Antimicrobial regional limb perfusion: Does it really fight infection?

Abstract

Summary Over the last decades the use of antimicrobial regional limb perfusion (A‐RLP) has increased and A‐RLP is nowadays commonly used to treat orthopaedic infections by many equine practitioners. There have been a large number of studies published on the use of A‐RLP, many of which describe regional drug pharmacokinetics and clinical safety of the administration of different antimicrobials by A‐RLP. A limited number of studies describe the clinical use of A‐RLP as prophylactic or therapeutic treatment. However, despite being in use for 30 years there is still limited evidence about the efficacy of A‐RLP as a means to prevent and treat orthopaedic infections in horses.

Evaluation of factors associated with surgical site infection in equine proximal interphalangeal joint arthrodesis: 54 cases (2010–2019)

“…The extremely large confidence interval for the odds ratio (3.039–6392.058) indicates some degree of model misspecification, and these numbers should be interpreted with caution, but the model was significantly degraded in its ability to predict outcomes without this factor and so it was included in the final model. Despite the increased frequency of use of antimicrobial regional limb perfusion (A‐RLP) in equine practice and a large number of studies investigating side effects and drug pharmacokinetics indicating relative safety with its use, there remains a lack of evidence that A‐RLP makes a difference in prophylaxis or treatment of equine orthopaedic infections (Rubio‐Martinez, 2021). However, greater evidence for efficacy in human medicine has reported improved outcomes in people treated for diabetic and ischaemic nonhealing pedal ulcers (Agarwal et al., 2005; Seidel et al., 1994), infected total knee arthroplasty (Lazzarini et al., 2003) and chronic osteomyelitis (Finsterbush & Weinberg, 1972).…”

Review of the role of biofilms in equine wounds: Clinical indications and treatment strategies

“…In treatment of distal limb wounds, antibiotics can also be delivered via regional limb perfusion (RLP). Despite the frequency of use and large number of studies investigating drug pharmacokinetics and side effects associated with RLPs of antibiotics, there remains a lack of evidence supporting whether RLP makes a difference in prophylaxis or treatment of equine orthopaedic infections (Rubio‐Martinnez, 2021). The clinical benefits of RLP are difficult to confirm or compare between studies due to the lack of standardisation or determination of optimal methods of technique in terms of drug selection, perfusate volume and concentration, duration of tourniquet application and whether the procedure is performed under general anaesthesia or standing sedation (Biasutti et al., 2021).…”