Bleach Baths for Atopy ???

Hello, Summarians!

Bacteria and their control will continue to be a huge trend in the coming year (decade). Here are a couple of studies that could help us do a better job. What are your thoughts on mandatory sensitivity testing?

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Decreasing MSRP in Dogs

The text addresses the critical issue of antimicrobial resistance (AMR) due to the use of antimicrobial drugs in both human and veterinary medicine. In Europe, particularly the UK, significant progress has been made in reducing antimicrobial use in livestock through strict regulations and collaborative efforts, leading to a notable decrease in antimicrobial agents used in food-producing animals. Attention is also shifting towards small animal practices, where efforts are underway to reduce excessive and inappropriate antimicrobial prescribing through various voluntary and compulsory strategies, including educational initiatives and app-based prescribing support. 

A key focus is the case of Methicillin-resistant Staphylococcus pseudintermedius (MRSP) in dogs, particularly in Germany, where legislation requiring bacterial culture and susceptibility results before prescribing certain antimicrobials was introduced. This study shows that such legislative interventions led to an increased uptake of susceptibility testing and a reduction in methicillin resistance among clinical S. pseudintermedius isolates. The overall decrease in MRSP, observed in the aftermath of these legislative changes, supports the hypothesis that mandatory susceptibility testing can enhance antimicrobial stewardship and curb resistance. However, the study also acknowledges limitations like its retrospective nature and variations in laboratory methods. 

In conclusion, the text underscores the positive impact of mandatory laboratory testing when prescribing high-priority critically important antimicrobials (HP-CIAs) in reducing multidrug resistance in clinical staphylococci. This approach, which maintains prescribing freedom while promoting rational antimicrobial use, is presented as an effective model for antimicrobial stewardship policies. 

Loeffler A, Beever L, Chang Y-M, Klein B, Kostka V, Meyer C, et al. Intervention with impact: Reduced isolation of methicillin-resistant Staphylococcus pseudintermedius from dogs following the introduction of antimicrobial prescribing legislation in Germany. Vet Rec. 2023;e3714. https://doi.org/10.1002/vetr.3714 

Bottom line — The impact of mandatory testing shows that it leads to less antibiotic resistance.

Smartphone-based EKG.

The development and usage of smartphone-based electrocardiograph (s-ECG) devices represent a significant advancement in both human and veterinary cardiology. These devices are more manageable than standard ECG machines (st-ECGs) due to their small size and battery operation. They also allow for the digital tracings to be shared instantly with veterinary centers worldwide, facilitating rapid consultations. 

Recent studies have shown the feasibility and clinical utility of s-ECGs in human medicine, but only a few have explored their use in veterinary settings, particularly in dogs. These studies have primarily used single-lead s-ECGs and have focused more on heart rate and rhythm rather than detailed ECG measurements. Moreover, there's a lack of information about the dog breeds involved in these studies. 

This study aims to expand the knowledge about the utility of s-ECGs in dogs, including those with specific chest conformations. It compares a wide range of ECG variables obtained using a six-lead s-ECG with those from a six-lead st-ECG in dogs referred for cardiology consultation. The findings indicate a perfect agreement between the two devices in classifying heart rate and rhythms, including both normal and pathological rhythms. However, the agreement was less satisfactory in detecting ST segment deviation and assessing T wave polarity, suggesting that the two devices should not be used interchangeably for these assessments. 

The study also notes differences in quantitative ECG parameters between the s-ECG and st-ECG, which could be attributed to the devices' different settings or the dogs' somatotypes. Despite these differences, the mean discrepancies were clinically negligible. Notably, the study found that the s-ECG could detect breed-related ECG peculiarities similarly to the st-ECG. 

The study concludes that the six-lead s-ECG is comparable to the st-ECG in assessing heart rate and rhythm but not in classifying ST segment deviation or T wave polarity. While the s-ECG's diagnostic yield is clinically acceptable for measuring waves, segments, and intervals, the numerical data from the s-ECG and st-ECG are not interchangeable. However, the study is limited by the small number and breeds of dogs evaluated and the absence of a wide range of rhythm disturbances. Further research involving more breeds and a variety of heart rhythms is needed to validate and expand these preliminary findings. 

Romito G, Castagna P, Sabetti MC, Ablondi M, Cipone M. Evaluating the accuracy of a six-lead smartphone-based electrocardiographic device compared with standard electrocardiography in brachymorphic dogs. Vet Rec. 2023;e2879. https://doi.org/10.1002/vetr.2879 

Bottom line — Early results support this as a beneficial option

Bleach Baths for Atopy?

This study investigates the safety and impact of diluted bleach baths on healthy canine skin and its effect on staphylococcal populations, particularly S. pseudintermedius. The study is grounded in the context of using similar treatments for human atopic dermatitis (AD), where diluted bleach (0.005% hypochlorite) baths have been effective in reducing the severity of the condition, presumably by decreasing microbial dysbiosis and staphylococcal colonization. 

Key findings from the study include: 

• Tolerance in Dogs: Repeated diluted bleach baths were well-tolerated in healthy dogs. Despite no rinsing after baths, which could potentially increase skin irritation, no signs of irritation were observed. 

• Concentration Selection: The chosen concentration of 0.005% hypochlorite was based on a balance between efficacy and safety, as higher concentrations (0.05%) had shown cytotoxic effects in previous studies. 

• Anti-inflammatory and Antimicrobial Potential: Past studies suggest diluted bleach has anti-inflammatory and antimicrobial properties. However, this study did not show a significant change in the density of S. pseudintermedius on healthy dog skin. Possible reasons include low baseline levels of the bacteria on healthy skin, the concentration of hypochlorite not being high enough for antimicrobial effects, or limitations in the qPCR technique used for measuring bacterial density. 

• Limitations and Recommendations for Further Research: The study's limitations include a small sample size and the inclusion of only healthy dogs. As bleach baths are mainly used for humans with S. aureus-colonized AD, the effects on atopic canine skin are still uncertain. Further research is suggested to evaluate the treatment's efficacy and safety in dogs with superficial pyoderma and AD. 

In summary, the study demonstrates that diluted bleach baths are safe for healthy dogs, but further research is necessary to assess its effectiveness and safety in treating canine skin conditions like AD. 

Banovic F, Reno L, Lawhon SD, Wu J, Hoffmann AR. Tolerability and the effect on skin Staphylococcus pseudintermedius density of repeated diluted sodium hypochlorite (bleach) baths at 0.005% in healthy dogs. Vet Dermatol. 2023; 34: 489–494. https://doi.org/10.1111/vde.13186 

Bottom line — Potentially useful for difficult-to-manage cases.

Just putting things in perspective …