Psudomonas/klebsiella infected scratches

[ChasseurSauteur]

Having dealt with an insanely stubborn case of scratches for the past several months with my gelding, my vet finally cultured the scabs, which came back positive for pseudomonas and klebsiella.

I understand these are opportunistic, hospital-type infections that tend to show up in horses with compromised immune systems - which is unfortunately the case for my guy, who has periodic flareups of cellulitis/lymphangitis which require treatment with hard-core antibiotics and steroids. Apparently topical treatment with flamazine is sometimes effective, but ultimately we’re probably looking at IV abx to treat.

Wondering if anyone has experience with treating either of these infections - did you have to go the IV meds route? If so, did it do the trick? Is this the kind of thing I can expect to recur? (Will be chatting with my vet of course, but would love to get a sense from other folks who have dealt with this.)

Many thanks in advance for any thoughts.

[wsmoak]

I don’t know if it’s the same thing, but have you seen Elisa Wallace’s posts about the wound on her mustang Hwin’s foot, and how that was treated?

()

[glitterless]

Not sure if this would work, but with humans we use vinegar dressings for pseudomonas. It might be worth researching or discussing with your vet. Good luck!

[AnastasiaBeaverhousen]

Try medical grade Manuka Honey, if you can find it for psuedomonas.

[lenapesadie]

I do not have experience with those particular infections. However, I do have experience with chronic scratches on a horse that also gets cellulitis, all the other forms of skin gunk, reactions to bug bites, abscesses, laminitis and founder and treating the scratches with IV abx.

After culture / sensitivity prep of scabs from scratches vet Rx gentamicin given IV. Apparently gentamicin is most often used on broodmares and the stereotypical treatment is just a few days of the gentamicin IV. At any rate vet had to make an educated guess on length of course of gentamicin for my boy. Vet thought 7-10 days. Did 10 days. While I saw some improvement with the gentamicin (while also washing and applying ointment to the scratches 2X daily), the scratches slowly came back after the abx course ended.

If horse can survive his current bout with laminitis and founder we will try the gentamicin again. If we are able to do so, vet says we will do the gentamicin iv daily until the scratches are totally healed. We are guessing 30 days but we will treat until fully healed.

What abx is your vet recommending?

[hoopoe]

this is probably best addressed to your vet. It would be typical when treating skin conditions that very long term medication is used. I suspect they will wish to use an oral product quite long term combined with a secondary topical approach. The fungal aspect of scratches may keep the bacteria in play or opportunistic

[SMK]

Definitely follow the advice of your vet, but I’m happy to give a bit of background on the pathogens and their involvement in chronic infections in humans. I studied this for several years.

Pseudomonas (do you know what species?) are well known for their rapid and widespread development of antibiotic resistance. On that note, flamazine, a sulfa drug, is a very poor choice for Pseudomonas, as they are widely resistant to sulfa drugs. Anyway, a resistance panel is critical in Pseudomonas infections, though not always indicative of treatment success in chronic infections. But absolutely a necessary place to start with these bugs.

These guys are frequent colonizers of diabetic wounds, which is probably a closer model to what you’re seeing that acute hospital acquired infections. There, you’d likely have a different class of abx given IV than what is being treated topically. But these wound infections are sometimes very, very hard to clear in immunocompromised patients. Not only do they have preexisting abx resistance, but they develop new resistances quite rapidly. So you can’t assume a drug that once worked will work months later.

In chronic lung infections, treatment for flareups is often IV abx to supplement oral and inhaled abx. Having the drug in the bloodstream means it can reach the wound from the other side, you you’ve got a two pronged attack.

I’m very happy your vet cultured the scabs. These are certainly secondary pathogens, but once established, need to be treated far differently than species that we think may cause the initial infections.

[NaturallyHappy]

I know nothing about this, but wanted to share our vet used Exceed very successfully on a horse with a year long skin thing on his face. This was the third vet this horse’s owner had look at said horse’s face.

[lenapesadie]

As an aside, I also saw improvements in scratches during a course of Exceed (given for cellulitis) even though the culture / sensitivity prep of the scratches did not indicate Exceed.

[ChasseurSauteur]

Thank you so much for these thoughts, all! Gives me lots to chat about with the vet next week. And @SMK thank you for that detailed breakdown. The vet’s reasoning for the flamazine was due to the silver content - but now I wonder if it will do anything.

Will update for those interested once we have a more precise treatment plan.

[AnastasiaBeaverhousen]

OP
There are various causes of "scratches " .
Which is why you get varied suggestions on treatment.

People use "scratches ", “mud fever” and "dew Poisoning " interchangeably.
Causes

1. Exposure to too wet conditions that create an environment ideal for fungal infections. The fungal infections create an environment that allows opportunistic bacterial growth as well as yeast.

Most people here have made their own topical treatments using a mixture of zinc oxide, an anti fungal, and something for yeast. All these are available OTC

2. Allergies - consult a vet. Allergy testing in horses isn’t always accurate.

A lot of posters in previous threads have said their horses tested positive for allergies to staph.
Again ask your vet about treatment.

3. A compromised immune system usually due to a lack in certain vitamins and minerals, or too much iron.
   It is better to get a vet to draw blood and verify this than trying to supplement on your own.

4. Photo sensitivity caused by ingesting certain legumes like alfalfa and clover, especially alsike clover, or plants such as wild parsley or wild carrot. This is no means a complete list. You can do a search on the web and use your county extension to find which plants grow in your area , what they look like and how to avoid them.

This one is probably the most difficult to resolve because it may be difficult to keep your horse from eating those plants. You can switch to a different hay, but eradicating clover or other wild plants may be difficult or even impossible .

In this case you can try and make your horse as comfortable as possible, and wait for fall and winter when the plants die off.

5. Parasites and flies can cause reactions that create skin problems.

Swat creme or leggings can help with that.

This whole scratches thing is doubly frustrating because you try and treat it and it seems to clear up and then it pops back up again.

Been there, done that.

Good luck. Hope this helps.

[Dutchmare433]

We had a really persistent case last winter which cultures showed had Pseudomonas, staph aureus, and a third organism which I cannot remember (it’s late!).

We did several rounds of smz and doxy (and an anti fungal) pre culture. They helped marginally.

We did a course of Rifampin post culture under the assumption that the pseudomonas was an environmental contaminant. (This is reasonable as it is ubiquitous.)

It cleared it up probably 95%

Any idea which sp klebsiella?