Important Updates on Diagnosing and Treating Foal Sepsis - EquiManagement on Audio

This episode of EquiManagement on Audio provides a comprehensive update on the diagnosis and treatment of foal sepsis, a leading cause of morbidity and mortality in newborn horses. The discussion centers on evolving diagnostic criteria, moving away from the outdated reliance on systemic inflammatory response syndrome (SIRS) toward a more accurate definition that requires both proven or suspected infection and systemic manifestations of infection. Experts like Dr. Daniela Espinosa-Seowan and Dr. David Wong highlight the limitations of SIRS, citing a 2025 study of 1,068 foals that found no predictive value for infection or mortality. Instead, blood lactate levels emerge as the most reliable prognostic indicator. The episode emphasizes the importance of early, empiric antimicrobial therapy guided by local resistance patterns and the World Health Organization’s antimicrobial priority list, with a strong push for de-escalation to combat multidrug resistance. Emerging biomarkers like nucleosomes show promise in identifying severe sepsis but require further study. The episode concludes with a call for standardized scoring systems to improve field diagnosis and treatment outcomes. Key takeaways include: (1) Abandon SIRS as a standalone diagnostic criterion for foal sepsis; (2) Use blood lactate as a primary prognostic tool; (3) Implement local antimicrobial surveillance to guide empiric therapy; (4) Prioritize de-escalation of antibiotics once culture results are available; (5) Monitor for multidrug-resistant pathogens like Enterococcus and E. coli; (6) Develop field and clinical scoring systems to improve early detection; (7) Consider nucleosomes as a potential marker for severe sepsis; and (8) Maintain vigilance in all neonatal foals, especially those with failure of passive transfer. The tone is cautiously optimistic, emphasizing progress while acknowledging ongoing challenges in diagnosis and treatment.