Page 1122 - Clinical Small Animal Internal Medicine

1060 Section 9 Infectious Disease

(SSIs, BSIs, pneumonia). The high degree of antimicro- Box 116.1 Key methods to manage multidrug‐
VetBooks.ir bial resistance, ability to propagate for extended periods resistant infections and reduce the risk of hospital‐
in small animal hosts as a commensal, and environmen-
associated infections
tal persistence make enterococci particularly challenging
when involved in HAIs.
Reduce the prevalence of MDROs in patients
Prudent antimicrobial use
●
Salmonella spp. ● Therapy directed by culture and susceptibility testing
Withholding therapy (as appropriate) for patients
Salmonella has been identified as a source of sporadic ● only colonized and not infected
illness and hospital‐associated outbreaks in small animal Discontinue use of higher risk devices (e.g., urinary
hospitals. A notable concern with Salmonella HAIs is ● and intravenous catheters) when no longer
the occurrence of zoonotic transmission with accompa- medically required
nying human infections. Factors increasing the risk of Infection control practices
Salmonella shedding in small animals include consump- ●
tion of raw meat diets and exposure to livestock. As with Reduce within‐hospital exposure
E.coli, ESBL‐producing strains are a concern for antimi- ● Hand hygiene
crobial resistance and have been identified in small ● Environmental cleaning and disinfection
animals. ● Personal protective equipment (e.g., gloves, gowns)
● Cohorting patients with similar infectious disease
risks
Acinetobacter spp and Pseudomonas spp. Isolation of known or suspected infectious cases
●
As opportunistic pathogens in small animals and able to Prompt recognition and response
persist in the environment for extended periods, ● Culture and susceptibility testing
Acinetobacter and Pseudomonas are important in veteri- ● HAI surveillance (e.g., passive surveillance for HAIs,
nary HAIs. Documented HAIs involving A. baumannii reporting of pathogens and syndromes of interest)
include intravenous and urinary catheters, surgical drain ● Education of staff and clients
infections, SSIs, pneumonia, and BSIs. SSIs, including
cardiovascular device infections, have been attributed to HAI, hospital‐associated infection; MDRO, multidrug‐resistant
organism.
P. aeruginosa. Identification of hospital clusters of
Pseudomonas infections should prompt investigation of
potentially contaminated environmental, equipment principles of therapy are the same as for antimicrobial‐
(e.g., endoscope) or consumable (e.g., catheter prepara- sensitive pathogens: ensuring the appropriate drug (and
tion supplies) sources. dose) is selected based on the patient and infection. As
infections caused by MDROs appear clinically identical
to those caused by antimicrobial‐susceptible bacteria,
Management culture and susceptibility testing are fundamental in this
process. Local therapy (e.g., topical therapy, antimicro-
Although complete prevention of HAIs and MDROs is bial‐impregnated materials, intraarticular injection) is
our goal, given the nature of medicine, bacterial adapta- often overlooked, and in many cases can provide ade-
tion, and numerous mechanisms for antimicrobial resist- quate drug levels for treatment and may be an alternative
ance, it is inevitable they will continue to occur. Methods for drugs that are not an option for systemic therapy.
to manage MDR infections and reduce the risk of HAIs However, the possibility of systemic absorption of locally
and nosocomial transmission are paramount (Box 116.1). administered drugs must be considered.
Efforts should be directed toward prompt identifica- In addition to treating MDROs, it is important to pre-
tion, appropriate therapy, and infection control prac- vent their development. Prudent antimicrobial use will
tices. Establishing and maintaining an infection control help reduce the risk for HAIs at both the individual
program is vital to integrating these efforts and protect- patient and hospital population levels. Clinicians should
ing the health of pets and people. avoid using antimicrobials when a bacterial infection has
not been confirmed by culture. Antimicrobials used in
the initial treatment of an infection should be selected
Therapy
based on the effectiveness against the most likely organ-
Antimicrobial therapy is an important part of the treat- isms causing the infection and penetration into the body
ment of many MDROs and HAIs. Although available site affected. Guidelines are available to assist veterinar-
antimicrobial choices may be limited, the general ians in antimicrobial selection.