Antimicrobial-associated diarrhoea in three equine referral practices
Antimicrobial-associated diarrhoea in three equine referral practices
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DOI：
10.1111/j.2042-3306.2012.00595.x
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发表时间：
2013-03-01
影响因子：
2.2
通讯作者：
Weigel, D. J.
中科院分区：
文献类型：
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作者：
Barr, B. S.;Waldridge, B. M.;Weigel, D. J.
进行研究的原因：尽管抗菌剂相关腹泻（AAD）是马中最常见的抗菌剂治疗不良反应，但很少进行关于AAD患病率的多中心研究。目的：确定在非腹泻条件下接受抗菌剂治疗后发生腹泻的马中AAD的患病率，并确定使用的抗菌剂。研究方法：对2009年3家转诊医院的数据库进行了检索，以确定接受抗菌剂治疗非胃肠疾病的未住院马（断奶年龄或更大）。本研究纳入了2009年期间出现腹泻的符合这些标准的马。收集每个住院病例的其他信息，包括给予的抗菌剂和粪便病原体检测结果。结果如下：在接受抗菌剂治疗非胃肠体征的5251匹马中，32匹被诊断为可能的AAD，患病率为0.6%（95%置信区间：0.430.86%）。AAD诊断马的死亡率为18.8%（6/32）。患有AAD的马平均接受4.2天治疗。AAD马中最常用的抗菌药物为庆大霉素联合青霉素（n = 7）、恩诺沙星（n = 7）和多西环素（n = 4）。在4匹马的粪便样本中鉴定出艰难梭菌，其中2匹死亡，3匹马的沙门氏菌。结论：AAD的患病率较低。马实践中常用的任何抗菌剂类别都是马AAD的潜在原因。其他风险因素，如机会性肠道病原体，可能在继发于抗菌药物使用的腹泻发展中发挥作用。潜在相关性：虽然马AAD的风险较低，但抗菌治疗的后遗症是可能的，特别是当存在机会性肠道病原体或其他风险因素时。由于任何抗菌药物类别的药物都可能涉及AAD，因此临床医生有额外的动力来确保抗菌药物的明智使用。
Reasons for performing study: Although antimicrobial-associated diarrhoea (AAD) is the most frequently observed adverse effect of antimicrobial therapy in horses, few multicentred studies on the prevalence of AAD have been performed. Objectives: To determine the prevalence of AAD in horses that developed diarrhoea after antimicrobial treatment for nondiarrhoeic conditions and identify the antimicrobials used. Methods: The 2009 database of 3 referral hospitals was searched to identify nonhospitalised horses (weanling age or older) treated with antimicrobials for nongastrointestinal conditions. Horses with these criteria that presented with diarrhoea during 2009 were included in the study. Additional information, including antimicrobial administered and results of faecal pathogen testing, was gathered on each hospitalised case. Results: Of the 5251 horses treated with antimicrobials for nongastrointestinal signs, 32 were diagnosed with probable AAD, a prevalence of 0.6% (95% confidence interval: 0.430.86%). The AAD-diagnosed horses had an 18.8% (6/32) mortality rate. Horses with AAD had been treated for an average of 4.2 days. The most frequently used antimicrobials in horses with AAD were gentamicin in combination with penicillin (n = 7), enrofloxacin (n = 7) and doxycycline (n = 4). Clostridium difficile was identified in faecal samples from 4 horses, 2 of which died and Salmonella from 3 horses. Conclusions: Results indicated that the prevalence of AAD is low. Any antimicrobial class commonly used in equine practice is a potential cause of equine AAD. Other risk factors, such as opportunistic enteropathogens, may play a part in the development of diarrhoea secondary to antimicrobial usage. Potential relevance: Although the risk of equine AAD is low, this sequela of antimicrobial treatment is possible especially when opportunistic enteropathogens or other risk factors are present. Because drugs from any antimicrobial class can be potentially involved in AAD, clinicians have additional incentive to ensure the judicious use of antimicrobial agents.