Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999–2009)

Abstract

Objective—To describe the clinical use of regional limb perfusion with antimicrobials (A-RLP), complications, and outcome in a large series of patients. Design—Retrospective case series. Animals—174 horses. Procedures—Medical records of horses treated with A-RLP between 1999 and 2009 were reviewed. Signalment, primary complaint, horse use, etiology, duration of clinical signs, previous treatment, structures involved, concurrent conditions, A-RLP characteristics, additional treatments, complications, and outcome were recorded. At long-term follow-up, 2 outcomes were investigated: survival rate and return to previous use at the same or higher level. Univariate and multivariate logistic regression analyses were conducted. Results—Group 1 (96 horses) included septic synovitis. Group 2 (50 horses) included extrasynovial lacerations (23 horses) and fresh, minimally contaminated intrasynovial lacerations without evidence of established synovial infection (27 horses). Group 3 (28 horses) included miscellaneous other conditions. Only minor complications were reported in 12.26% of horses that received IV (n = 155) and 33% of horses that received intraosseous (27) A-RLP. Horses with septic synovitis had a lower survival rate (53.43%) than did horses with lacerations (91.89%). Within group 2, no significant differences in short- or long-term outcomes were found between horses with extrasynovial and fresh, minimally contaminated intrasynovial lacerations. For the horses returning to previous use, 80% of horses with septic synovitis and 72.72% of horses with lacerations were performing at the same or higher level at the time of follow-up. Conclusions and Clinical Relevance—The results of the present study indicated that A-RLP is a safe technique with minimal adverse effects. The IV route presented fewer complications than intraosseous injection. Horses with infection of synovial structures had a lower survival rate than did those with acute, minimally contaminated intrasynovial lacerations. The latter had a similar prognosis for horses with extrasynovial lacerations treated with A-RLP.

Effect of emptying the vasculature before performing regional limb perfusion with amikacin in horses

“…Intravenous regional limb perfusion (IV-RLP) has become a common method for administration of local antimicrobials in the treatment of infections of the equine distal limb [1][2][3]. Intravenous regional limb perfusion achieves high concentrations of antimicrobial in the target region and is thought to improve the success of therapy when treating bacterial infections.…”

Effects of regional limb perfusion volume on concentrations of amikacin sulfate in synovial and interstitial fluid samples from anesthetized horses

“…3,5,6 The MIC of amikacin against most equine bacterial pathogens is 16 µg/mL. 3,5,6 Aminoglycosides such as amikacin are concentrationdependent antimicrobials, and attainment of the MIC is recognized as sufficient for bacterial killing. However, achievement of fluid concentrations > 10 times the MIC can increase the efficacy of treatment and discourage formation of antimicrobial resistance.…”

“…[1][2][3][4][5][6] These concentrations reportedly exceed 50 times the MICs of antimicrobials against common equine bacterial pathogens. 3,5,6 The MIC of amikacin against most equine bacterial pathogens is 16 µg/mL. 3,5,6 Aminoglycosides such as amikacin are concentrationdependent antimicrobials, and attainment of the MIC is recognized as sufficient for bacterial killing.…”

Evaluation of 10‐minute versus 30‐minute tourniquet time for intravenous regional limb perfusion with amikacin sulfate in standing sedated horses

“…Regional limb perfusion with antibiotics is a simple procedure that allows effective levels of antibiotics to be administered locally with minimal systemic effects (Rubio-Martinez and Cruz 2006, Rubio-Martinez and others 2012). …”