Antibiotic-Resistant Staph Infection

[okaygreatthanks]

Remy has been battling a staph infection for the last couple of months, which we started seeing a veterinary dermatologist for about a month ago.

We did a skin culture last week, and it’s antibiotic resistant to everything except sulfur-based antibiotics (which was the derm’s first choice) and Zeniquin. Sulfur-based antibiotics are notorious for adverse reactions in Dobermans, and Zeniquin isn’t recommended for young dogs as it can cause cartilage damage. Remy’s just about 15 months old, so neither of these are ideal.

Has anyone had experience using these antibiotics for their puppy?

Sometimes it’s necessary to use a heavy antibiotic if the infection warrants it, but the risks are very worrying.

I’m also taking Remy to our regular vet tomorrow for a full thyroid panel, because I want to rule that out as an underlying cause for all of his skin issues. I know the vets probably think I’m a crazy helicopter mom, but that’s kind of a prerequisite for owning this breed, and I don’t really care – I’ll always advocate for my dog.

For a fuller picture of why I have concerns, here’s backstory on some of the health issues he’s had this past year:

In February he had a histiocytoma on his paw pad which kept getting rubbed raw, so we did a blood panel at the vet to check for infection. Much to our surprise/dismay, his liver enzymes were quite elevated (ALT at 372). We first tried a course of antibiotics and Denamarin for a few weeks, but he couldn’t tolerate the Denamarin so we had to discontinue that. At our recheck about a month later, his ALT was still at 388. This led us down a spiral of tests per the vet’s recommendation: bile acids, TAMU GI panel, ultrasound, etc. Everything came back fine, so the vet’s next suggestion was a liver biopsy to test for copper storage disease. I don’t like to put dogs under anesthesia unless it’s an emergency (plus anesthesia is hard on the liver!), so after consulting with our breeder and confirming there are no known liver issues in her lines, plus knowing Remy’s a garbage-mouth who probably ate something toxic, we decided to hold off on that and see if they’d come down. Guess what? They did! It took about 3 months, but by late May his liver enzymes were perfectly normal. For data-nerds like myself, here’s all his enzyme results from this debacle:

2/22/23
ALT - 372 (scale 10-125)
ALP - 257 (scale 23-212)
GGT - 23 (scale 0-11)

3/15/23
ALT - 388 (scale 10-125)
ALP - 233 (scale 23-212)
GGT - 8 (scale 0-11)
AST - 52 (scale 0-50)

4/13/23
ALT - 284 (scale 10-125)
ALP - 150 (scale 23-212)
GGT - 1 (scale 0-11)
AST - 45 (scale 0-50)

5/23/23
ALT - 86 (scale 10-125)
ALP - 107 (scale 23-212)
GGT - 0 (scale 0-11)
AST - 37 (scale 0-50)

7/17/23
ALT - 129 (scale 10-125)

At our late May appointment, Remy had gotten an insect bite on his leg that he’d chewed on, plus I noticed a couple other bumps nearby and that he’d been itchy. I asked if it could be a staph infection (because it looked like a classic staph infection) but she shot that down and said it was probably seasonal allergies, and recommended Apoquel for the itching. I *specifically* asked if Apoquel would elevate his liver enzymes and she assured me it wouldn’t, so I deferred to her expertise. While Remy was on the Apoquel, the itching got a bit better, but his bumps never went away, and he began to get hives all over his back and neck.

So, that brings us to the July results where his ALT is elevated again! Lo and behold, I Googled it, and immediately found out that Apoquel does in fact cause elevated liver enzymes. At this appointment, we got a different vet, who finally confirmed my original suspicion: staph infection!



Remy also had an ear infection at this time, and was prescribed two weeks of Amoxicillin-Clavulanate, Otic Suspension, and CeraDerm shampoo. This vet thought it could be secondary to allergies, so we made an appointment with the dermatologist who is currently overseeing treatment.

He’s now taken four weeks of Amoxicillin-Clavulanate, which is known to be hard on the liver, so we’ll be checking his enzymes again tomorrow along with the thyroid panel. Thank goodness the liver is a regenerative organ, but it’s hard not to worry about long-term damage after all he’s been through, hence my concern about more antibiotics (specifically sulfur-based ones which are very heavy-hitters). We do plan to do a liver biopsy during his cryptorchid neutering just to have 100% peace of mind that it’s not copper storage disease.

For now, we’re bathing him 3x weekly with Douxo S3 Pyo, and I’m holding off on choosing an antibiotic until we get his thyroid results (and latest liver panel) tomorrow, and we'll be continuing to work with the vet derm on potential allergies once we get the staph infection squared away.

 

[JanS]

Wow you've really been through the gambut with him and I hope you can figure it out. Thankfully we don't have any experience with it but it's good to run all of the tests.

Keep us posted on how things go.

 

[Kaiser2016]

That's quite the chemical load on such a young Dobe! But I have also learned through the other threads here that skin issues are complicated to treat. It's good that he's seeing a Derm. Get him on a good probiotic to help support his immune system.

I *specifically* asked if Apoquel would elevate his liver enzymes and she assured me it wouldn’t, so I deferred to her expertise.

Ugh, that is terribly disappointing. This Apoquel seems to be the go-to solution for so many vets, but it only suppresses symptoms instead of treating the underlying cause.

the vets probably think I’m a crazy helicopter mom, but that’s kind of a prerequisite for owning this breed,

Ya, that's me too, especially in the first few years. Have you considered a holistic vet? They still prescribe things like a normal vet but they have a much better understanding of how all the body systems work together.

 

[okaygreatthanks]

That's quite the chemical load on such a young Dobe! But I have also learned through the other threads here that skin issues are complicated to treat. It's good that he's seeing a Derm. Get him on a good probiotic to help support his immune system.

I know, it really is a lot! Since the culture came back pointing to those two antibiotic options for staph, I feel we'll have to choose one. But I do want to see tomorrow's bloodwork first.

He's been on PPP FortiFlora and I just started giving him colostrum to boost his immune system, so I hope that'll start helping.

Ugh, that is terribly disappointing. This Apoquel seems to be the go-to solution for so many vets, but it only suppresses symptoms instead of treating the underlying cause. Have you considered a holistic vet? They still prescribe things like a normal vet but they have a much better understanding of how all the body systems work together.

Very disheartening. I really don't like throwing drugs at issues when they're so young and their immune systems are still developing, especially without trying to figure out the cause first. That's a great thought about finding a holistic vet – I'll look into that, thank you!

 

[Kswoodssue]

I read an article about a series of injections to essentially desensitize the dog to the staph, but no idea how effective or widely done it is. My suggestion is this; find a vet that you trust and let them take care of your dog. If the staph becomes systemic, and the elevated liver enzymes are nothing to fool with, it could be a life or death situation. I would give no supplements at all without the vet’s ok first. Sometimes being an advocate is allowing the professional to run the show.

 

[Ravenbird]

interesting piece on Apoquel, the side effects and "my experience" words from a vet...

Apoquel side effects- a veterinary dermatologist's experience

Apoquel is overall a wonderful medication for the treatment of atopic dermatitis in dogs. There are a few things veterinarians and owners should monitor.

www.petdermatologyclinic.com

 

[Ddski5]

Damn….
That’s a lot..

I work at an LTACH hospital and see MRSA, MSSA, acinetobacter, bacteremia in practically all of our patients. Our patients specifically come to our hospital to get 4-6 weeks of hard cord IV antibiotics to kill the bacteria bug that is ailing them.

Reading through your post, it seems as if everything is according to procedure. Do a sensitivity culture to find out what bug they have and match it to the antibiotic in which will kill the bacteria.

I will ask our infectious disease people on their thoughts on this and get back ASAP.

 

[Ddski5]

Do you know specifically what staph came up on Remy’s culture?

 

[Ddski5]

I know that vets like PPP probiotic but in my research and readings, I find that PPP it is not quality.
Do a search on this forum for best probiotic and I would go with the recommendations from @strykerdobe.

I currently use:

 

[okaygreatthanks]

My suggestion is this; find a vet that you trust and let them take care of your dog. If the staph becomes systemic, and the elevated liver enzymes are nothing to fool with, it could be a life or death situation. Sometimes being an advocate is allowing the professional to run the show.

I totally agree! Staph isn't something to mess around with, which is which I'm so frustrated that it wasn't diagnosed correctly by the first vet when I specifically asked if it was staph, and that it wasn't cultured by the second vet to find the best antibiotic to treat it since it'd been going without treatment for weeks at that point, and we were still waiting to get into the vet derm who was booked out. I feel like time is of the essence to treat it at this point, but I definitely want to look around at vets/holistic vets and find one we trust to work with in the future.

will ask our infectious disease people on their thoughts on this and get back ASAP.

Thank you so much, I really appreciate that!

Do you know specifically what staph came up on Remy’s culture?

The vet derm didn't send over the culture results, but told me over the phone that our two antibiotic options were a sulfur-based one, or the Veniquin. The sulfur ones make me nervous since they are tough on the liver and known to cause adverse reactions in Dobermans (according to the DPCA and other medical journals). The Veniquin was our other option, which she thought might not be quite as effective, but worth trying, although it's not recommended for young dogs since it can cause cartilage abnormalities while they're growing.

Once I have bloodwork from our appointment this afternoon and I can see if there are thyroid issues and where his liver enzymes are at, I'll feel better moving forward. I'm expecting the liver enzymes to be a bit elevated from the infection and the Amoxicillin-Clavulanate course since that's raised them in the past, but as long as they aren't extremely elevated, we'll probably move forward with the sulfur-based one and monitor very closely for side effects.

I know that vets like PPP probiotic but in my research and readings, I find that PPP it is not quality.

This is good to know, thank you! His gut and immune system have really taken a beating from all these antibiotics and the Apoquel...it's no wonder he's having a hard time fighting off the staph. I just feel so bad for him.

interesting piece on Apoquel, the side effects and "my experience" words from a vet...

Very interesting, and reading the note about NOT prescribing it to dogs with liver issues/elevated enzymes really burns me up. Yes, Remy's enzymes were in the normal range at the time it was prescribed, but he had a history of elevated enzymes which she was well aware of and I specifically asked about contraindications. It's made it hard for me to trust that vets are considering his health history and breed sensitivities when prescribing drugs.

 

[Ddski5]

We did a skin culture last week, and it’s antibiotic resistant to everything except sulfur-based antibiotics (which was the derm’s first choice) and Zeniquin. Sulfur-based antibiotics are notorious for adverse reactions in Dobermans, and Zeniquin isn’t recommended for young dogs as it can cause cartilage damage. Remy’s just about 15 months old, so neither of these are ideal.

So I don’t know the specific bug Remy has but discussing this with hospital md.
-Without hesitation, the first thing he said was Bactrim- a sulfa drug
-Then I explained the adverse reactions of Dobermans. Then he said Doxycycline is effective against staph and it’s not sulfa based.
-so this is where the culture is important- did it establish that this staph is resistant to Doxycycline?
-you can try mupirocin topically.

You know, to me, this sounds serious enough to take him to an animal hospital.

I am pretty much conditioned to be anti-vet and I hate that. All the dealings I’ve had with vets…well, we will say none have been good. I pretty much now take mine to an animal hospital. I feel confident they are providing the best specialized care possible. Now they cost more than a regular vet but at same time that’s prob why I feel confident…they are not doing any stupid arse test or procedures that I know aren’t warranted. They don’t have to upcharge- they are already expensive…haha, just can’t win here.

So therefore, mine have pet insurance.

 

[okaygreatthanks]

So I don’t know the specific bug Remy has but discussing this with hospital md.
-Without hesitation, the first thing he said was Bactrim- a sulfa drug
-Then I explained the adverse reactions of Dobermans. Then he said Doxycycline is effective against staph and it’s not sulfa based.
-so this is where the culture is important- did it establish that this staph is resistant to Doxycycline?
-you can try mupirocin topically.

You know, to me, this sounds serious enough to take him to an animal hospital.

I am pretty much conditioned to be anti-vet and I hate that. All the dealings I’ve had with vets…well, we will say none have been good. I pretty much now take mine to an animal hospital. I feel confident they are providing the best specialized care possible. Now they cost more than a regular vet but at same time that’s prob why I feel confident…they are not doing any stupid arse test or procedures that I know aren’t warranted. They don’t have to upcharge- they are already expensive…haha, just can’t win here.

So therefore, mine have pet insurance.

Thank you so, so much for asking that!

I've been emailing with the vet dermatologist this morning and asking if there's anything else we can try, like Doxycycline or Cefpodoxime (he's had that one before without any issues). The derm noted that she sees antibiotic-resistant staph infections at least a few times a week and that Remy's is localized and what she'd consider to be mild to moderate lesions, so that's encouraging. I just worry about new side-effects/symptoms from those tough antibiotics, but we'll see what they say in terms of options.

Funnily enough, his primary vet is an animal hospital because we've ended up needing urgent care and it's tough to get appointments these days. That's why we've seen a few different vets there, just depends who's on staff.

And thank goodness we have pet insurance too!

 

[okaygreatthanks]

An update to say that those are indeed our only two antibiotic options for treatment.

But just as I’ve been lamenting about not trusting vets, in a twist of luck at the hospital tonight, we got our favorite vet who’s always booked up and hasn’t been available to treat Remy since he was 4 months old!

He really understands Dobermans and larger breed dogs, and recommended going with the Zeniquin, because the risks for Dobies with sulfur antibiotics are just not worth it. He’s going to be working directly with Remy’s dermatologist to help manage treatment and monitor his liver levels (they were elevated again, ALT at 350 unfortunately, but we expected that with everything he’s going through). He also mentioned that we could try cold laser therapy for any concentrated patches of staph that continue to be resistant, as there isn’t any bacteria immune to laser — good to know!

While we won’t have the thyroid panel back until next week, he thinks it’s unlikely that Remy is hypothyroid, but wants to rule it out to make sure it’s not the root cause for liver and skin issues. If anything is off, he wants to refer us to an internal medicine vet that he trusts to oversee that. Hopefully we won’t have to cross that bridge, but I feel a bit of relief knowing that there’s a plan in place for solid care if Remy needs it.

Thanks again to everyone for all your support and suggestions, it really means a lot!

(I’ll share updates as Remy progresses through his staph treatment just in case it’s helpful should anyone find their pup in a similar dilemma down the road. Attaching some pics of his staph lesions…and him being a super chill boy at the vet for good measure).

*Edit to say that the antibiotic is in fact called Zeniquin, not "Veniquin" like I said a response earlier...my brain is a bit fried this week

 

[Ravenbird]

Sounds like the best news yet - a vet to trust & working with you! Looking forward to positive updates.

On a different note, when things are cleared up with Remy, if you haven't already can you ask these knowledgeable vets the WHY question? I've always believed that prevention is so much easier than cures, but so much of the time we never know what causes these things. Immune deficiency? Hereditary? Does he have any Blues/Fawns in his family (known for skin problems)? None of this is as important as seeing Remy recover from his misery, but if there is anything that the rest of us should be aware of in prevention, I'd love to hear it.

Speedy recover mojo being sent your way!

 

[okaygreatthanks]

Sounds like the best news yet - a vet to trust & working with you! Looking forward to positive updates.

Yes, it was the win that we needed this week!

On a different note, when things are cleared up with Remy, if you haven't already can you ask these knowledgeable vets the WHY question? I've always believed that prevention is so much easier than cures, but so much of the time we never know what causes these things. Immune deficiency? Hereditary? Does he have any Blues/Fawns in his family (known for skin problems)? None of this is as important as seeing Remy recover from his misery, but if there is anything that the rest of us should be aware of in prevention, I'd love to hear it.

Absolutely happy to share any insights gained from this! I know he doesn’t have any dilutes in his line, nor any liver issues (chronic active hepatitis or copper storage), but his distant relative is allergic to beef and his half sister is allergic to chicken, so I have a feeling allergies could be at play.

Our breeder suggested doing the Jeans Dodd Nutriscan test to screen for food allergies (which is how they discovered his relatives’ allergies). It’s not cheap ($300!) so we’re holding off for a bit since this kiddo is burning a hole through our wallet…insurance usually reimburses most of it, but they won’t pay for that test since it’s not though a vet.

 

[maddie9955]

Our male Loki had skin issues when he was young. We did the testing, found out what he was allergic too and it took about a month to
clear up. And the insurance did pay for the testing.

 

[strykerdobe]

Also there should be NO vaccinations given! Vaccines are only given to healthy animals. When was the last time he was vaccinated, and all these issues began?

Also, most vets will only treat symptoms and not take time for true causes for a cure.

For sure work on keeping the gut healthy since all these antibiotics also kill good bacteria and upset the microbiome in the gut. 80% of the Immune System is located in the gut. I would continue giving probiotics for months. Can also add Raw Goats milk from Primal Raw Pet Foods. Or Answers Raw Goats milk.
They have lots of good bacteria to help the gut.

 

[strykerdobe]

Will post this in its own thread.
Here is a very good article on why it's so important.

The Guide to Your Pet’s Microbiome​

• August 5, 2021

Dr. Chris Besent​

Chris Bessent, DVM, MSOM, Dipl. OM, L.Ac. has over thirty years of experience in veterinary medicine including certificates in veterinary acupuncture, veterinary chiropractic and veterinary Chinese herbology. Imbued with Eastern philosophy and the knowledge that food is the foundation of health, Dr. Bessent also received her degree in veterinary nutrition and began to formulate recipes fit for a carnivore from nothing but whole foods. Currently, she divides her time between the Simple Food Project and Herbsmith, both of which are owned and operated out of her facilities in southeastern Wisconsin.

The Guide to Your Pet’s Microbiome – Herbsmith

www.herbsmithinc.com

 

[JanS]

While we won’t have the thyroid panel back until next week, he thinks it’s unlikely that Remy is hypothyroid, but wants to rule it out to make sure it’s not the root cause for liver and skin issues.

You honestly never know and that's how Albert looked before he was diagnosed. Our vet said it was a good call to have him tested for it so he could be treated. It was a simple, reasonably priced med that kept his levels right were they needed to be.

 

[okaygreatthanks]

Our male Loki had skin issues when he was young. We did the testing, found out what he was allergic too and it took about a month to
clear up. And the insurance did pay for the testing.

Thank you, this is great to know! I think insurance will pay for testing if it’s through a vet, just not sure about Nutriscan, but I’m going to check into it.