Nosocomial infection rates in veterinary referral hospitals: using syndromic surveillance to establish baseline rates

2011 Fall.Includes bibliographical references.Nosocomial, or hospital-acquired, infections are considered to be the most common complication affecting hospitalized human patients, but their impact on hospitalized veterinary patients is less well understood. In fact, the incidence of nosocomial infections that occur in veterinary hospitals has not been established. There is evidence, however, that nosocomial infections are of great consequence in veterinary medicine and can have considerable negative effects on the individual patient as well as on the veterinary hospital as a whole. Due to the increased risk of infection in hospitalized patients, it is anticipated that some nosocomial infections will occur. Establishing a baseline rate of infection using surveillance techniques will allow investigators to ascertain the proportion of infections that can be prevented using infection control measures. The purpose of this study was to establish baseline rates of infection using a syndromic surveillance system created for implementation in small animal and equine referral hospitals. This study included weaned dogs, cats, and horses (n=2248) that were hospitalized in the critical care unit of one of five participating veterinary hospitals during a 12 week period in 2006. Clinicians actively performed syndromic surveillance on hospitalized patients and reported their results no later than the time of the patient’s discharge from the hospital. Adjusted rates of nosocomial events were estimated using Poisson regression, and risk factors associated with an increased risk of developing a nosocomial event were analyzed using multivariable logistic regression. Adjusting for hospital of admission, 19.7% of horses, 16.3% of dogs, and 12% of cats included in this study were reported to have experienced a nosocomial event occur during hospitalization. The only risk factor found to have a positive association with the development of a nosocomial event in all three species was placement of a urinary catheter. Surgical site inflammation and intravenous catheter site inflammation were two of the most commonly reported events across all species. Results of this study suggest that nosocomial event rates can be established using syndromic surveillance systems in multiple hospitals. Data pertinent to risk factors for the occurrence of nosocomial events can also be effectively collected using the same technique. Further research is warranted in order to evaluate how generalizable these results are to other veterinary healthcare settings

The standards of reporting trials in pets (PetSORT): Explanation and elaboration

Well-designed randomized controlled trials (RCTs) provide the best evidence of the primary research designs for evaluating the effectiveness of interventions. However, if RCTs are incompletely reported, the methodological rigor with which they were conducted cannot be reliably evaluated and it may not be possible to replicate the intervention. Missing information also may limit the reader's ability to evaluate the external validity of a trial. Reporting guidelines are available for clinical trials in human healthcare (CONSORT), livestock populations (REFLECT), and preclinical experimental research involving animals (ARRIVE 2.0). The PetSORT guidelines complement these existing guidelines, providing recommendations for reporting controlled trials in pet dogs and cats. The rationale and scientific background are explained for each of the 25 items in the PetSORT reporting recommendations checklist, with examples from well-reported trials

The standards of reporting randomized trials in pets (PetSORT): Methods and development processes

BackgroundReporting of clinical trials conducted in client- and shelter-owned dog and cat populations is not optimal, which inhibits the ability to assess the reliability and validity of trial findings and precludes the ability to include some trials in evidence synthesis.ObjectiveTo develop a reporting guideline for parallel group and crossover trials that addresses the unique features and reporting requirements for trials conducted in client- and shelter-owned dog and cat populations.DesignConsensus statement.SettingVirtual.ParticipantsFifty-six experts from North America, the United Kingdom, Europe, and Australia working in academia, government (research and regulatory agencies), industry, and clinical veterinary practice.MethodsA steering committee created a draft checklist for reporting criteria based upon the CONSORT statement and the CONSORT extensions for reporting of abstracts and crossover trials. Each item was presented to the expert participants and was modified and presented again until >85% of participants were in agreement about the inclusion and wording of each item in the checklist.ResultsThe final PetSORT checklist consists of 25 main items with several sub-items. Most items were modifications of items contained in the CONSORT 2010 checklist or the CONSORT extension for crossover trials, but 1 sub-item pertaining to euthanasia was created de novo.ConclusionThe methods and processes used to develop this guideline represent a novel departure from those used to create other reporting guidelines, by using a virtual format. The use of the PetSORT statement should improve reporting of trials conducted in client- and shelter-owned dogs and cats and published in the veterinary research literature

Demographic factors associated with joint supplement use in dogs from the Dog Aging Project

Osteoarthritis (OA) is one of the most prevalent age-related chronic conditions that afflict companion dogs, and multiple joint supplements are available to prevent or treat OA, though the efficacy of these treatments is controversial. While the demographic factors that are associated with OA diagnosis are well established, the factors that are associated with joint supplement use are not as well studied. Using data collected from the Dog Aging Project, we analyzed owner survey responses regarding joint supplement administration and OA diagnosis for 26,951 adult dogs. In this cross-sectional analysis, logistic regression models and odds-ratios (OR) were employed to determine demographic factors of dogs and their owners that were associated with joint supplement administration. Forty percent of adult dogs in our population were given some type of joint supplement. Perhaps not surprisingly, dogs of older age, larger size, and those that were ever overweight were more likely to receive a joint supplement. Younger owner age, urban living, owner education, and feeding commercial dry food were associated with a reduced likelihood of administration of joint supplements to dogs. Interestingly, mixed breed dogs were also less likely to be administered a joint supplement (OR: 0.73). Dogs with a clinical diagnosis of OA were more likely to receive a joint supplement than those without a reported OA diagnosis (OR: 3.82). Neutered dogs were more likely to have a diagnosis of OA, even after controlling for other demographic factors, yet their prevalence of joint supplement administration was the same as intact dogs. Overall, joint supplement use appears to be high in our large population of dogs in the United States. Prospective studies are needed to determine if joint supplements are more commonly administered as a preventative for OA or after an OA clinical diagnosis

Chikungunya, West Nile, And Zika, Oh My! Emerging Zoonotic Viruses and the Concept of One Health

In the last 30 years we have identified an increased number of emerging infectious diseases in humans and it is estimated that 70 percent of those diseases are zoonotic, arising from animals. Historically, zoonoses most often arose from domestic animals, poultry and livestock. Increasingly these diseases are arising from wildlife species and spreading faster than in the past with recent examples including West Nile and Zika viruses as well as Chikungunya virus. In fact, the next human pandemic disease is predicted to be zoonotic and arising from wildlife. This talk will focus on zoonotic diseases and the many drivers behind their emergence, among them climate and habitat changes; a human population expanding into areas previously only habited by wildlife; and globalization, making rapid travel around the planet commonplace

Veterinary cancer epidemiology: using canine spontaneous tumor models for the study of human cancers

2014 Fall.Includes bibliographical references.Cancer is the second leading cause of death in humans worldwide and the most common cause of death for humans in developed countries. Cancer is also the leading cause of mortality in dogs. Animal models, primarily genetically engineered mice, have been used historically in research aimed at discovering causes and treatments for human cancer types, but the canine model has been underutilized in this research area. Though the field of canine cancer epidemiology is relatively new, it has great potential to produce answers to research questions pertaining to cancer prevention, development, and treatment relevant to both dogs and humans. In fact, the canine spontaneous tumor model is actually a better model for use in human cancer epidemiology research than other animal models or even human populations. This is due to the fact that dogs spontaneously produce many different types of tumors that are molecularly indistinguishable from human tumors. Canine DNA shares a large amount of ancestral sequence with human DNA, but dogs have greater genetic homogeneity - even across breeds - than do humans, which simplifies disease mapping at the genomic level. Dogs live in the same environments as humans, too, so they share many similar exposures to environmental factors that may contribute to the development of cancer. Tumors in dogs progress at a rapid rate as compared to humans and many tumor types that are rare in humans occur frequently in dogs. These facts, when considered along with the existence of an accelerated aging process in dog, support how use of the canine spontaneous tumor model will allow us to gain a greater understanding of genetic and environmental contributions to human disease and do so at a rapid pace. The primary aims of my dissertation were to examine the current body of evidence produced through canine cancer epidemiology research, produce new research using study designs similar to those used in human cancer epidemiology research, and show how we can advance knowledge of cancer risk and pathogenesis in both fields using the canine spontaneous tumor model. • Through utilization of systematic review methodology I was also able to identify a lack of consistency in study design and statistical methods used in veterinary cancer research even when exploring the same research question. • Then, with a study population of nearly 68,000 dogs admitted to hospitals across the United States over a 20-year time frame, I was able to show there are several breed-specific and hormone-dependent risks associated with development of lymphoma, many of which had not been previously reported, likely due to the use of small samples sizes in veterinary cancer research. • I also discovered differences in the geographic distribution of dogs diagnosed with two different subtypes of lymphoma in the US. This implies molecular characterization of some cancers, which is commonly done in human epidemiologic research, may be a necessary component of future veterinary epidemiologic research in order for us to truly identify risks for disease occurrence. • Lastly, I utilized a study population composed only of Bernese mountain dogs, a breed known to be predisposed to developing a cancer type that is rare in humans, to investigate exposure variables associated with disease outcome. The results of this project suggested a mechanism of disease pathogenesis not previously reported in either the veterinary or the human literature. As a body of work, these individual studies contribute to advancing the concept of using canine spontaneous tumor models in lieu of using other animal models for comparative research. In addition, the canine model can be superior to use of human subjects in many instances, including when determining the etiology of rare cancer types or when determining the pathogenetic basis of disease. In order to continue positively contributing to the field of cancer epidemiology, veterinary epidemiologists must increase the rigor with which we are conducting studies, report research in a transparent manner by conforming to accepted reporting guidelines, and ensure we are investigating appropriate research questions

Canine lymphoma case control database

Zip file includes: data and readme file.Authors are from Purdue University. Department of Comparative Pathobiology and Colorado State University. Department of Clinical Sciences.These data were collected by the Veterinary Medical Database and include demographic information about 67,712 dogs seen at veterinary teaching hospitals in North America between 1989 and 2011. 18,826 of these dogs were diagnosed with lymphoma (cases) and the control series were matched to case dogs by institution of admission, age, and year of admission in up to a 3:1 ratio.Cases 1990-2009; controls 1989-2011

Predicting health outcomes in dogs using insurance claims data

Abstract In this paper we propose a machine learning-based approach to predict a multitude of insurance claim categories related to canine diseases. We introduce several machine learning approaches that are evaluated on a pet insurance dataset consisting of 785,565 dogs from the US and Canada whose insurance claims have been recorded over 17 years. 270,203 dogs with a long insurance tenure were used to train a model while the inference is applicable to all dogs in the dataset. Through this analysis we demonstrate that with this richness of data, supported by the right feature engineering, and machine learning approaches, 45 disease categories can be predicted with high accuracy

Approaches Used to Construct Antibiograms for Dogs in a Veterinary Teaching Hospital in the United States

Non-judicious antimicrobial use (AMU) is a major driver of antimicrobial resistance (AMR). In human hospitals, cumulative antibiograms are often used by clinicians to evaluate local susceptibility rates and to select the most appropriate empiric therapy with the aim of minimizing inappropriate AMU. However, the use of cumulative antibiograms to guide empiric antimicrobial therapy in veterinary hospitals in the United States is limited, and there are no specific guidelines or standardized methods available for the construction of antibiograms in veterinary clinical settings. The objective of this methods article is to describe the approaches that were used to construct antibiograms from clinical samples collected from dogs seen at a veterinary teaching hospital. Laboratory data for 563 dogs for the period from 1 January 2015 to 31 December 2015 was utilized. We used the Clinical and Laboratory Standards Institute (CLSI) guidelines for use in the construction of the antibiograms in human healthcare settings as the basis for the veterinary antibiograms. One general antibiogram and antibiograms stratified by hospital section, the anatomic region of sample collection/by sample type, were created and the challenges encountered in preparing these antibiograms were highlighted. The approaches described could be useful in guiding veterinary antibiogram development for empiric therapy

Antimicrobial Susceptibility of Bacteria Isolated from Freshwater Mussels in the Wildcat Creek Watershed, Indiana, United States

Antimicrobial resistance (AMR) is a global health crisis that threatens the health of humans and animals. The spread of resistance among species may occur through our shared environment. Prevention of AMR requires integrated monitoring systems, and these systems must account for the presence of AMR in the environment in order to be effective. The purpose of this study was to establish and pilot a set of procedures for utilizing freshwater mussels as a means of surveillance for microbes with AMR in Indiana waterways. One hundred and eighty freshwater mussels were sampled from three sites along the Wildcat Creek watershed in north-central Indiana. Specimens were evaluated for the presence of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species), Escherichia coli, Campylobacter, and Salmonella species, and the isolates were tested for antimicrobial resistance. A total of 24 bacterial isolates were obtained from tissue homogenates of freshwater mussels collected at a site directly downstream from Kokomo, Indiana. Of these, 17 were Enterobacter spp., five were Escherichia coli, one was Pseudomonas aeruginosa, and one was Klebsiella pneumoniae. All isolates were resistant to three or more antimicrobial drug classes. Further work is necessary to determine the source of the bacterial species found in the mussels