Peer-reviewed veterinary case report
Horse with chronic mouth-to-sinus infection - treatment options
By Fletcher, J R et al.·Published in Australian veterinary journal·2022·School of Veterinary Science, Australia·View original on PubMed →
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Original publication title: Successful treatment of a chronic oroantral fistula infected with extensively drug resistant bacteria using long-term oesophageal tube feeding and several non-conventional treatments in a horse.
- Species:
- horse
Plain-English summary
An 8-year-old Andalusian cross gelding developed a chronic oroantral fistula (a hole between the mouth and sinus) after a dental procedure that removed part of a tooth. Despite initial treatments with antibiotics, the horse continued to have issues, including a severe infection caused by drug-resistant bacteria. After 70 days, the horse was fed through a special tube to prevent further contamination while receiving various alternative treatments. Eventually, the combination of these treatments led to the successful healing of the fistula after about four months.
People also search for: horse dental problems · oroantral fistula treatment in horses · antibiotic-resistant infections in horses
Abstract
BACKGROUND: Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses. CASE REPORT: An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116. CONCLUSION: These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/34859426/