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      Suggested guidelines for using systemic antimicrobials in bacterial skin infections: part 1—diagnosis based on clinical presentation, cytology and culture

      research-article
      , DVM, DipECVD 1 , , Doct.Vét., Dip.ECVD, DESV, DV 2 , , Lic Vet, PhD, DipECVD 3 , , DVM, DipECVD 4 , , BSc, BVSc, CertVD, PhD, CBiol, MSB, MRCVS 5 , , DVM, DipECVD 6
      The Veterinary Record
      BMJ Publishing Group
      Dermatology, Bacterial diseases, Antimicrobials

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          Abstract

          Systemic antimicrobials are critically important in veterinary healthcare, and resistance is a major concern. Antimicrobial stewardship will be important in maintaining clinical efficacy by reducing the development and spread of antimicrobial resistance. Bacterial skin infections are one of the most common reasons for using systemic antimicrobials in dogs and cats. Appropriate management of these infections is, therefore, crucial in any policy for responsible antimicrobial use. The goals of therapy are to confirm that an infection is present, identify the causative bacteria, select the most appropriate antimicrobial, ensure that the infection is treated correctly, and to identify and manage any underlying conditions. This is the first of two articles that will provide evidence-led guidelines to help practitioners address these issues. This article covers diagnosis, including descriptions of the different clinical presentations of surface, superficial and deep bacterial skin infections, how to perform and interpret cytology, and how to best use bacterial culture and sensitivity testing. Part 2 will discuss therapy, including choice of drug and treatment regimens.

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          Most cited references15

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          Staphylococcal colonization of mucosal and lesional skin sites in atopic and healthy dogs.

          Staphylococcal colonization was compared in healthy dogs and in dogs with atopic dermatitis. Bacterial swabs were collected from the nasal mucosa, ear and perineum of 43 healthy and 24 atopic dogs and also from potentially infected skin lesions of the atopic dogs. Coagulase positive staphylococcal isolates were identified to the species level. At the time of this study Staphylococcus intermedius was considered a single species but has since been recognized as comprising at least three species with canine isolates believed to belong to Staphylococcus pseudintermedius. Of atopic dogs, 87.5% were colonized with S. intermedius compared to only 37.2% of healthy dogs. The ear was the only carriage site that showed any significant difference in S. intermedius isolation between healthy and atopic dogs. The perineum represented the most frequently colonized mucosal site for both groups. Sampling the nasal mucosa alone identified 71.4% of atopic and 37.5% of healthy S. intermedius carriers. Inclusion of a perineal swab identified 100% of atopic and 93.8% of healthy carriers. S. intermedius was isolated from all the lesional sites sampled from atopic dogs. Significantly fewer dogs were colonized by Staphylococcus aureus than S. intermedius, and there was no significant difference between S. aureus colonization of atopic and healthy dogs. S. aureus was not recovered from any lesions in atopic dogs. The results show that S. intermedius carriage is more prevalent in atopic dogs compared to healthy dogs and that to identify staphylococcal carriers both the nasal mucosa and the perineum should be sampled.
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            Surveillance of healthy cats and cats with inflammatory skin disease for colonization of the skin by methicillin-resistant coagulase-positive staphylococci and Staphylococcus schleiferi ssp. schleiferi.

            In this study, bacterial cultures were collected from five sites on each of 50 healthy cats and 48 cats with inflammatory skin disease (ISD), to determine prevalence of carriage and relative frequency of methicillin resistance in coagulase-positive staphylococci and Staphylococcus schleiferi ssp. schleiferi. Latex agglutination testing for penicillin-binding protein 2a (PBP2a) and pulsed field gel electrophoresis (PFGE) were performed on all methicillin-resistant (MR) isolates. Polymerase chain reaction (PCR) for the mecA gene was performed on MR S. intermedius and S. schleiferi isolates. Staphylococcal chromosomal cassette (SCCmec) typing was performed on all MR S. aureus isolates. Coagulase-positive staphylococci and S. schleiferi ssp. schleiferi were isolated from 24 of 48 cats with ISD: Staphylococcus aureus (14 of 24, 58%), Staphylococcus intermedius (11 of 24, 46%), Staphylococcus schleiferi ssp. schleiferi (1 of 24, 4%), and Staphylococcus hyicus (1 of 24, 4%). Prevalence of MR was 7% for S. aureus, 0% for S. intermedius, 100% for S. schleiferi ssp. schleiferi, and 0% for S. hyicus. Coagulase-positive staphylococci were isolated from 17 of 50 healthy cats: S. aureus (10 of 17, 59%), S. intermedius (11 of 17, 65%), and S. schleiferi ssp. coagulans (1 of 17, 6%). Prevalence of MR was 20% for S. aureus, 18% for S. intermedius, and 0% for S. schleiferi ssp. coagulans. All MR isolates were positive for PBP2a via latex agglutination. Methicillin-resistant S. intermedius and S. schleiferi ssp. schleiferi isolates were also positive for the mecA gene via PCR. Methicillin-resistant S. aureus isolates were identified as SCCmec type II. Results of PFGE indicated heterogeneity among isolates. There was no significant difference in staphylococcal isolation or methicillin resistance between study groups. While present, MR coagulase-positive staphylococci are significantly less common in these study populations.
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              Pyoderma caused by Pseudomonas aeruginosa infection in dogs: 20 cases.

              In this report we describe the historical, clinical, histopathological and microbiological features, as well as treatments and clinical outcome, of pyoderma where Pseudomonas aeruginosa alone was isolated on bacterial culture from lesional skin. Twenty dogs were included in this retrospective study. Seven dogs without prior history of systemic or skin disease presented with acute deep pseudomonal pyoderma characterized by a sudden onset of dorsal truncal pain. Skin lesions in these dogs consisted of erythematous papules, haemorrhagic bullae, ulcers and haemorrhagic crusts confined to the dorsum. An excellent clinical response was achieved with 3-4 weeks of treatment with oral fluoroquinolones. Thirteen dogs with a more gradual onset of skin lesions associated with pseudomonal pyoderma had a history of prior skin, ear or systemic disease and had previously been treated with antibiotics and/or immunomodulatory drugs. Skin lesions in these dogs were variable and similar to those described for superficial and deep staphylococcal pyoderma. In this group, one dog was euthanized prior to commencement of treatment, two dogs were lost to follow up, and 9 had resolution of lesions following treatment with topical silver sulfadiazine (one dog), fluoroquinolones (six dogs) or cephalexin (two dogs) administered orally for 3 to 12 weeks. Rod-shaped bacteria were not always detected on cytology. Histopathology of dogs with deep pseudomonal pyoderma was characterized by severe perforating suppurative folliculitis and furunculosis.
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                Author and article information

                Journal
                Vet Rec
                Vet. Rec
                vetrec
                veterinaryrecord
                The Veterinary Record
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0042-4900
                2042-7670
                19 January 2013
                : 172
                : 3
                : 72
                Affiliations
                [1 ]Cabinet Vétérinaire, Spa, Belgium
                [2 ]Clinique Vétérinaire Saint-Bernard, Lomme, France
                [3 ]Centro de Dermatología Veterinaria Adervet, Madrid, Spain
                [4 ]Servizi Dermatologici Veterinari, Peveragno, CN, Italy
                [5 ]The University of Liverpool, School of Veterinary Science, Leahurst Campus, Neston, Cheshire, UK
                [6 ]Veterinaire Specialisten, Oisterwijk, The Netherlands
                Author notes
                E-mail for correspondence: timn@ 123456liv.ac.uk
                Article
                vetrec-2012-101069
                10.1136/vr.101069
                3551225
                23292951
                8eafbc59-015c-4ce0-9b2a-e0a287b60f76
                British Veterinary Association

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode

                History
                : 5 December 2012
                Categories
                1506
                Research
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                Veterinary medicine
                dermatology,bacterial diseases,antimicrobials
                Veterinary medicine
                dermatology, bacterial diseases, antimicrobials

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