Apparent Outbreaks ofClostridium Difficile-Associated Diarrhea in Horses in a Veterinary Medical Teaching Hospital

Abstract

Abstract.Intestinal colonization with toxigenic strains of Clostridium difficile was documented in 9 of 10 horses with acute onset diarrhea in a veterinary medical teaching hospital, whereas a similar isolate was detected in only 1 of 23 other horses without diarrhea in the hospital. One horse with diarrhea was infected simultaneously with both C. difficile and Salmonella krefeld. Clostridium difficile was detected by fecal culture on selective medium, confirmed with a latex particle agglutination test, and identified as toxigenic by polymerase chain reaction amplification of toxin A and toxin B gene sequences. Using an arbitrarily-primed polymerase chain reaction, 6 distinct C. difficile isolates were detected in the feces of the 9 affected horses at the time of the outbreak of diarrhea.Although species of the genus Clostridium, particMaterials and methods ularly C. perfringens, are known causes for enterocolitis in neonatal foals, the role of C. difficile as an enteroAnimals. In the spring of 1993, 10 adult horses developed pathogen in the adult horse is largely unknown. Intesdiarrhea in a 2-day period in the large animal clinic of the tinal colonization with C. difficile has been described University of California Veterinary Medical Teaching Hospital. The affected horses had been hospitalized for periods in the horse, 12 and there are reports of C. difficile in-of time ranging from 0 to 22 days, and 7 of the 10 horses fection in neonatal foals with associated necrotizing enterocolitis 7-9 and in an adult horse with typhlocolitis. 15 Despite the relative paucity of information regarding intestinal colonization of horses with C. difficile, the organism is a common nosocomial pathogen in human patients and causes pseudomembranous colitis associated with antibiotic therapy. 10,18 Several studies have confirmed the presence of C. difficile in animals in veterinary practices and teaching hospitals, although those reports were limited to examinations of small animals. 2,3,13,22 We recently dehad been in the hospital for 4 days or longer. All of the horses were receiving 1 or more antibiotics (ampicillin, 6 horses; gentamicin, 8 horses; ceftiofur, 1 horse; trimethoprim-sulfamethoxazole, 1 horse), and all but 2 of the horses were hospitalized for colic or diarrhea. Four of these horses had had celiotomies during their treatment for colic. Of the two horses without colic, one had uterine torsion and another was undergoing treatment for a subepiglottic mass. Affected horses were located in 4 separated areas (different buildings) of the hospital at the time of fecal sampling. There were 23 other horses without diarrhea in the hospital at this time.Laboratory methods. Specimens of the diarrheal feces were tected C. difficile in small animal patients in our teaching hospital, and although both toxigenic and nontoxigenic isolates were detected, the association between intestinal colonization and clinical signs was not clear. 20In the present study, we present evidence of colonization of adult horses with toxigenic strains...

Nosocomial Infections and their Surveillance in Veterinary Hospitals

“…C. difficile spores are comparatively resistant to common disinfectants making C. difficile a lasting environmental contaminant. Many studies have reported a strong association between nosocomial C. difficile infection and antibiotic therapy in horses (Madewell et al, 1995;Ruby et al, 2009;Barr et al, 2013). In a Prospective study conducted in horses pre-treated with penicillin followed by experimental infection resulted in increased isolation of C. difficile from faecal samples, revealing the role of antimicrobials as a risk factor (Gustafsson et al, 2004).…”

“…Prevalence studies have shown that 4-9% patients endure from a nosocomial infection (Mielke, 2010). The occurrence of nosocomial infections in veterinary hospitals has not been well established and in nascent stage (Boerlin et al, 2001;Johnson, 2002;Morley, 2004;Smith, 2004;Traub-Dargatz et al, 2004;Morley and Weese, 2008), even though the nosocomial infections are of immense significance in the field of veterinary medicine since quite a lot of March 2015 | Volume 3 | Special issue 2 | Page 2 nosocomial outbreaks of different etiologies in veterinary hospitals has been documented (Castor et al, 1989;Madewell et al, 1995;Hartmann et al, 1996;Konkle et al, 1997;Tillotson et al, 1997;Seguin et al, 1999;Weese and Armstrong, 2003;Cherry et al, 2004;Wright et al, 2005;Weese et al, 2006a;Dallap et al, 2010;Goehring et al, 2010;Steneroden et al, 2010). Six of those outbreaks had evidence of zoonotic infection (Konkle et al, 1997;Seguin et al, 1999;Cherry et al, 2004;Wright et al, 2005;Weese et al, 2006a).…”

The Comparative Pathology ofClostridium difficile-associated Disease

“…6 The rate of C. difficile isolation from horses with diarrhea varies from 12.7 to 90% of adults, and 16.7 to 63% of foals. 71,92,159 However, the highest culture rates were associated with CDAD outbreaks and might not accurately reflect the rate in all cases of equine diarrhea. Of all equine diarrhea cases at one veterinary teaching hospital, 20-25% were attributed to C. difficile.…”

Equine Colitis X Associated with Infection by Clostridium Difficile NAP1/027

“…7 Clostridium difficile-associated diarrhea of variable severity occurs sporadically and epidemically in adult horses. It is often antibiotic associated or nosocomial, 6,7,18 and the role of the organism in its etiology has been confirmed via a prospective study. Clostridium difficile was isolated from .12% of horses with colitis but from only 0.4% of normal adults.…”