Sepsis and survival in critically ill calves: Risk factors and antimicrobial use

Abstract

Background Sepsis is a life‐threatening disease for which critically important antimicrobials (CIA) frequently are used. Diagnostic and therapeutic guidelines for sepsis and critically ill calves are largely lacking. Objectives Identify factors associated with mortality in critically ill calves and describe bacteria obtained from blood cultures of critically ill calves with sepsis and their antimicrobial resistance. Animals Two‐hundred thirty critically ill calves, mainly Belgian Blue beef cattle. Methods Retrospective cohort study. Logistic regression, survival analysis, and decision tree analysis were used to determine factors associated with mortality. Results Of the critically ill calves, 34.3% had sepsis and 61.3% died. The final survival model indicated that calves with sepsis (hazard risk [HR]: 1.6; 95% confidence interval [CI]: 1.0‐2.5; P = .05), abnormal behavior (HR: 2.3; 95% CI: 1.3‐4.0; P = .005), and hypothermia (HR: 0.82; 95% CI: 0.72‐0.95; P = .01) had a significantly higher mortality risk. In a second survival model, hypothermia (HR: 0.87; 95% CI: 0.78‐0.96; P = .004) and hypoglycemia (HR: 2.2; 95% CI: 1.5‐3.3; P < .001) were risk factors for mortality. Decision tree analysis emphasized the importance of behavior, hypochloremia, hypoglycemia, hyperkalemia, and lung ultrasonography for mortality risk. Escherichia coli (30.6%) was most frequently isolated from blood cultures, of which 90.9% were multidrug resistant. Inappropriate use of antimicrobials was frequent for penicillin, amoxicillin, and sulfamethoxazole/trimethoprim, but less for CIA. Conclusions and Clinical Importance Many critically ill calves have sepsis, which increases mortality risk. Bacteria involved are often resistant to first‐intention antimicrobials but less resistant to CIA. The other identified risk factors for mortality can support therapeutic decision‐making.

Effect of time of sample collection after onset of diarrhea on fecal microbiota composition of calves

“…The most common bacteria isolated from the blood culture of bacteremic diarrheic calves is E . coli and other bacteria from the family Enterobacteriaceae translocated from the lumen of the gastrointestinal tract 40‐43 . Thus, the enrichment of Escherichia/Shigella identified in the D 24‐48 groups might lead to the development of systemic clinical signs such as fever, anorexia, or severe depression leading farmers to administer antimicrobial treatment.…”

“…[37][38][39] The most common bacteria isolated from the blood culture of bacteremic diarrheic calves is E. coli and other bacteria from the family Enterobacteriaceae translocated from the lumen of the gastrointestinal tract. [40][41][42][43] Thus, the enrichment of Escherichia/Shigella identified in the D 24-48 groups might lead to the development of systemic clinical signs such as fever, anorexia, or severe depression leading farmers to administer antimicrobial treatment. This highlights the importance of developing treatment strategies such as fecal matter transplantation, probiotics, or prebiotics to manipulate the gastrointestinal microbiota soon after diarrhea onset to limit the negative effects of dysbiosis on calf health and reduce antimicrobial drugs use in diarrheic calves.…”

Bayesian evaluation of sensitivity and specificity of blood culture media and hypoglycemia in sepsis‐suspected calves

“…Critical illness was defined as severe respiratory (tachypnea/dyspnea), cardiovascular (tachycardia/bradycardia/prolonged capillary refill time/abnormal jugular vein filling time) or neurological derangement (posture/mental state), apart or in combination. 4,37 Description of the methodology used for clinical examination is available elsewhere. 4 Details about prior treatment were obtained from the medical history.…”

“…Given that animals come in 1 at a time, we consider this independent observations from 1 population, though the same prevalence of sepsis was found in different populations (diarrheic calves, critically ill calves) in previous literature. 4,14,17 A conditionally dependent BLCM model was made using a WINBUGS code shared by Dr S. Buczinski (University of Montreal) (Supplementary Table 2). To be complete, we also performed the conditionally independent tests.…”

“…Sepsis is a life-threatening disease in cattle that, similar to other species, requires timely initiation of appropriate antimicrobial therapy to maximize survival. [1][2][3][4][5][6] In humans, broad-spectrum, bactericidal, intravenously administrated antimicrobials are recommended. 7 This translates often in the need for fluoroquinolones or 3rd/4th generation cephalosporins.…”