C-reactive protein and haptoglobin concentrations in critically ill neonatal foals.

BackgroundAccurate diagnostic markers for sepsis in neonatal foals are needed. Plasma C‐reactive protein concentration (p[CRP]) and haptoglobin concentration (p[Hp]) are well‐established biomarkers of infection in humans, but studies are lacking in foals.Hypothesesp[CRP]) and p[Hp] are increased in septic foals compared to sick nonseptic and healthy control foals, and are predictive of survival.AnimalsEighty critically ill foals (40 septic, 40 sick nonseptic) and 39 healthy control foals <1 week of age.MethodsMulticenter, prospective observational clinical study. Venous blood was collected at admission from septic and sick nonseptic foals and from clinically healthy foals at 24 h of age. A diagnosis of sepsis was made based on positive blood culture or a sepsis score >11, and p[CRP] and p[Hp] were measured by using ELISA tests. Data were analyzed by using the Mann‐Whitney U‐test and forward stepwise multivariable linear regression. P < .05 was considered significant.ResultsPlasma [CRP] was positively associated with age, serum globulin, adrenomedullin, and bilirubin concentrations, aspartate aminotransferase activity, glutamyl‐transferase activity, band neutrophil count, and rectal temperature, and was increased in foals with toxic neutrophils, enterocolitis, colic, rib fractures and septic arthritis. Surprisingly, p[Hp] was lower in septic foals than in sick nonseptic foals. Neither p[CRP] or p[Hp] was predictive of survival in critically ill foals.Conclusions and Clinical ImportancePlasma [CRP] increases with inflammation in neonatal foals but is not indicative of sepsis. Single time point, admission sampling of p[CRP] and p[Hp] do not appear to be useful biomarkers for sepsis in foals.

Temporal trends in in vitro antimicrobial susceptibility patterns of bacteria isolated from foals with sepsis: 1979–2010

Monitoring the development of antimicrobial resistance is important for the rational selection of appropriate antimicrobial drugs to initiate treatment of foals with sepsis. To identify temporal trends in antimicrobial susceptibility patterns of bacteria isolated from foals with sepsis. Retrospective review of medical records. Foals aged <30 days with a diagnosis of sepsis, confirmed by culture of bacteria, were included. Susceptibility data, expressed as minimum inhibitory concentrations (MICs) (MIC50 , MIC90 , MIC range) and percent of isolates that were susceptible to a particular antimicrobial drug, were compared for bacteria isolated from foals during 3 different time periods: 1979-1990, 1991-1997 and 1998-2010. The Cochran-Armitage trend test and the Jonckheere-Terpstra test were used for statistical analysis. A total of 1091 bacterial isolates were cultured from 588 foals. Enterobacteriaceae, Actinobacillus spp. and β-haemolytic Streptococcus spp. showed a decrease in percent of isolates susceptible to gentamicin over time. Enterobacteriaceae, Actinobacillus spp. and β-haemolytic Streptococcus spp. showed an increase in MIC values for amikacin. Enterobacteriaceae showed a decrease in percent of isolates susceptible to ceftiofur. Enterococcus spp. and Pseudomonas spp. showed increased MIC values to ceftiofur. Enterobacteriaceae showed increased MIC values to ceftizoxime. Enterococcus spp. became more resistant to imipenem and showed increased MIC values to ticarcillin/clavulanic acid. In contrast, several trends in increased susceptibility were also seen. Based on these in vitro results, the combination of amikacin and ampicillin remains an appropriate choice for initiating treatment of sepsis in foals while awaiting culture and susceptibility test results, although increasing development of resistance to amikacin was demonstrated. The decrease in in vitro activity of ceftiofur against Enterobacteriaceae is of concern. Similarly, the development of resistance of Enterococcus spp. to imipenem is an important finding that warrants monitoring in the future. Judicious use of antimicrobials is therefore crucial.

Synovial Fluid D‐Dimer Concentration in Foals with Septic Joint Disease

Increased synovial fibrinolytic activity (detected by increases in synovial D-Dimer concentrations) has been observed in different joint diseases in humans and adult horses, presumably in order to minimize fibrin deposition within the joint and thus avoid its detrimental effects. To investigate fibrinolytic pathway activation in joint sepsis in foals by measuring synovial D-Dimer concentrations. Eighteen septic foals with septic joints, 9 septic foals without septic joints, 9 systemically healthy foals with septic joint, and 3 controls are included. Prospective observational clinical study of foals admitted for septic arthritis. Synovial D-Dimer concentration and routine synovial fluid analysis were performed. Diagnosis of joint sepsis was made whenever synovial total nucleated cell count was >30,000 cells/μL, synovial total protein >4 g/dL, and neutrophil percentage of >80%, or synovial fluid culture resulted positive. Results were compared among groups by general lineal models. Synovial D-Dimer concentration was significantly (P < .001) higher in the foals with septic joints compared with foals without joint disease (P < .001). Septic joint disease is associated with a marked increase of synovial D-Dimer concentration (marked activation of the fibrinolytic activity) within the affected joint. Although further studies are needed, the measurement of synovial D-Dimer concentration may be considered a complementary diagnostic marker of septic joint disease.

Blood Arginine Vasopressin, Adrenocorticotropin Hormone, and Cortisol Concentrations at Admission in Septic and Critically Ill Foals and their Association with Survival

Sepsis is an important cause for neonatal foal mortality. The hypothalamic-pituitary-adrenal axis (HPAA) responses to sepsis are well documented in critically ill humans, but limited data exist in foals. The purpose of this study was to evaluate the HPAA response to sepsis in foals, and to associate these endocrine changes with survival. Blood concentrations of arginine vasopressin (AVP), adrenocorticotropin hormone (ACTH), and cortisol will be higher in septic foals as compared with sick nonseptic and healthy foals. The magnitude of increase in hormone concentration will be negatively associated with survival. Fifty-one septic, 29 sick nonseptic, and 31 healthy foals of < or =7 days of age were included. Blood was collected at admission for analysis. Foals with positive blood culture or sepsis score > or =14 were considered septic. Foals admitted with disease other than sepsis and healthy foals were used as controls. AVP, ACTH, and cortisol concentrations were measured using validated immunoassays. AVP, ACTH, and cortisol concentrations were increased in septic foals. Septic nonsurvivor foals (n = 26/51) had higher plasma ACTH and AVP concentrations than did survivors (n = 25/51). Some septic foals had normal or low cortisol concentrations despite increased ACTH, suggesting relative adrenal insufficiency. AVP, ACTH, and cortisol concentrations were higher in sick nonseptic foals compared with healthy foals. Increased plasma AVP and ACTH concentrations in septic foals were associated with mortality. Several septic foals had increased AVP : ACTH and ACTH : cortisol ratios, which indicates relative adenohypophyseal and adrenal insufficiency.

Evaluation of a score designed to predict sepsis in foals

AbstractObjective:To evaluate the accuracy of a published score designed to predict sepsis in foals in a clinical setting and to evaluate the association of clinical and clinicopathological variables with sepsis.Design:Observational study. Retrospective for data from 1998. Prospective in 1999–2001.Setting:Foal intensive care unit of a university hospital.Animals:Client‐owned foals of less than 10 days of age, presenting from 1998 to 2001.Interventions:None.Measurements and main results:Data from the history and physical examination, together with admission hematology, biochemistry and arterial blood gas analysis were used to generate the published sepsis scores. The same data were investigated for their statistical relationship with sepsis. The presence or absence of sepsis was determined from blood culture, culture of sites of suspected local infection, clinical course and/or post‐mortem examination.The modified sepsis score was calculated for 168 foals, which were classified as septic (86), non‐septic (45) or not possible to classify (37). The modified sepsis score correctly predicted sepsis in 58 out of 86 foals and non‐sepsis in 34 out of 45 foals, resulting in a sensitivity of 67%, a specificity of 76%, a positive predictive value of 84% and a negative predictive value of 55%. Abnormal neutrophil cytology, an immunoglobulin concentration of less than 400 mg/dl, and low blood glucose concentration had the strongest association with sepsis.Conclusions:The low negative predictive value of the sepsis score limited its clinical utility. The sepsis score should not be used to define sepsis in clinical studies, unless previously validated in the study center.