Influence of intravenous regional limb perfusion with amikacin sulfate on<i>Staphylococcus aureus</i>bioburden in distal limb wounds in horses

Freeland, Russell B.; Morello, Samantha L.; DeLombaert, Melissa; Rajamanickam, Victora

doi:10.1111/vsu.12638

Cited by 10 publications

(11 citation statements)

References 47 publications

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“…These factors may influence surgeons' perception of risk of SSI and could make them more likely to institute ongoing prophylactic local antimicrobial therapy. Regional limb perfusion is efficacious at achieving therapeutic concentrations of an antimicrobial in a local environment in healthy tissue; however, some question still remains regarding the value of local antimicrobial therapy in traumatized or infected tissue . Edwards‐Milewski et al failed to establish a benefit of RLP with amikacin in aseptically created wounds.…”

Section: Discussionmentioning

confidence: 99%

“…Regional limb perfusion is efficacious at achieving therapeutic concentrations of an antimicrobial in a local environment in healthy tissue [18][19][20][21] ; however, some question still remains regarding the value of local antimicrobial therapy in traumatized or infected tissue. [22][23][24] Edwards-Milewski et al 22 failed to establish a benefit of RLP with amikacin in aseptically created wounds. In a study by Cox et al, 20 the authors were unable to establish therapeutic antibiotic levels in bone after RLP with ceftiofur sodium.…”

Section: Discussionmentioning

confidence: 99%

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Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008–2016)

2019

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Objective To determine the prevalence of surgical site infection (SSI) after internal fixation and to identify risk factors for SSI and nonsurvival. Study design Retrospective study. Animals One hundred fifty‐five horses with long bone fractures or arthrodesis treated by internal fixation at 1 hospital between 2008–2016. Methods Signalment, diagnosis, surgical repair, surgeon, surgical time, antimicrobial use, SSI onset, bacterial identification, and adjunct treatments were recorded. Perioperative variables were analyzed to identify risk factors associated with outcomes. Results Surgical‐site infection was reported in 22 of 155 (14.2%) horses, which is lower than what has been previously reported (P = .003). Horses with fetlock arthrodesis or ulnar fracture were more likely to develop SSI. Local prophylactic antimicrobial therapy was associated with an increased risk of SSI. Horses with SSI were 12 times (P < .0001) less likely to survive to discharge than horses without SSI. Horses with a fetlock or carpal arthrodesis or those with radial/humeral/femoral fractures were less likely to survive. No association was identified between open fractures, open reduction and internal fixation, or surgical times and SSI. Conclusion The prevalence of SSI in this population was lower than what has been previously reported. Horses with fetlock or carpal arthrodesis or radial/humeral/femoral fractures were at increased risk for SSI and/or nonsurvival to discharge. A protective role of local antimicrobial therapy for SSI could not be established. Clinical relevance The impact of SSI on outcomes of cases of equine internal fixation remains substantial. Identification of cases at higher risk of SSI should influence surgical technique, postoperative management, and early intervention when SSI is suspected. Additional investigation is warranted regarding local antimicrobial therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008–2016)

2019

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“…When considering a novel drug for IVRLP, an objective method for assessing its efficacy is required. With respect to antimicrobial IVRLP, this is relatively straightforward with known minimal inhibitory concentrations or evaluating the effect on microbial growth . With respect to an analgesic IVRLP, however, there is no clear target concentration.…”

Section: Discussionmentioning

confidence: 99%

“…With respect to antimicrobial IVRLP, this is relatively straightforward with known minimal inhibitory concentrations or evaluating the effect on microbial growth. 7,8,10,39 With respect to an analgesic IVRLP, however, there is no clear target concentration. Previous reports of nociceptive studies have described that IV butorphanol administration imparts an analgesic benefit when administered at a dose of 0.1 mg/kg (50 mg in an average 500-kg horse).…”

Section: Discussionmentioning

confidence: 99%

Synovial butorphanol concentrations and mechanical nociceptive thresholds after intravenous regional limb perfusion in standing sedated horses

et al. 2019

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Objective To determine synovial butorphanol concentrations and mechanical nociceptive threshold (MNT) changes after butorphanol intravenous regional limb perfusion (IVRLP). Study design Experimental Animals Six adult horses. Methods Cephalic IVRLP was performed with 10 mg butorphanol in sedated horses with a wide rubber tourniquet and a total volume of 30 mL. Radiocarpal synovial fluid and serum concentrations along with MNT were evaluated prior to and 0.5, 1, 2, 4, and 6 hours after IVRLP. Butorphanol concentrations were determined with liquid chromatography coupled to tandem mass spectrometry positive electrospray ionization. Results Butorphanol concentrations reached mean (SD) peak concentrations of 9.47 ng/mL (±12.00) in synovial fluid and 3.89 ng/mL (3.29) in serum 30 minutes after IVRLP. Concentrations remained above baseline for 4 hours in synovial fluid (P ≤ .017) and for 2 hours in serum (P ≤ .016). The only difference in MNT was detected 1 hour after IVRLP, when MNT were higher in controls than in treated horses (P = .047). Conclusion Butorphanol IVRLP seemed well tolerated and resulted in measurable levels of butorphanol in the radiocarpal synovial fluid of five of six horses. Clinical significance Intravenous regional limb perfusion appears to be a viable alternative to administer butorphanol, but additional investigation is required to evaluate the dose and local concentrations required for analgesia.

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“…The most common breeds were Arabian (33, 26%) and 26 were local Arabian crosses (20.5%), followed by Quarter Horse (28, 21.3%). Other breeds included Tennessee Walking Horse (8), German/ Belgian Warmbloods (7), Ponies and Pony crosses (4), Single-Footing horse (4), Appaloosa (3), Missouri Fox Trotter (2), Appendix (2), Thoroughbred (2), Rocky Mountain (1), Azteca (1), Paint (1), Friesian (1) and Miniature Horse (1). Three horses were of unknown breed.…”

Section: Study Populationmentioning

confidence: 99%

Intralesional application of medical grade honey improves healing of surgically treated lacerations in horses

Mandel

Sutton

Abu

et al. 2019

Equine Veterinary Journal

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Summary Background Infection and dehiscence of simple lacerations is common in horses, and consistently effective methods of prevention are yet to be found. Honey has been shown to promote wound healing when applied topically; however, intralesional application prior to wound closure has not been reported. Objectives To examine whether intralesional application of medical grade honey (MGH) would reduce the incidence of infection and dehiscence following wound closure. Study design Prospective, open‐label randomised block design clinical study. Methods Lacerations, treated by field practitioners, were divided into treatment and control groups using block randomisation. Horses in the treatment group received a single intralesional treatment with l‐mesitran gel (MGH). Data were collected at the time of wound closure and at suture removal. Results Data from 127 horses were included, 69 MGH‐treated and 58 control cases. No adverse effects of the MGH were recorded. MGH‐treated horses were more likely to completely heal (P = 0.006, odds ratio [OR] 3.40 95% confidence interval [CI] 1.41–8.20), to have no signs of infection (P = 0.007, OR 3.64, CI 1.42–9.26) and for the veterinarians to report some degree of satisfaction (P = 0.04, OR 2.72, CI 1.05–7.09) compared to control cases. Numbers needed to treat for complete healing was 5.1 (CI 2.8–40). Main limitations Clinical studies have inherent flaws compared to wound healing models, because of variability between wounds. There were more horses with limb injuries in the control group, although not statistically significant, this may have biased the results. Clinical satisfaction and signs of infection were subjective evaluations and evaluators were not blinded to the treatment group. Conclusions Intralesional application of MGH to lacerations prior to wound closure may be beneficial in preventing infection and dehiscence. Larger, blinded studies focusing on wounds at a specific location with more objective assessment should be pursued.

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Influence of intravenous regional limb perfusion with amikacin sulfate onStaphylococcus aureusbioburden in distal limb wounds in horses

Abstract: IVRLP may not effectively concentrate amikacin within a wound bed and did not influence S. aureus bioburden in an experimentally created wound infection.

Cited by 10 publications

References 47 publications

Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008–2016)

Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008–2016)

Synovial butorphanol concentrations and mechanical nociceptive thresholds after intravenous regional limb perfusion in standing sedated horses

Intralesional application of medical grade honey improves healing of surgically treated lacerations in horses

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