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Home / Equine Research Bank / Vet Med Sci / Do post-surgical multiresistant urinary infections occur in ...
Veterinary medicine and science2023; 9(5); 2042-2052; doi: 10.1002/vms3.1201

Do post-surgical multiresistant urinary infections occur in horses? Case of unilateral pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria as a complication of cystotomy.

Abstract: Pyelonephritis is a serious condition that is rarely described in horses. In contrast, urinary tract infections are common in humans and small animals, and multi-drug-resistant urinary infections are an emerging threat. In this report, we describe a horse with unilateral pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria belonging to the Enterobacter cloacae complex. [Correction added on 9 August 2023, after first online publication: The preceding sentence was corrected.] An 11-year-old Swedish warmblood gelding was diagnosed with a cystolith and a cystotomy through an open left para-inguinal approach was performed. Seven days after surgery the horse presented with pyrexia, dullness and colic. Diagnostic testing and renal transabdominal ultrasonography confirmed the presence of a right-sided pyelonephritis. Culture and antimicrobial susceptibility testing revealed a pure growth of extended-spectrum beta-lactamases-producing E. cloacae complex bacteria with resistance against beta-lactams, aminoglycoside and trimethoprim-sulphonamide classes. Treatment included prolonged oral antimicrobials according to susceptibility testing results (enrofloxacin), judicious use of non-steroidal anti-inflammatory drugs, fluid therapy and gastric ulcer prophylaxis. The horse recovered successfully and is currently in good health (follow-up of 5 years). Once the infection resolved, unilateral renal scarring occurred. Multidrug-resistant upper-urinary infections occur in horses and should be considered in a post-surgical patient that develops fever. Early diagnosis, urine bacterial culturing and antimicrobial susceptibility testing were crucial in this case to successful management.
© 2023 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.
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Publication Date: 2023-07-19 PubMed ID: 37466019PubMed Central: PMC10508549DOI: 10.1002/vms3.1201Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research article presents a case study on a horse with pyelonephritis, a type of urinary infection that became resistant to multiple drugs after a cystotomy surgery. The horse was treated with oral antibiotics, non-steroidal anti-inflammatory drugs, fluids, and medications to prevent gastric ulcers, and has recovered successfully.

Case Presentation

  • The study discusses a particular case of an 11-year-old Swedish warmblood gelding diagnosed with a cystolith, a type of urinary bladder stone. The horse underwent a cystotomy, a surgical procedure to remove the bladder stone, conducted through an open left para-inguinal approach.
  • Seven days post-surgery, the horse exhibited symptoms like fever, dullness, and colic, indicative of an infection. Further diagnostic tests and renal transabdominal ultrasonography confirmed the presence of pyelonephritis, a severe inflammation of the kidney, on the right side.

Identifying the Causal Bacterium and Its Resilience

  • Culture and antimicrobial susceptibility testing were performed to identify the causative agent being E. cloacae complex bacteria, which belong to the beta-lactamase category. These bacteria have developed resistance against multiple classes of antibiotics such as beta-lactams, aminoglycoside, and trimethoprim-sulphonamide.
  • These bacteria produce extended-spectrum beta-lactamases (ESBLs) – enzymes that confer resistance to a range of antibiotic drugs. ESBLs are capable of breaking down several types of antibiotics, and their presence signals a multi-drug-resistant urinary tract infection.

Treatment and Outcomes

  • The treatment protocol involved a prolonged course of oral antimicrobials, specifically enrofloxacin, as prescribed based on the susceptibility testing results. The horse also received non-steroidal anti-inflammatory drugs, fluid therapy, and gastric ulcer prophylaxis.
  • After a successful recovery and a follow-up period of 5 years, the horse has reported good health. However, the resolution of the infection led to unilateral renal scarring.

Significance of the Case Study

  • This study substantiates the emergence of multi-drug-resistant upper-urinary tract infections in horses, particularly following surgical procedures. It highlights the importance of considering such infections in post-surgical patients with fever.
  • Furthermore, this case accentuates the importance of early diagnosis, urine bacterial culturing, and antimicrobial susceptibility testing in managing such infections effectively.

Cite This Article

APA
Scala E, van Galen G, Skärlina EM, Durie I. (2023). Do post-surgical multiresistant urinary infections occur in horses? Case of unilateral pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria as a complication of cystotomy. Vet Med Sci, 9(5), 2042-2052. https://doi.org/10.1002/vms3.1201

Publication

Veterinary medicine and science
ISSN: 2053-1095
NlmUniqueID: 101678837
Country: England
Language: English
Volume: 9
Issue: 5
Pages: 2042-2052

Researcher Affiliations

Scala, Elisa
  • Evidensia Specialisthästsjukhuset Strömsholm, Strömsholm, Sweden.
van Galen, Gaby
  • Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia.
  • Goulburn Valley Equine Hospital, Congupna, Victoria, Australia.
Skärlina, Elin M
  • Evidensia Specialisthästsjukhuset Strömsholm, Strömsholm, Sweden.
Durie, Inge
  • Evidensia Specialisthästsjukhuset Strömsholm, Strömsholm, Sweden.

MeSH Terms

  • Horses
  • Male
  • Humans
  • Animals
  • Cystotomy / veterinary
  • beta-Lactamases / therapeutic use
  • Urinary Tract Infections / veterinary
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / microbiology
  • Pyelonephritis / veterinary
  • Bacteria
  • Horse Diseases / surgery

Conflict of Interest Statement

No conflict of interest to declare.

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Citations

This article has been cited 2 times.
  1. Kabir A, Lamichhane B, Habib T, Adams A, El-Sheikh Ali H, Slovis NM, Troedsson MHT, Helmy YA. Antimicrobial Resistance in Equines: A Growing Threat to Horse Health and Beyond-A Comprehensive Review. Antibiotics (Basel) 2024 Jul 29;13(8).
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  2. van Galen G, Divers TJ, Savage V, Schott HC 2nd, Siwinska N. ECEIM consensus statement on equine kidney disease. J Vet Intern Med 2024 Jul-Aug;38(4):2008-2025.
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