Osteomyelitis and Osteonecrosis after Intraosseous Perfusion with Gentamicin

Parker, Russell; Bladon, B. M.; McGovern, Kate; Smith, Ken

doi:10.1111/j.1532-950x.2010.00685.x

Cited by 23 publications

(14 citation statements)

References 23 publications

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“…When venous access to the distal portion of the limb is unattainable, intraosseous perfusion has been advocated (Mattson et al. , 2004), but intraosseous perfusion requires orthopedic equipment and skills, causes temporary pain by elevating the intraosseous pressure, and may result in the leakage of perfusate during the administration and in osteonecrosis (Rubio‐Martinez & Cruz, 2006; Parker et al. , 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Multiple treatments using RLP are often needed to resolve persistent infection, and premature termination of RLP is likely to occur because of loss of venous access to the PD vein (Butt et al, 2001;Mattson et al, 2004). When venous access to the distal portion of the limb is unattainable, intraosseous perfusion has been advocated (Mattson et al, 2004), but intraosseous perfusion requires orthopedic equipment and skills, causes temporary pain by elevating the intraosseous pressure, and may result in the leakage of perfusate during the administration and in osteonecrosis (Rubio-Martinez & Cruz, 2006;Parker et al, 2010). Consequently, when venous access to the distal portion of the limb is unattainable, such as when the veins below the carpus or tarsus suffer from thromboses or collapse or when the distal portion of the limb is covered with a cast, the cephalic or saphenous veins can be used for RLP Levine et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of regional limb perfusion with amikacin using the saphenous, cephalic, and palmar digital veins in standing horses

Kelmer

Bell

Martı́n-Jiménez

et al. 2012

Vet Pharm & Therapeutics

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Previous studies have shown that regional limb perfusion (RLP) using the palmar digital (PD) vein delivers therapeutic concentration of amikacin to the distal limb. Our hypothesis was that using the cephalic and saphenous veins for RLP will enable delivery of therapeutic concentrations of amikacin to the distal limb. Nineteen healthy horses participated in the study. The cephalic, saphenous, or PD vein was used to perfuse the limb with amikacin. Two grams of amikacin was used for RLP using the saphenous and the cephalic veins, and one gram was used in the PD vein. Synovial samples were collected from the metacarpo-/metatarsophalangeal (MCP/MTP) joint, and blood samples were collected from the jugular vein. Maximum concentration (Cmax) of amikacin in the MCP/MTP joint using the cephalic and the saphenous vein was 277 and 363 mg/L, respectively. The amikacin concentrations achieved in the synovial fluid of the MCP/MTP joint in the current study were between 69 and 91 times the minimally inhibitory concentration of common susceptible bacterial pathogens causing orthopedic infections in horses. To conclude, this study shows that use of the proximal veins for RLP to treat distal limb infections is a viable alternative to using the palmar or plantar digital vein.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of regional limb perfusion with amikacin using the saphenous, cephalic, and palmar digital veins in standing horses

Kelmer

Bell

Martı́n-Jiménez

et al. 2012

Vet Pharm & Therapeutics

View full text Add to dashboard Cite

show abstract

“…2001; Mattson et al . 2004), but a recent case report documented progressive osteonecrosis and ultimately pathological fracture following IORLP with high doses of gentamicin in the proximal phalanx (Parker et al . 2010).…”

Section: Introductionmentioning

confidence: 99%

“…There have been concerns over the potentially toxic effects of some antibiotics, particularly aminoglycosides, on human mesenchymal stromal cells (MSC) when high local concentrations are sustained (Miclau et al 1995;Isefuku et al 2003;Chang et al 2006). Intraosseous regional limb perfusion is generally well tolerated in horses, with minimal transient side effects reported (Butt et al 2001;Mattson et al 2004), but a recent case report documented progressive osteonecrosis and ultimately pathological fracture following IORLP with high doses of gentamicin in the proximal phalanx (Parker et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Thein vitroeffects of antibiotics on cell viability and gene expression of equine bone marrow‐derived mesenchymal stromal cells

Parker

Clegg

Taylor

2011

Equine Veterinary Journal

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“…12 Reported complications of A-RLP include thrombophlebitis of the injected vein, soft tissue inflammation over the intraosseous infusion site, difficult injection into the medullary cavity of the bone, and osteonecrosis of the injected bone. 3,6,13 On the basis of clinical experiences and anecdotal clinical reports, 1,5,11,12,14 it is believed that the use of A-RLP has helped increase the successful outcome of horses with orthopedic infections. However, information about ease of use, complications, and short-and long-term results after clinical application of A-RLP in a large number of cases is lacking.…”

mentioning

confidence: 99%

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

Rubio‐Martínez

Elmas²,

Black³

et al. 2012

javma

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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.

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Osteomyelitis and Osteonecrosis after Intraosseous Perfusion with Gentamicin

Abstract: Lower doses of perfusate within the medullary canal of P1 or alternative perfusion sites should be considered.

Cited by 23 publications

References 23 publications

Evaluation of regional limb perfusion with amikacin using the saphenous, cephalic, and palmar digital veins in standing horses

Evaluation of regional limb perfusion with amikacin using the saphenous, cephalic, and palmar digital veins in standing horses

Thein vitroeffects of antibiotics on cell viability and gene expression of equine bone marrow‐derived mesenchymal stromal cells

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

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