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Nosocomial Klebsiella oxytoca infection in two dogs117The following antimicrobials were assayed: azithromycin,amikacin, amoxicillin, amoxicillin/clavulanicacid, cephalexin, cephalotin, ciprofloxacin,enrofloxacin, ceftriaxone, gentamicin, neomycin,piperacilin, metronidazole, trimethoprim/sulfamethoxazoleand oxytetracycline. Initial beta-lactamaseactivity was detected by the hydrolysis of nitrocefin(cefinase). Screening tests for extended-spectrumβ-lactamaseactivity were evaluated regardingtheir susceptibility to cefpodoxime, ceftazidime,cefotaxime and cefuroxime (BBL-Difco). Confirmationtests for ESBL were done by E-test (E-test, AB-Biodisk, Dalvägen, Solna, Sweden) for cefotaxime/cefotaxime+clavulanic acid (CT/CTL) and ceftazidime/ceftazidime+clavulanic acid (TZ/TZL).Bacteriology identification revealed infection byKlebsiella oxytoca, β-lactamase positive by nitrocefintesting, but ESBL negative (Table 1). Accordingto the susceptibility testing, the dog was prescribedamoxicillin+clavulanic acid 20 mg/kg p/o q12h forone month and carprofen 2 mg/kg p/o q12h, thedose of latter to be gradually decreased by the owneraccording to the intensity of pain.Table 1: Antimicrobial susceptibility profile from microorganisms isolated from dog 1 and dog 2Dog 1 Dog 2osteomyelitisKlebsiella oxytoca(synovial fluid)deceasedKlebsiella oxytoca(liver, kidney, spleen, peritoneal fluid,small intestine)Escherichia coli (small intestine)Susceptibility testing K. oxytoca K. oxytoca E. coliazithromycin R R Ramikacin S S Samoxicillin R R Iamoxicillin+clav.acid S S Scephalexin S I Icephalotin S S Sciprofloxacin S S Senrofloxacin S S Sceftriaxone S Sgentamycin S S Sneomycin S S Spiperacillin S Smetronidazole R Rtrimethoprim/sulpha S S Soxytetracycline S Scefpodoxime S S Sceftazidime S S Scefotaxime S S Scefuroxime S S Sβ-lactamase activity by+ + +nitrocefin testingE-test, ESBL CT/CTL - - -E-test, ESBL TZ/TZL - - -S, sensitive; I, intermediate sensitive; R, resistant; E-test ESBL CT/CTL, extended specter β-lactamase, cefotaxime/cefotaxime+clavulanic acid; E-test ESBL TZ/TZL, extended specter β-lactamase, ceftazidime/ ceftazidime+clavulanicacid; +, positive; -, negative
118 A. Seliškar, I. Zdovc, B. ZorkoTwo weeks after the commencement of the therapy,the dog was much less in pain and able to useright front leg, although it was still lame. The dogwas brought for a control check 6 weeks after theend of amoxicillin+clavulanic acid therapy. No lamenessor pain was observed at the clinical examinationand according to the owners it was doing well.Figure 1: Lateral radiograph of the right humeral head 3weeks after the intravenous catheter-related infection withKlebsiella oxytoca. Osteomyelitis with definitive pattern oflysis and solid pattern of periostal new bone is seen.Figure 2: Lateral radiograph of the right humeral head 6weeks after the end of amoxicillin+clavulanic acid therapy(20 m/kg p/o q 12h for one month) shows resolution of thelytic process. The shape of the humeral head is irregularand severe osteoarthritis of the shoulder joint is visible.Radiographic examination of the right shoulder jointshowed resolution of the lytic process. The shape ofthe humeral head was irregular and severe osteoarthritisof the shoulder joint was visible (Figure 2).Case 2Dog 2, a 2 years-old intact working male Germanshepherd weighing 30.6 kg, considered healthy afterphysical examination including pulse and respiratoryrate and heart and lung auscultation, was brought toCSAMS-VFLJ for extraction of left mandibular fourthpremolar tooth three weeks after the dog 1. Body temperaturewas not measured because of the dog’s uncooperativeness.The extraction was performed undergeneral anaesthesia with isoflurane in 100 % oxygenafter premedication with medetomidine 0.025 mg/kgi/m and butorphanol (Torbugesic, Fort Dodge AnimalHealth, Iowa) 0.1 mg/kg i/m and induction to anesthesiawith propofol at a dose of 2 mg/kg i/v. Intravenouscatheter placement procedure was the same as in thedog 1. The dog was given perioperatively carprofen 4mg/kg i/v and Lactated Ringer’s solution at 10 ml/kg/h. At the end of the procedure, medetomidine wasreversed with atipamezole 0.05 mg/kg i/m. Single doseof methadone (Heptanon, Pliva, Zagreb, Croatia) 0.4mg/kg s/c was administered for postoperative analgesia.Panting that was observed soon thereafter wasthought to be a consequence of methadone administrationor relatively warm recovery room (23 to 24°C).The dog’s body temperature was not measured becauseit’s aggressive temper. Two hours later, the dogwas discharged to a home care with carprofen 2 mg/kg p/o q12h to be given following three days. At thattime, it was alert but still mildly ataxic and weak.Later in the afternoon, the dog’s caretaker noticedthat the dog is apathetic and sleepy, and itrefused water and food. Its pulse was thready. Thedog was given additional dose of atipamezole (dosenot known) by staff veterinarian and sent back toCSAMS-VFLJ. On the admission (7 hours after theend of procedure) the dog was in cardiopulmonaryarrest. Cardiopulmonary resuscitation (CPR) wasperformed with no success. During CPR, considerableamount of smelly dark reddish intestinal contentswere released.Post-mortem examination carried out at Institutefor Pathology, Forensic and Administrative VeterinaryMedicine, Veterinary Faculty, University ofLjubljana revealed severely congested kidneys, liverand small intestinal wall. The small intestine wasfilled with hemorrhagic contents, while large intestinewas empty. The spleen and lungs were congestedas well. The subcutaneous blood vessels werecongested with non-coagulated blood and the muscleswere pale. Non-coagulated blood was found inright ventricle.
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