Successful treatment of a chronic oroantral fistula infected with extensively drug resistant bacteria using long-term oesophageal tube feeding and several non-conventional treatments in a horse.
Abstract: Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses. Methods: An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116. Conclusions: These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.
© 2021 Australian Veterinary Association.
Publication Date: 2021-12-02 PubMed ID: 34859426DOI: 10.1111/avj.13136Google Scholar: Lookup
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Summary
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This research describes the successful treatment of a horse’s chronic oral condition (oroantral fistulae or OAF) caused by drug-resistant bacteria using unconventional treatment approaches, including oesophageal tube feeding and alternative therapeutics like apple cider vinegar.
Introduction and Background
- The study focuses on an 8-year-old Andalusian cross gelding horse which presented with a clinical crown fracture of tooth 209. The horse’s tooth fracture was iatrogenic, meaning it was inadvertently caused by a medical treatment or procedure. The tooth went through a process known as repulsion of its apical portion, resulting in an acute OAF, a passageway formed mistakenly between the oral cavity and the maxillary sinus in the horse.
- Unfortunately, despite initial treatments involving penicillin and gentamicin injections, followed by oral intake of trimethoprim-sulphonamide and doxycycline, the acute OAF persisted and converted into a chronic OAF by day 24.
Progress of the Problem and Diagnosis
- By day 48, the horse was diagnosed with septic sinusitis, a serious infection in the lining of the sinuses, caused by multidrug-resistant Escherichia coli (E.coli) bacteria. A 30-day treatment with enrofloxacin, an antibiotic to which the bacteria was in vitro susceptible, was attempted but proved unsuccessful.
- Further microbial cultures kept yielding multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) of these pathogens displayed various strains of E. coli, each possessing different resistant and virulence genes.
- A computed tomography scan on day 70 confirmed the position of the OAF and revealed regional osteomyelitis, infection in the bone, and septic sinusitis.
Treatment and Conclusion
- A cervical oesophagostomy tube provided enteral (via the gastrointestinal tract) nutrition from day 74 for 3 months to prevent contamination of oral feed. The persistent OAF was treated with non-conventional therapeutics like apple cider vinegar, propolis, and amikacin impregnated products, eventually resolving on day 116.
- The result of these combined methods was the successful treatment of the complicated OAF. Importantly, the application of WGS techniques in identifying resistant genes in future could help guide the selection of more suitable antibiotics when dealing with MDR or XDR organisms.
Cite This Article
APA
Fletcher JR, Yuen KY, Stewart AJ, Young AC, Gibson JS, James OA, Medina-Torres CE, Forde BM, Sole-Guitart A.
(2021).
Successful treatment of a chronic oroantral fistula infected with extensively drug resistant bacteria using long-term oesophageal tube feeding and several non-conventional treatments in a horse.
Aust Vet J, 100(3), 107-113.
https://doi.org/10.1111/avj.13136 Publication
Researcher Affiliations
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia.
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia.
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia.
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia.
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia.
- Australian Veterinary Equine Dentistry, Clayfield, Queensland, 4011, Australia.
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia.
- School of Chemistry and Molecular Biosciences, The University of Queensland, St. Lucia, Queensland, 4072, Australia.
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, 4343, Australia.
MeSH Terms
- Animals
- Anti-Bacterial Agents / therapeutic use
- Enteral Nutrition / veterinary
- Escherichia coli
- Horse Diseases / drug therapy
- Horses
- Male
- Oroantral Fistula / complications
- Oroantral Fistula / therapy
- Oroantral Fistula / veterinary
- Pharmaceutical Preparations
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Citations
This article has been cited 1 times.- Munif MR. Surgical repair of orocutaneous fistula in the left submandibular region of a day-old calf with ectopic incisors.. J Adv Vet Anim Res 2022 Sep;9(3):509-515.
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