Studies have reported mortality rates of dogs and cats with sepsis to be between 20% and 68%. Because there are so few studies regarding the timing of antibiotic administration to septic dogs, current treatment recommendations are developed from human data. Human studies have reported a decline in mortality from 38.5% to 19% when appropriate antimicrobials are administered within 1 hour of triage of septic patients. In a recent retrospective study published in the latest issue of JAAHA, researchers evaluated the records of 175 dogs diagnosed with sepsis to determine if the time to any antibiotic administration and time to appropriate antibiotic administration affected hospitalization time and mortality.
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Jake Wolf, DVM, DACVECC, is a clinical assistant professor and co-service chief of emergency and critical care at University of Florida College of Veterinary Medicine. He discusses this study and the clinical takeaways in this Q&A.
Q: Unsurprisingly, the study found a significant association between time to appropriate antimicrobial administration and length of hospitalization (dogs with longer times from admission to appropriate antimicrobial administration had significantly longer hospitalization stays). The study found no association between time to any antimicrobial administration and length of hospitalization for dogs diagnosed with sepsis. Did that, or any other finding, surprise you?
I was surprised that we did not find an association with mortality and time to appropriate antimicrobial administration, though that could be due to the low mortality rate we had in this study due to the heterogeneous diseases we included. I was less surprised that time to any antimicrobial administration and outcome/length of hospitalization were not associated. It makes sense to me that if you use the “wrong” antimicrobial, there will be no clinical benefit! This underlines the importance of selecting the correct antimicrobial as early in the course of treatment as possible.
Q: This study includes any dog with the diagnosis of sepsis. Considering the mean hospitalization time was 2 days and the survival rate was 80% for dogs in this study, the implication would be that the dogs included in this study were not in critical condition. Do you think that the acute patient physiological and laboratory evaluation fast (APPLEfast) scores—calculated based on biochemical parameters and mentation at time of admission—diminished the effect of disease severity and hospitalization time?
Our hope in including APPLEfast scores was to control for disease severity so that we could try to ensure the effect was due to antimicrobial administration. However, there were a few dogs with high APPLEfast scores, which fits with this population of dogs being less severely affected. I think this highlights the limitations of the current definition of sepsis in veterinary medicine, which includes dogs that may not necessarily be systemically ill.
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Q: Did your clinical recommendations change because of this retrospective analysis?
This study highlighted the importance of choosing the appropriate antimicrobial as early as possible. To me, there are a few ways to do that:
- Ensure a thorough antimicrobial history is taken to determine if the patient is at risk for a multidrug resistant infection.
- Collect a sample for culture and sensitivity as early in the course of disease as possible.
- Establish an antibiogram for your facility to know the most likely organisms for each infection and the resistance pattern for those bacteria.
I try to instill these clinical takeaways in my students and house officers.
Q: If you were to conduct another study on the timing of antibiotic administration and its effects on hospitalization time and mortality of dogs diagnosed with sepsis, what would you do differently?
I think a multicenter study looking at time to antimicrobial administration in dogs with septic shock, not just sepsis, would be interesting. Unfortunately, we did not have enough dogs with septic shock to examine this subcategory separately.
Q: Is there anything you would like our readers to know that has not been mentioned?
I think another aspect that we looked at was the effect of source control on outcomes. This study found that dogs that received surgical source control were more likely to survive than those that did not. Furthermore, dogs that had source control performed were more likely to receive faster appropriate antimicrobial therapy, likely since we were able to sample and culture these dogs earlier and more reliably. To me, this instilled the importance of early sample collection, even in dogs where source control is not possible (i.e., endotracheal washes for dogs with pneumonia). We did not look at the effect of time to source control on outcome, which would be an interesting study.
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Read the full study
The effect of time of antimicrobial administration on the outcome of septic dogs.
Kidd A, Colee J, Perez-Rodriguez V, Wolf J.
JAAHA | doi:10.5326/JAAHA-MS-7473