{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T23:01:00Z","timestamp":1754262060088,"version":"3.40.5"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T00:00:00Z","timestamp":1638403200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust Veterinary J"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>An 8\u2010year\u2010old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5\u2009days), followed by oral trimethoprim\u2010sulphonamide (10\u2009days) and then oral doxycycline (14\u2009days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug\u2010resistant (MDR) <jats:italic>Escherichia coli<\/jats:italic> was confirmed. Although susceptible to enrofloxacin in vitro, 30\u2009days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug\u2010resistant (XDR) gram\u2010negative microorganisms. Whole\u2010genome sequencing (WGS) revealed multiple sequence types of <jats:italic>E. coli<\/jats:italic>, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3\u2009months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These non\u2010conventional therapeutics, antimicrobials and long\u2010term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.<\/jats:p><\/jats:sec>","DOI":"10.1111\/avj.13136","type":"journal-article","created":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T05:07:06Z","timestamp":1638508026000},"page":"107-113","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Successful treatment of a chronic oroantral fistula infected with extensively drug resistant bacteria using long\u2010term oesophageal tube feeding and several non\u2010conventional treatments in a horse"],"prefix":"10.1111","volume":"100","author":[{"given":"JR","family":"Fletcher","sequence":"first","affiliation":[{"name":"School of Veterinary Science The University of Queensland  Gatton Queensland 4343 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