Antimicrobial prophylaxis is considered sufficient to preserve an acceptable surgical site infection rate in clean ortho
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cta Veterinaria Scandinavica Open Access
RESEARCH
Antimicrobial prophylaxis is considered sufficient to preserve an acceptable surgical site infection rate in clean orthopaedic and neurosurgeries in dogs Kirsi Johanna Välkki1*, Katariina Hanne Thomson2, Thomas Sven Christer Grönthal1, Jouni Juho Tapio Junnila3, Merja Hilma Johanna Rantala1, Outi Maria Laitinen‑Vapaavuori1 and Sari Helena Mölsä1
Abstract Background: Surgical site infections (SSI) are associated with increased morbidity and mortality. To lower the incidence of SSI, antimicrobial prophylaxis is given 30–60 min before certain types of surgeries in both human and veterinary patients. However, due to the increasing concern of antimicrobial resistance, the benefit of antimicrobial prophylaxis in clean orthopaedic and neurosurgeries warrants investigation. The aims of this retrospective crosssectional study were to review the rate of SSI and evaluate the compliance with antimicrobial guidelines in dogs at a veterinary teaching hospital in 2012–2016. In addition, possible risk factors for SSI were assessed. Results: Nearly all dogs (377/406; 92.9%) received antimicrobial prophylaxis. Twenty-nine dogs (7.1%) did not receive any antimicrobials and only four (1.1%) received postoperative antimicrobials. The compliance with in-house and national protocols was excellent regarding the choice of prophylactic antimicrobial (cefazolin), but there was room for improvement in the timing of prophylaxis administration. Follow-up data was available for 89.4% (363/406) of the dogs. Mean follow-up time was 464 days (range: 3–2600 days). The overall SSI rate was 6.3%: in orthopaedic surgeries it was 6.7%, and in neurosurgeries it was 4.2%. The lowest SSI rates (0%) were seen in extracapsular repair of cranial cruciate ligament rupture, ulnar ostectomy, femoral head and neck excision, arthrotomy and coxofemoral luxation repair. The highest SSI rate (25.0%) was seen in arthrodesis. Omission of antimicrobials did not increase the risk for SSI (P = 0.56; OR 1.7; C I95% 0.4–5.0). Several risk factors for SSI were identified, including methicillin-resistant Staphylococcus pseudintermedius carriage (P = 0.02; OR 9.0; C I95% 1.4–57.9) and higher body temperature (P = 0.03; OR 1.69; C I95% 1.0–2.7; mean difference + 0.4 °C compared to dogs without SSI). Conclusions: Antimicrobial prophylaxis without postoperative antimicrobials is sufficient to maintain the overall rate of SSI at a level similar to published data in canine clean orthopedic and neurosurgeries. Keywords: Antibiotic, Canine, Prophylaxis, Surgery
*Correspondence: [email protected] 1 Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, Viikintie 49, 00014 Helsinki, Finland Full list of author information is available at the end of the article
Background Surgical site infection (SSI) is defined as an infection that emerges after surgery [1]. This inherent risk in surgical procedures is associated with increased morbidity, costs, and even
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