Lauren A. Sullivan

Evaluation of open versus closed urine collection systems and development of nosocomial bacteriuria in dogs

OBJECTIVE To determine whether use of a closed urine collection system would decrease the incidence of nosocomial bacteriuria in hospitalized dogs, compared with use of an open urine collection system (used, sterile IV bags). DESIGN Randomized controlled trial. ANIMALS 51 hospitalized dogs requiring indwelling urinary catheterization for >or= 24 hours. PROCEDURES Dogs were randomly assigned to an open or closed urine collection system group. A standardized protocol for catheter placement and maintenance was followed for all dogs. A baseline urine sample was collected via cystocentesis for aerobic bacterial culture, with additional urine samples obtained daily from the urine collection reservoir. RESULTS 27 dogs were assigned to the open urine collection system group, and 24 were assigned to the closed urine collection system group. The incidence of nosocomial bacteriuria in dogs with open urine collection systems (3/27 [11.1%]) was not significantly different from incidence in dogs with closed urine collection systems (2/24 [8.3%]). Median duration of catheterization was 2 days for dogs in both groups; the range was 1 to 7 days for dogs in the open group and 1 to 5 days for dogs in the closed group. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that for dogs requiring short-term indwelling urinary catheterization, the type of urine collection system (open vs closed) was not associated with likelihood of developing nosocomial bacteriuria. Use of a strict protocol for urinary catheter placement and maintenance was likely key in the low incidence of nosocomial bacteriuria in the present study.

Retrospective evaluation of fluid overload and relationship to outcome in critically ill dogs.

OBJECTIVE To determine if critically ill dogs have an increased risk of fluid overload (FO) during hospitalization compared to less ill dogs, and to determine if FO is associated with increased mortality during hospitalization. DESIGN Observational, case-control study. SETTING University teaching hospital. ANIMALS Thirty-four critically ill dogs and 15 comparatively healthy stable postoperative dogs with neuro-orthopedic disease. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data recorded included underlying disease, body weight, and APPLEfast score at admission, single-day and composite APPLEfull scores during hospitalization, total fluid volume administered (L), total fluid volume output (L), and outcome. Percent FO (%FO) was calculated using the equation 100 × ([fluid volume administered - fluid volume lost]/1000 mL/L) - (% dehydration at admission), with fluid volume expressed as mL/kg of baseline body weight. Critically ill dogs developed greater %FO during hospitalization compared to stable postoperative dogs (12.1 ± 11.7% vs 0.5 ± 5.2%, P = 0.001), and half (8 out of 16) of the dogs with %FO ≥ 12% died. Composite APPLEfull scores were weakly positively correlated with %FO, whereas APPLEfast and single-day APPLEfull scores recorded at admission were not. The odds ratio for death was 1.08 for every percent increase in FO during hospitalization (95% confidence limits 1.012-1.59, P = 0.02). CONCLUSIONS Critically ill dogs are at increased risk for FO during hospitalization, and a weak but significant association exists between %FO, illness severity, and mortality. Prospective studies are warranted to confirm the findings of this retrospective study.Objective To determine if critically ill dogs have an increased risk of fluid overload (FO) during hospitalization compared to less ill dogs, and to determine if FO is associated with increased mortality during hospitalization. Design Observational, case-control study. Setting University teaching hospital. Animals Thirty-four critically ill dogs and 15 comparatively healthy stable postoperative dogs with neuro-orthopedic disease. Interventions None. Measurements and Main Results Data recorded included underlying disease, body weight, and APPLEfast score at admission, single-day and composite APPLEfull scores during hospitalization, total fluid volume administered (L), total fluid volume output (L), and outcome. Percent FO (%FO) was calculated using the equation 100 × ([fluid volume administered − fluid volume lost]/1000 mL/L) − (% dehydration at admission), with fluid volume expressed as mL/kg of baseline body weight. Critically ill dogs developed greater %FO during hospitalization compared to stable postoperative dogs (12.1 ± 11.7% vs 0.5 ± 5.2%, P = 0.001), and half (8 out of 16) of the dogs with %FO ≥ 12% died. Composite APPLEfull scores were weakly positively correlated with %FO, whereas APPLEfast and single-day APPLEfull scores recorded at admission were not. The odds ratio for death was 1.08 for every percent increase in FO during hospitalization (95% confidence limits 1.012–1.59, P = 0.02). Conclusions Critically ill dogs are at increased risk for FO during hospitalization, and a weak but significant association exists between %FO, illness severity, and mortality. Prospective studies are warranted to confirm the findings of this retrospective study.

Comparison of routine urinalysis and urine Gram stain for detection of bacteriuria in dogs

Objective To determine the utility of performing urine Gram stain for detection of bacteriuria compared to routine urine sediment examination and bacterial aerobic urine culture. Design Prospective, observational study. Setting University teaching hospital. Animals Urine samples acquired via cystocentesis through convenience sampling from 103 dogs presenting to a tertiary referral institution. Interventions All samples underwent routine urinalysis, including sediment examination, as well as urine Gram stain and quantitative bacterial aerobic urine culture. Measurements and Main Results The urine Gram stain demonstrated improved sensitivity (96% versus 76%), specificity (100% versus 77%), positive predictive value (100% versus 83%), and negative predictive value (93% versus 69%) when identifying bacteriuria, compared to routine urine sediment examination. Conclusions The urine Gram stain is highly sensitive and specific when detecting the presence of bacteria in canine urine samples. Gram staining should be considered when bacteriuria is highly suspected and requires rapid identification while bacterial culture is pending.OBJECTIVE To determine the utility of performing urine Gram stain for detection of bacteriuria compared to routine urine sediment examination and bacterial aerobic urine culture. DESIGN Prospective, observational study. SETTING University teaching hospital. ANIMALS Urine samples acquired via cystocentesis through convenience sampling from 103 dogs presenting to a tertiary referral institution. INTERVENTIONS All samples underwent routine urinalysis, including sediment examination, as well as urine Gram stain and quantitative bacterial aerobic urine culture. MEASUREMENTS AND MAIN RESULTS The urine Gram stain demonstrated improved sensitivity (96% versus 76%), specificity (100% versus 77%), positive predictive value (100% versus 83%), and negative predictive value (93% versus 69%) when identifying bacteriuria, compared to routine urine sediment examination. CONCLUSIONS The urine Gram stain is highly sensitive and specific when detecting the presence of bacteria in canine urine samples. Gram staining should be considered when bacteriuria is highly suspected and requires rapid identification while bacterial culture is pending.

Comparison of tissue oxygen saturation in ovariohysterectomized dogs recovering on room air versus nasal oxygen insufflation

OBJECTIVE To compare tissue oxygen saturation in ovariohysterectomized dogs recovering postoperatively on room air versus nasal oxygen insufflation. DESIGN Prospective clinical study. SETTING University teaching hospital. ANIMALS Twenty dogs undergoing ovariohysterectomy. INTERVENTIONS Dogs were randomized to breathe either room air or 100 mL/kg/min of nasal oxygen insufflation for 2 hours postoperatively. Tissue oxygen saturation (StO(2)) was evaluated at 2 mm and 20 mm lateral to the surgical incision, as well as in the inguinal region using a noninvasive tissue oximeter. MEASUREMENTS AND MAIN RESULTS In dogs recovered on nasal oxygen insufflation (n = 10), tissue oxygen saturation was significantly higher--20 mm from the surgical site (88.44 ± 2.50%, P = 0.02) and in the inguinal region (83.56 ± 1.91%, P = 0.032)-- compared to dogs recovered on room air (n = 10, 79.11% ± 2.50 and 77.12% ± 1.91, respectively). CONCLUSIONS In ovariohysterectomized dogs, oxygen supplementation for 2 hours postoperatively improves tissue oxygen saturation 20 mm adjacent to the linea alba and in the inguinal region. Oxygen supplementation in postoperative dogs is an inexpensive and easily applicable method to improve tissue oxygen saturation.

Evaluation of ultrasound‐guided vascular access in dogs

Objective To describe the technique and determine the feasibility, success rate, perceived difficulty, and time to vascular access using ultrasound guidance for jugular vein catheterization in a cardiac arrest dog model. Design Prospective descriptive study. Setting University teaching hospital. Animals Nine Walker hounds. Measurements and Main Results A total of 27 jugular catheterizations were performed postcardiac arrest using ultrasound guidance. Catheterizations were recorded based on the order in which they were performed and presence/absence of a hematoma around the vein. Time (minutes) until successful vascular access and perceived difficulty in achieving vascular access (scale of 1 = easy to 10 = difficult) were recorded for each catheterization. Mean time to vascular access was 1.9 minutes (95% confidence interval, 1.1–3.4 min) for catheterizations without hematoma, versus 4.3 minutes (1.8–10.1 min) for catheterizations with hematoma (P = 0.1). Median perceived difficulty was 2 of 10 (range 1–7) for catheterizations without hematoma, versus 2 of 10 (range 1–8) for catheterizations with hematoma (P = 0.3). A learning curve was evaluated by comparing mean time to vascular access and perceived difficulty in initial versus subsequent catheterizations. Mean time to vascular access was 2.5 minutes (1.0–6.4 min) in the initial 13 catheterizations versus 3.3 minutes (1.5–7.5 min) in the subsequent 14 catheterizations (P = 0.6). Median perceived difficulty in the first 13 catheterizations (3, range 1–8) was significantly greater (P = 0.049) than median perceived difficulty in the subsequent 14 catheterizations (2, range 1–6). Conclusions Ultrasound-guided jugular catheterization is associated with a learning curve but is successful in obtaining rapid vascular access in dogs. Further prospective studies are warranted to confirm the utility of this technique in a clinical setting.OBJECTIVE To describe the technique and determine the feasibility, success rate, perceived difficulty, and time to vascular access using ultrasound guidance for jugular vein catheterization in a cardiac arrest dog model. DESIGN Prospective descriptive study. SETTING University teaching hospital. ANIMALS Nine Walker hounds. MEASUREMENTS AND MAIN RESULTS A total of 27 jugular catheterizations were performed postcardiac arrest using ultrasound guidance. Catheterizations were recorded based on the order in which they were performed and presence/absence of a hematoma around the vein. Time (minutes) until successful vascular access and perceived difficulty in achieving vascular access (scale of 1 = easy to 10 = difficult) were recorded for each catheterization. Mean time to vascular access was 1.9 minutes (95% confidence interval, 1.1-3.4 min) for catheterizations without hematoma, versus 4.3 minutes (1.8-10.1 min) for catheterizations with hematoma (P = 0.1). Median perceived difficulty was 2 of 10 (range 1-7) for catheterizations without hematoma, versus 2 of 10 (range 1-8) for catheterizations with hematoma (P = 0.3). A learning curve was evaluated by comparing mean time to vascular access and perceived difficulty in initial versus subsequent catheterizations. Mean time to vascular access was 2.5 minutes (1.0-6.4 min) in the initial 13 catheterizations versus 3.3 minutes (1.5-7.5 min) in the subsequent 14 catheterizations (P = 0.6). Median perceived difficulty in the first 13 catheterizations (3, range 1-8) was significantly greater (P = 0.049) than median perceived difficulty in the subsequent 14 catheterizations (2, range 1-6). CONCLUSIONS Ultrasound-guided jugular catheterization is associated with a learning curve but is successful in obtaining rapid vascular access in dogs. Further prospective studies are warranted to confirm the utility of this technique in a clinical setting.

Thromboelastographic evidence of inhibition of fibrinolysis after ε‐aminocaproic acid administration in a dog with suspected acute traumatic coagulopathy

OBJECTIVE To describe the thromboelastographic changes in fibrinolysis with ε-aminocaproic acid treatment in a dog with suspected acute traumatic coagulopathy. CASE SUMMARY A 9-year-old female spayed Airedale Terrier was presented with multiple injuries consistent with motor vehicle trauma. After surgical repair of a diaphragmatic hernia and minor laceration of the right cranial lung lobe, the dog continued to produce copious volumes of hemorrhagic fluid from the thoracic cavity despite multiple plasma transfusions, autotransfusions, and failure to locate a definitive source of bleeding during 2 separate surgeries. ε-Aminocaproic acid treatment was initiated and was associated with rapid clinical improvement and diminished fibrinolysis based on a modified plasma-based thromboelastogram. NEW OR UNIQUE INFORMATION PROVIDED This report describes thromboelastographic evidence of inhibition of fibrinolysis after ε-aminocaproic acid administration in a dog with suspected acute traumatic coagulopathy. Thromboelastrography may be useful in monitoring therapy with antifibrinolytic drugs.

Evaluation of an outpatient protocol in the treatment of canine parvoviral enteritis

Objective To compare 2 treatment protocols (standard in-hospital versus modified outpatient) in affecting the duration of treatment or survival of dogs with parvoviral enteritis. Design Prospective, randomized study. Setting University teaching hospital. Animals Client-owned dogs with naturally acquired parvovirus were randomized to receive either an inpatient (n = 20) or outpatient (n = 20) treatment protocol. Interventions Both groups received intravenous (IV) fluid resuscitation and correction of hypoglycemia at hospital admission. Following stabilization, basic inpatient interventions included administration of IV fluids, administration of cefoxitin (22 mg/kg IV q 8 h), and maropitant (1 mg/kg IV q 24 h). Basic outpatient interventions (provided in-hospital) included administration of subcutaneous (SC) fluid (30 mL/kg q 6 h), administration of maropitant (1 mg/kg SC q 24 h) and cefovecin (8 mg/kg SC once). Using daily electrolyte and glucose evaluations, dextrose and potassium supplementation was provided intravenously (inpatients) or orally (outpatients) as indicated. Rescue criteria were used in both groups for analgesia and nausea. All dogs were syringe fed a commercial canine convalescence diet (1 mL/kg PO q 6 h) until voluntary appetite returned. Measurements and Main Results Protocol success, defined as survival to hospital discharge, was 90% (18/20) for the inpatient group compared to 80% (16/20) for the outpatient group (P = 0.66). There was no difference detected in duration of hospitalization for inpatient dogs (4.6 ± 2 days) versus outpatient dogs (3.8 ± 1.8 days, P = 0.20). Metabolic disturbances were frequent in the outpatient group, with 50% of dogs requiring dextrose supplementation and 60% of dogs requiring potassium supplementation. Conclusions An outpatient protocol may be a reasonable alternative for dogs that cannot receive standard in-hospital treatment for parvoviral enteritis. Diligent supportive care and monitoring are still required to optimize treatment of dogs with parvoviral enteritis in an outpatient setting.OBJECTIVE To compare 2 treatment protocols (standard in-hospital versus modified outpatient) in affecting the duration of treatment or survival of dogs with parvoviral enteritis. DESIGN Prospective, randomized study. SETTING University teaching hospital. ANIMALS Client-owned dogs with naturally acquired parvovirus were randomized to receive either an inpatient (n = 20) or outpatient (n = 20) treatment protocol. INTERVENTIONS Both groups received intravenous (IV) fluid resuscitation and correction of hypoglycemia at hospital admission. Following stabilization, basic inpatient interventions included administration of IV fluids, administration of cefoxitin (22 mg/kg IV q 8 h), and maropitant (1 mg/kg IV q 24 h). Basic outpatient interventions (provided in-hospital) included administration of subcutaneous (SC) fluid (30 mL/kg q 6 h), administration of maropitant (1 mg/kg SC q 24 h) and cefovecin (8 mg/kg SC once). Using daily electrolyte and glucose evaluations, dextrose and potassium supplementation was provided intravenously (inpatients) or orally (outpatients) as indicated. Rescue criteria were used in both groups for analgesia and nausea. All dogs were syringe fed a commercial canine convalescence diet (1 mL/kg PO q 6 h) until voluntary appetite returned. MEASUREMENTS AND MAIN RESULTS Protocol success, defined as survival to hospital discharge, was 90% (18/20) for the inpatient group compared to 80% (16/20) for the outpatient group (P = 0.66). There was no difference detected in duration of hospitalization for inpatient dogs (4.6 ± 2 days) versus outpatient dogs (3.8 ± 1.8 days, P = 0.20). Metabolic disturbances were frequent in the outpatient group, with 50% of dogs requiring dextrose supplementation and 60% of dogs requiring potassium supplementation. CONCLUSIONS An outpatient protocol may be a reasonable alternative for dogs that cannot receive standard in-hospital treatment for parvoviral enteritis. Diligent supportive care and monitoring are still required to optimize treatment of dogs with parvoviral enteritis in an outpatient setting.

Surface micropattern reduces colonization and medical device-associated infections

Purpose. Surface microtopography offers a promising approach for infection control. The goal of this study was to provide evidence that micropatterned surfaces significantly reduce the potential risk of medical device‐associated infections. Methodology. Micropatterned and smooth surfaces were challenged in vitro against the colonization and transference of two representative bacterial pathogens ‐ Staphylococcus aureus and Pseudomonas aeruginosa. A percutaneous rat model was used to assess the effectiveness of the micropattern against device‐associated S. aureus infections. After the percutaneous insertion of silicone rods into (healthy or immunocompromised) rats, their backs were inoculated with S. aureus. The bacterial burdens were determined in tissues under the rods and in the spleens. Results. The micropatterns reduced adherence by S. aureus (92.3 and 90.5% reduction for flat and cylindrical surfaces, respectively), while P. aeruginosa colonization was limited by 99.9% (flat) and 95.5% (cylindrical). The micropatterned surfaces restricted transference by 95.1% for S. aureus and 94.9% for P. aeruginosa, compared to smooth surfaces. Rats with micropatterned devices had substantially fewer S. aureus in subcutaneous tissues (91%) and spleens (88%) compared to those with smooth ones. In a follow‐up study, immunocompromised rats with micropatterned devices had significantly lower bacterial burdens on devices (99.5 and 99.9% reduction on external and internal segments, respectively), as well as in subcutaneous tissues (97.8%) and spleens (90.7%) compared to those with smooth devices. Conclusion. Micropatterned surfaces exhibited significantly reduced colonization and transference in vitro, as well as lower bacterial burdens in animal models. These results indicate that introducing this micropattern onto surfaces has high potential to reduce medical device‐associated infections.

The effects of omeprazole therapy on bacterial colonization of the pharynx in healthy dogs.

OBJECTIVE To identify the relative abundance of commensal pharyngeal flora in healthy dogs and determine if abundance of pharyngeal flora is altered during omeprazole administration. ANIMALS Eight adult Beagles. PROCEDURES A total of 3 baseline pharyngeal swabs, collected 48 hours apart, were obtained from each dog. Omeprazole (1 mg/kg PO q 24 h) was administered for a total of 12 days. During omeprazole administration, pharyngeal swabs were obtained on Days 8, 10, and 12. All swabs were submitted for semiquantitative aerobic and anaerobic culture. Growth of bacterial isolates, as well as genus of isolates, was compared between the pretreatment (n = 24) and treatment (n = 24) swabs. RESULTS A greater abundance of several bacterial species was identified during the treatment period, including coagulase-negative Staphylococcus (P < 0.01), Bacillus (P < 0.01), and Pasteurella (P = 0.05). The abundance of bacterial species in samples collected during the treatment period was unchanged for Escherichia coli (P = 0.16), Provotella (P = 0.40), hemolytic Streptococcus (P = 0.34), and nonhemolytic Streptococcus (P = 0.14). CONCLUSIONS AND CLINICAL RELEVANCE This small study indicates that shifts in canine pharyngeal flora may occur during omeprazole therapy. Further studies are warranted to determine the clinical significance of gastric acid suppressants on pharyngeal flora in dogs.

Palatability Assessment of an Oral Recuperation Fluid in Healthy Dogs During the Perioperative Period

The objective of this study was to determine whether healthy dogs undergoing elective surgery will accept and prefer an oral recuperation fluid (ORF) to water during the perioperative time period and if the consumption of an ORF would lead to increased caloric intake during the final preoperative and first postoperative periods. This prospective, observational study was performed in the setting of a University Veterinary Teaching Hospital. A total of 67 healthy dogs were presented for routine ovariectomy (n = 30) or castration (n = 37). Before surgical intervention, dogs were offered an ORF to assess their voluntary acceptance of the fluid. After 2 hours, the ORF was offered alongside water to assess fluid preference. Routine castration or ovariectomy was then performed. During the immediate postoperative period, dogs were reassessed as to their acceptance and preference of the ORF. A high percentage of dogs accepted the ORF in both the preoperative (55/67, 82%) and postoperative (42/67, 63%) periods (P < .01 and P = .04, respectively). Of dogs that demonstrated a preference between the ORF and water, 87% (95% CI: 77%-93%) chose the ORF preoperatively, whereas 98% (95% CI: 87%-99.5%) chose the ORF postoperatively (P < .01 and P < .01, respectively). Dogs that consumed the ORF in each measurement period ingested a higher amount of food (measured as percentage of kilocalories offered) when compared with those that did not consume the ORF (preoperatively 83% vs. 49%, P < .01; postoperatively 51% vs. 27%, P = .01). A commercially manufactured veterinary ORF was found to be palatable, as determined by acceptance and preference testing, in healthy dogs during the preoperative and postoperative phases of routine sterilization. Further studies in dogs undergoing more intensive surgical procedures or recovering from nonsurgical illness or both are warranted.