Antibiotic Resistant Clostridium Perf In Kittens

[EchoTheCat]

Hi guys. I have a litter of 5 foster kittens that I have been treating for diarrhea for 4 months and I'm absolutely beside myself. These kittens had every imaginable parasite on the planet. At the end of September they tested positive for c. perf (>6000 thous/g). This was after they had been treated with a round of Metronidazole. Treated with a second course of Metronidazole for 17 days and they got worse as soon as I stopped giving it. I then did a third round of Metronidazole for 23 days per my vet and also treated with 18 days with the probiotic S. boulardii. We retested recently and the clostridium level is now about ~4000 thous/g. The copy of the PCR that I have says that clostridium below 300 thous/g is unlikely to be contributing to diarrhea. I do think they are getting worse again but it took 2 weeks this time instead of immediately getting worse. I won't be doing Metronidazole again as it's obviously not working. Does anyone have experience with Metronidazole resistant C. perf in kittens? I'm completely frustrated and beside myself. I just want get these cats well enough to be adopted.

 

[micknsnicks2mom]

hi and welcome to TCS!

i'm so sorry those kittens are having such a rough time, and you as well.

i have no experience in this area, but i'm sure someone who does have experience will be along shortly.

i'm going to ask you some questions, to get a little more info.

have you tried getting a second opinion, from another (completely unrelated to your current) vet? sometimes things may just need a 'set of fresh eyes' on them, to be able to recommend a new or different treatment.


what foods are they currently eating? please tell us what changes to their diet, and the frequency of those changes -- to the best of your ability/memory (i understand how these kind of things can get...complicated, involved).

you mention that the kittens have been treated with the probiotic S. boulardii for 18 days. are they currently being given any probiotics? i'm wondering if their 'good' gut flora may have been totally obliterated, and so may need rebuilding.

now, i know this may not be something you're able to consider, and i'm assuming you're fostering these kittens...? but have you considered whether it might be worth trying a raw food diet? i'm just asking if this might have been considered, not suggesting at this point.

what do you know about the kittens history before they came to you, before they were (?)rescued? not sure if this might be helpful info, but can't hurt to know more if the info is available.

are they experiencing any other symptoms, along with or separately from the diarrhea?

how are the kittens appetites, and their energy level? are their weights in the 'normal' range?

have they been able to be given their (normal) kitten vaccinations?



we're here for you!



edited to add: i see that you are fostering the kittens, sorry that i missed that.

 

[foxxycat]

I am sorry you are struggling with diarrhea. Micksnicks have some great questions. I wonder if it's diet related and the antibiotic is slowing down the inflammation for some reason.

some cats have a sensitivity to corn in foods. most grocery store foods have corn. I found that Tractor Supply has a good store line called 4Health that doesn't have corn. It does have peas and potatoes but it may just be what will stop the stinkies.

What about a combo probiotic? Maybe they need several kinds.

I hope you get some answers..I don't have much experience with runny poop but canned plain pumpkin could help-I have heard it works for both issues-constipation and runny stinkies. adult cats it's 1 tsp a day- probably try 1/4 tsp to start. some cats will lick it off your finger others hate it. If they hate it-you can smear it on the roof of their mouth-I have an adult older cat where 1/4 tsp swiped on her mouth works like a charm 12 to 24 hours later for constipation-maybe it will work for the stinkies?

When you use pumpkin-I put some in a tuperware container and add water to stir-then make it like a pudding consistency. then it won't splash as bad when they eat it-otherwise it will splatter when they lick it. plus extra water won't hurt them. my young cat loves pumpkin. She comes running when I get it out of the frig. I get about a weeks worth out of the pudding pumpkin mixture. Some people freeze it in balls-I found it changes the texture of the pumpkin-I don't like it and neither did the cats=but you may have luck with it.

 

[EchoTheCat]

Hi micknsnicks - thanks for your response - I'll try to answer your questions.

I have not yet got a second opinion... my vet is going to consult with the people who do the test, and I'm not sure what she will recommend after that.

They're eating the Merrick adult chicken food (grain free, no corn) and

 

[EchoTheCat]

Whoops, posted that too soon.

They're also getting different flavors of Performatrin Ultra canned food twice a day (no fish). That's also grain free. They've been eating that for the last couple of months (though I did recently transition them from kitten Merrick to adult Merrick).

I'm now giving Forti-Flora (not the S. boulardii as it was expensive) as well as the feline digestive enzymes by Dr. Goodpet. I have given the Proviable as well, and I sprinkle Benefiber on their food once a day (I think that would have the same effect as pumpkin).

They are foster kittens. I've definitely thought about doing raw food, but I'm not sure how that might affect the clostridium, and it is more expensive since the rescue does pay for the food.

I pulled them from a shelter in late July. They were five weeks old and the Mom was taken away too soon. Other than that, I don't know very much about their history. I do know that they had tapeworms, fleas, ear mites, giardia (took two rounds of Panacur to get rid of), and coccidia. One almost died and had to spend a couple nights at the ER vet. After we treated all that and they didn't get better, we did the PCR and they were positive for cryptosporidium too (six weeks of Tylan cleared it up) but we can't get rid of this clostridium.

They're really healthy aside from the diarrhea. VERY active, they love their wet food, and their weights are fine (in fact, two in the litter are big for their age). They've had all their vaccines and been spayed and neutered as well.

 

[micknsnicks2mom]

thank you for that additional info! i'm so glad to read that the kittens are having good appetites as well as are quite active, and they're weights are good too (really excellent). and that's great that they've been able to have their kitten shots too!

i've done some online searching for info for you.

http://www.delawarevalleyacademyvm.org/pdfs/sep13/1DiarrheaCatsKittens_2013.pdf okay, so this 'paper' has a lot of info in it. note that there are two tables, which give some really good info. i found the sections on 'Antibiotic Therapy and 'Non-specific Therapy' very interesting. specifically,

'Antibiotics are often injudiciously administered without a valid diagnosis. Indiscriminate antibiotic usage can lead
to alterations in the commensal intestinal microflora and exacerbation of diarrhea or development of antibiotic
resistance.' and, 'In fact, fecal enteric diagnostic panels are often used indiscriminately and the results are easy to misinterpret.'
-- it's not the 'indiscriminate' part -- in your kitten's case, they had 'every imaginable parasite on the planet', so yours was not a case of indiscriminate antibiotic usage. it's the...cumulative effect of all the antibiotics your kittens needed to be given. and i think it's important to note that the fecal enteric diagnostic panels results are easy to misinterpret.

as well as --
'Dysbiosis (or dysbacteriosis) may be loosely described as microbial imbalance in the gut so that “bad” bacterial species outnumber “good” bacterial species. Causes of dysbiosis include bacterial or viral infections, intestinal parasites, diet, drug therapy (antibiotics), and altered gut secretions (e.g., exocrine pancreatic insufficiency leading to maldigestion). Dysbiosis can lead to abnormal digestion and/or absorption of nutrients, food intolerance or allergy,
and inflammation (and eventually inflammatory bowel disease).'

so those are some things that you might bring up, discuss with your vet as possibilities.

Raw Pet don't let the group name 'throw' you, this group has as one of their administrators Laurie Goldstein (ldg, here at TCS)-- which is who you might try to get in contact with. she may well be able to help you with treating the clostridium.

here's an (older) thread about 'kittens (, raw) and clostridium' here at TCS -- Kittens, Raw and Clostridium - safety? it's quite a lengthy thread, but may very well provide you with good info re treatments. you'll note that Laurie (ldg) provides much really good info in this thread. it's a lot to read through, to come across the specific info that might be of help to you, so i suggested you try to contact Laurie via the raw pet food group on facebook.

have you asked your vet about the litter box(es), and if special care would need to be taken to avoid re-infection (or continued infection) or 'spreading/re-spreading' of the clostridium infection between your five kittens? here's an article that contained this bit of possibly useful info (note that, if i'm understanding correctly, the C. perfringens can be spread through shared contact with 'litter' -- and i'm assuming that means cat litter) -- Clostridium perfringens -- the part i'm quoting below is down at the bottom, the second from last paragraph.

'In spite of its potential danger as an infectious agent, the avirulent forms of bacillus are commonly found in the intestinal tracts of warm-blooded animals, and it also inhabits terrestrial, marine and aquatic environments. The trouble starts when the balance of bacteria in the gut is disrupted, giving C. perfringens a chance to proliferate unchecked. It may contaminate soil, animal feed and litter, or be transmitted directly from infected to healthy animals.'

we care about you and your kittens, and the priority is to help them to become healthy. i can and will do online searches to locate more info for you, but i do not have knowledge or experience in this area myself. i do have quite a bit of knowledge and experience with cats/kittens and diarrhea, but not with clostridium. i'm saying this because that's why i referred you to Laurie, because she has extensive knowledge and experience, and specifically with/about clostridium.

 

[EchoTheCat]

Thanks for your reply- going to spend some time leafing through that info. My vet emailed back today with a few recommendations:
1. Switch them to a high protein/low carb diet such as limited ingredient venision or duck
2. Use benefiber (already doing that)
3. 2-4 weeks (ugh) of amoxicillin plus 1 more week of metronidazole (not inclined to do the metronidazole, as I just don't think it is working.)
4. Fecal transplant ?

Maybe some other posters can chime in... anyone have experience treating C. perf with Amoxicillin or fecal transplants? How long does it take to get better?

 

[micknsnicks2mom]

those sound like very good recommendations from your vet!

yes, to trying a high protein/low carb diet! that's one of the recommendations in the paper by delaware valley academy vm, linked to above. i'm not sure if it would matter, but duck is fatty, per my vet. my vet recommended not serving my girl with possible IBD any duck.

i can't comment on benefiber, though i have used plain/unflavored metamucil powder as part of treatment for two of my cat's IBD (with great success).

and, amoxicillin is mentioned as a treatment for clostridium in the tables, in the paper by delaware valley academy vm too.

fecal transplant is an excellent recommendation!!! it's something that is new(er), at least that i've come across, but can be very effective. here's a video interview by Dr Karen Becker, with Dr Roman, discussing fecal transplants -- Fecal Transplant: An Amazing Cure You've Probably Never Heard Of
https://healthypets.mercola.com/sit...13/fecal-transplants.aspx?_escaped_fragment_=
here's another article, by Dr Marty Becker, about fecal transplants -- When medicine is crap: Fecal transplants in veterinary medicine - Dr. Marty Becker i linked to this article specifically because of this...

'A fecal transplant a low-cost treatment for the life-threatening infection that could cure up to 90 percent of them, with minimal side effects, often within days.' (i added the in bold) here, he's referring to humans, not cats, but that leads me to think that it might well be similar for cats.

You are being redirected... here's a website that has a lot of info about fecal transplants (in humans). and from the section 'Fecal Transplant for Clostridium difficile' of the webpage linked to --

'Studies differ however most research seems to indicate that the rate of success using FMT to treat C diff is around 90%.


The rate of success for refractory C diff is around 55%.' (bear in mind that this is referring to treatment in humans, but still a very striking success rate. and i'm interpreting 'refractory' to be the same as/similar to recurrent)

and, from another webpage at the power of poop website --

'Fecal transplants (FMT) are the latest treatment for C.diff. They have a 80-90% success rate on the first infusion, depending on method used. If there is a recurrence, FMT has a higher success rating on the second attempt 93-98%. This makes it stand out from antibiotics which all have significantly lower success rates on the second attempt. Adverse reactions to FMT have been recorded as bloating, nausea and gas. Long term follow up show that people who receive FMT for C.diff have a healthier microbiome that has been observed up to 21 weeks after treatment. This improvement of microbial diversity can prevent future relapse.' (again, i added the in bold, and this is referring to treatment in humans)




this is just my opinion, but this might be a good point to discuss with your vet whether to have fecal transplants done now vs another course of antibiotics. my concern is that antibiotics and particularly continued treatment with them in patients with C perf can decimate/obliterate pretty much all the 'good' gut bacteria which then allows the C perf to flourish with nothing (no normal good bacteria, as well as other gut functions -- like bile, if i'm remembering what i read correctly) to prevent it from doing so -- again, from what i've read. i'm saying that potentially, more damage could be done to the kitten's...guts and their ability to function normally, the more antibiotics are given to them to treat the C perf.

if this were me, i would consider the options as best i'm able to at this point, then (taking a written list of 'points' and questions with me) i'd discuss this all with my vet, and ask the vet's opinion on the best choice...before making a decision on how to move forward.

 

[EchoTheCat]

Just wanted to give an update... I started the kittens on amoxicillin two days ago. I'm still trying to get in touch with my vet to ask about the fecal transplant, but I think it may be too late since we've already started the antibiotics. :/

 

[micknsnicks2mom]

thank you for the update!

i'll keep that the amoxicillin totally clears up the C perf.

actually, most (human, and likely cats too) patients who eventually have fecal transplants done have gone through many, many courses of various antibiotics. so i think as long as the kittens are deemed 'good' candidates for fecal transplant by the vet who's experienced in performing them, that option will still be available.

 

[EchoTheCat]

But, I've read that for humans, antibiotics need to be stopped 48 hrs before FMT... and since the kittens are *currently* on Amoxicillin, that means we would have to wait until 2 days after they finish the Amoxicillin to start FMT. As much as I want to do an FMT ASAP, I don't think it would make sense because the Amoxicillin might just kill all the good bacteria they get from the FMT. I hope I hear back from my vet today... I wish I had been able to wait to get all the info on FMT before starting the Amoxicillin.

 

[white shadow]

Hi EchoTheCat !

I'm going to suggest that you have a thorough read of this thread: Trouble in Raw Paradise - Clostridium perfringens and my cats

That member (carolina) isn't 'active' here these days....this post of hers will explain why: "Old" Members...that said, if you had questions, you could try 'paging' her.

Keep us posted !

 

[Pouncecat1]

Yes a fecal transplant is the way to go here. In people you only need to discontinue the antibiotics for 48 hours before doing the transplant. You also do not "need" to do a full course of antibiotic treatment. The fecal transplant should "cure" the disease by restoring a healthy gut population. If it comes back after this, I would definitely do the fecal transplant.

 

[micknsnicks2mom]

E EchoTheCat , how are the kittens doing with the amoxicillin? i'm keeping my that this course of antibiotics clears up the C perf.

we're here for you! for support, encouragement, and in any other ways we're able to.

 

[EchoTheCat]

So, Just wanted to give an update after doing the 2 weeks of Amoxicillin...
To be honest, I don't think they've improved that much. I took them to a specialist on Wednesday, who decided to run some tests (blood test, urinalysis, and Gram stain). I'm still waiting to hear back on what those results were. He was supposed to call me Wednesday night or Thursday morning. I called both Thurs and Fri early afternoon and still didn't hear back... and he's not there tomorrow, so now I'm going to have to wait until Tuesday to hear what the results are... almost a whole week after the actual appointment. Why do vets do this?

 

[EchoTheCat]

When I pressed my vet about the fecal transplant, my vet didn't seem to think it could actually be done in practice and was more of an experimental/research thing at this point. However, I talked to one of the other fosters, who told me about a Holistic vet that does fecal transplants. If I do not get any answers from the specialist then I will go to the Holistic vet.

 

[micknsnicks2mom]

E EchoTheCat -- i wasn't online for about a week (computer issues, now fixed), so i'm just catching up here at TCS. just wanting you to know that you and your kittens were not forgotten.

i'm sorry to hear that there doesn't seem to be much improvement after two weeks on amoxicillin for the kittens. but that was one of the recommended treatments from both your vet and the info found online about treating C perf, so now that treatment was tried.

yes, it's really very annoying when vet's (or human doctors) don't get back to us with test results! and i think the answer to why they do this is...because they can.

that's great that one of the other fosters told you about a Holistic vet that does fecal transplants!!! now you have another option, should you need it. if i'm not mistaken, Holistic vet's would be more...aware of, and knowledgeable about fecal transplants -- even that they're being done for cats now.

 

[EchoTheCat]

So all the test results were pretty normal and the vet didn't see any Clostridium. The vet wants them to have the Science Diet prescription food and is trying to get some for me for free. Every vet I've ever been to loves those prescription diets, though in this case I don't think that changing the food will help particularly much. He also suggested Betril or something else which I forgot, but we decided to just give them a chance to recover and not throw more medicine at them. Oh, and he also said there's no reason not to put them up for adoption. I do think they've gotten better after stopping the Amoxicillin and even though their stools are still soft sometimes they always use the litter box, so I don't think it's anything that an adopter couldn't manage.

 

[micknsnicks2mom]

i'm going to ask -- what are your thoughts, your 'gut feeling', as the person who knows the kittens the best?

do you feel the kittens should be put up for adoption? do you think a second opinion might be worth having on this, like from the Holistic vet?

i think it's a very good choice, not to throw more medicine at them. i would suggest giving the kittens a good probiotic though, to help build up their 'good' gut flora. with all the antibiotics these kittens have needed, it's quite possible/likely that most of their good gut flora has been...killed off. i use Now Probiotic-10, which comes in capsules -- i buy it through Amazon. i just sprinkle 1/3 capsule twice each day per cat on my cats wet food, then mix it in.

 

[micknsnicks2mom]

E EchoTheCat , i'm just wanting to check on you and the kittens.