Welcome to our very first AMR Vet Collective podcast!
1. Microbial skin disease with Linda Vogelnest
In this episode, Dr Vogelnest talks us through the key aspects of diagnosis and management of microbial skin disease from initial presentation to management of patients with multi-drug resistant MRSP infections and everything in between, with her characteristic empathy and understanding of the challenges of general practice.
The focus is on dogs and cats, but the diagnostic techniques discussed are suitable across all manner of species.
We are so excited to bring you our conversation with specialist veterinary dermatologist Dr Linda Vogelnest. This podcast is the first of what will be an ongoing series. We hope you enjoy it as much as we have enjoyed creating it.
About AMR Vet Collective Podcasts
One of the things we love about podcasts is that you can listen to them on the move, but for those of us without photographic memories, that can make it difficult to take note of all of the golden nuggets of advice that are packed into our podcast with Linda.
Don’t worry – we’ve got your back. Below is a summary of some of the major take-home messages from Linda – you’re welcome! Make sure you share them with your colleagues.
You can also find the video example of Linda performing a sticky-tape prep (thanks to Versatile Vet) on our continuing education page, as well as a download of the protocol to print and hang in your practice laboratory. If you’re not into learning by listening and prefer written notes, you can find a pdf download of the podcast transcript here as well.
Finally, if this podcast motivates you to review your management of skin cases and you don’t already have an AMS program in place in your practice, why not start small and kick off with an AMS program just targeting skin cases? Here’s a 12-step document to help you get started. It’s easier than you think. One of the things we love about podcasts is that you can listen to them on the move, but for those of us without photographic memories, that can make it difficult to take note of all of the golden nuggets of advice that are packed into our podcast with Linda.
Summary of take-home messages… AMR Vet Collective Podcast 1: Microbial skin disease with Linda Vogelnest
- We should be doing cytology on all skin cases before prescribing any form of therapy – for sticky-tape, sampling video click here.
- Sticky tape preps can be done on pretty much any species and lesion – may need to blot dry wet or oozing lesions first.
- Cytology in deep pyoderma can be trickier and bacteria may only be present in low numbers.
- Foci of neutrophils + lots of bacteria or yeast + skin lesions = microbial pyoderma. Don’t forget to look for an underlying cause.
Indications for culture
- The patient has been on appropriate therapy for 2-3 weeks
- The underlying disease is under control
- At recheck, the patient still has lesions present and cytology shows a high number of neutrophils and bacteria
- Use a dry swab and aim for approximately 10 seconds of rubbing over each lesion.
- Store sample in the fridge while waiting to send to the lab.
- Culture is nearly always indicated, preferably using a biopsy sample.
- If you have positive cytology and/or mixed deep and superficial pyoderma, a superficial swab may be appropriate for culture.
Always perform cytology in conjunction with bacterial culture, both to confirm that culture is indicated and to enable you to better interpret your culture results.
Microbial skin disease is pretty much always secondary to something
- With chronic skin disease, there is always an underlying disease (atopy, skin folds, allergy, trauma, metabolic disease etc).
- Ensuring the underlying disease is identified, diagnosed, and managed as well as possible is key to minimising episodes of skin disease flare-ups.
- Have you seen the same patient for skin disease more than 3-5 times over a 12-month period? Have you investigated for underlying disease? This qualifies as chronic skin disease and requires a long-term management plan.
- Patients with chronic skin disease need a long-term plan (to manage the underlying disease and REDUCE the incidence of pyoderma) and a short-term ‘flare’ plan (to manage episodes of pyoderma).
Cats ≠ dogs
- Superficial pyoderma lesions in cats often present quite differently in dogs. Cats rarely have alopecia, pustules, hyperpigmentation or lichenification. More commonly cats have erosions, excoriations, sometimes papular and/or show miliary dermatitis. The lesions are quite non-specific and can sometimes look like self-trauma.
- Cytology in cats is highly rewarding, with generally very high numbers of bacteria present in cases of bacterial disease.
- Where possible, treat superficial pyoderma topically.
Topical treatment options:
- 2-4% Chlorhexidine solution (NOT the scrub formulations which contain soap)
- Where there is irritation with Chlorhexidine or for skin and skin folds around the eyes consider 0.5-1% betadine solution or silver-sulfadiazine lotion such as Flamazine.
Topical antibiotics may be required when antiseptics are not effective:
- Fusidic acid (Conoptol eye gel for animals or Fucidin lotion which is a human ointment preparation)
If systemic antibiotics are required, use prescribing guidelines. Current recommendations are for 2-3 weeks of cephalexin or amoxicillin-clavulanate are the current first-line therapy options…
- Systemic antibiotics are nearly always required for deep pyoderma. Use culture and susceptibility results and prescribing guidelines to guide therapy.