Efficacy of Postoperative Antimicrobial Use for Clean Orthopedic Implant Surgery in Dogs: A Prospective Randomized Study in 100 Consecutive Cases

Objective To determine the influence of a 7‐day course of postoperative antibiotherapy (cefpodoxime) on surgical site infections (SSI) after tibial plateau leveling osteotomy (TPLO). Study design Prospective, randomized, double‐blinded, placebo‐controlled clinical study. Sample population One hundred fifty client‐owned dogs, with consent. Methods Dogs undergoing arthroscopy‐assisted TPLO were randomly assigned to 1 of 2 groups, the placebo group receiving perioperative cefazolin and 7 days of placebo medication after surgery or the treatment group receiving perioperative cefazolin and 7 days of postoperative cefpodoxime. Twenty‐seven factors were analyzed for association with SSI by using univariate analysis, Fisher's exact test, or Wilcoxon rank‐sum test. Results SSI rates did not differ (P = .34) between the placebo group (17%; 95% confidence level [CL] 7.94%‐26.43%) and the treatment group (11% SSI; 95% CL 3.98%‐18.88%). The probability that > 23% of dogs would benefit from postoperative antibiotherapy was less than 5%. The only association between the factors tested in this study and SSI involved the body weight (kg), with each 1 unit increase in kilogram weight increasing the odds of developing an SSI by 4.7%. Conclusion Although the wide CL may be consistent with a type II error, a 7‐day course of cefpodoxime after arthroscopy‐assisted TPLO did not influence postoperative SSI in the population tested here. In addition, only a small proportion of dogs would benefit from postoperative antibiotherapy under the conditions of our study. Clinical significance These results should prompt surgeons to reconsider systematic antibiotherapy after TPLO and justify additional studies to determine whether dogs predisposed to infection could benefit from such an approach.

Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 87%

A prospective, randomized, double‐blinded, placebo‐controlled clinical study on postoperative antibiotherapy in 150 arthroscopy‐assisted tibial plateau leveling osteotomies in dogs

Spencer¹,

Daye²

2018

“…The infection rate of 2.83% in the present study is comparable to the SSI rates found in previous veterinary studies . Ten SSIs would have gone undetected by our facility had active surveillance not been performed.…”

Section: Discussionsupporting

confidence: 86%

The impact of postdischarge surveillance on surgical site infection diagnosis

Stickney

Mankin

2017

Objective: To evaluate the impact of postdischarge surveillance on surgical site infection (SSI) diagnosis. Study design: Prospective enrollment with retrospective case reviewSample Population: Dogs and cats (n 5 1271) undergoing surgery April 2012-November 2013. Methods:The medical record of each animal was reviewed and a 30-day follow-up questionnaire was sent to each pet owner. A standardized definition of SSI was used to identify all animals with SSI. The method of SSI detection was recorded as: representation to the hospital, scheduled recheck, questionnaire, communication with the referring veterinarian, or a combination of the above.Results: SSI was identified in 36 (2.83%) of the 1271 animals included. All SSIs were diagnosed after discharge from the hospital. Seven of the 36 animals with SSI were diagnosed at re-presentation to the hospital, 5/36 at scheduled recheck, 10/36 on questionnaire, 10/36 at re-presentation to the hospital AND on questionnaire, and 4/ 36 on communication with referring veterinarian. Of the diagnosed SSIs, 72.2% were documented in the medical record. Therefore, without active postdischarge surveillance, 10/36 SSIs (27.8%) would have gone unknown to surgeons at our institution. Conclusion:Understanding the incidence of SSI with feedback to surgeons is an important aspect of an infection control program and has been shown to reduce SSI risks. Without active postoperative surveillance, 27.8% of SSIs would have gone unknown to surgeons. Implementing active surveillance will allow accurate reporting of incidence of SSIs in veterinary hospitals.

“…We did not find a benefit with the use of postoperative antibiotics for the prevention of SSI after TTA. This is both in contrast to and in agreement with other reports of studies that evaluated the benefit of postoperative antibiotics at reducing the occurrence of SSI in proximal tibial osteotomy …”

Section: Discussionsupporting

confidence: 92%

Impact of postoperative antibiotics on rates of infection and implant removal after tibial tuberosity advancement in 1,768 canine stifles

Ferrell¹,

Barnhart²,

Herman³

2019

Objective To report infection rate, implant removal rate, and postoperative antibiotic therapy after tibial tuberosity advancement (TTA) in dogs. Study design Retrospective study. Animals One thousand seven hundred sixty‐eight stifles in 1,732 dogs. Methods Medical records (January 2007‐December 2011) of dogs treated with a TTA were reviewed. Cases were included if at least 1 year of postoperative follow‐up was available and no additional procedures were performed on the stifle. Date of surgery, date of culture, culture and susceptibility results, postoperative antimicrobials used, and any implant removals were recorded. Use of postoperative antibiotics and implant removal were evaluated statistically for effect on infection occurrence and resolution. Results Postoperative infections were diagnosed in 82 of 1,768 (4.6%) stifles. Implants were removed from 32 (39%) stifles, with plate and screw removal only in 23 (71.9%) stifles. The rate of infection did not differ between dogs with or without postoperative antibiotic therapy. However, dogs receiving postoperative antibiotic therapy were at risk for developing an oxacillin‐resistant infection (P = .001). Oxacillin‐resistant infections were associated with a requirement for implant removal to achieve resolution compared with other types of bacterial infections (P < .05). Conclusion No benefit was detected with the use of postoperative antibiotics after TTA in this population. Implant removal was infrequent, and the requirement for cage removal was not commonly required for infection resolution. Clinical significance This study does not provide evidence to support postoperative antibiotic therapy after TTA. Postoperative infection can be treated in most dogs without removal of the TTA cage.