FREE SHIPPING over $40
OVER 9000 FIVE-STAR REVIEWS
5% OFF ALL SUBSCRIPTIONS
100% HAPPINESS GUARANTEE
Analyze Diet
0
Home / Equine Research Bank / Vet Med Sci / Evaluation of factors associated with surgical site infectio...
Veterinary medicine and science2022; 8(4); 1478-1488; doi: 10.1002/vms3.839

Evaluation of factors associated with surgical site infection in equine proximal interphalangeal joint arthrodesis: 54 cases (2010-2019).

Abstract: The frequency of surgical site infection (SSI) following orthopaedic implant placement in horses has been reported but not compared with respect to specific antibiotic protocols administered. To determine factors associated with SSI in horses undergoing proximal interphalangeal joint (PIPJ) arthrodesis including perioperative antibiotic protocols. Records were evaluated (2010-2019), and horses undergoing PIPJ arthrodesis were identified. Patient signalment, supervising surgeon, reason for surgery, limb, implants placed, anaesthetic time, duration casting/coaptation postoperatively, antibiotic regimen and incidence/onset SSI were recorded. Bayesian and frequentist logistic regressions were used to estimate the contribution of covariates to infection occurrence. Fifty-four PIPJ arthrodeses were performed. SSI occurred in 2/54 (3.7%) on day 15,30. Arthrodesis was performed most commonly for osteoarthritis (33/54, 61.1%), fracture (11/54, 20.4%), and subluxation (5/54, 9.3%). Perioperative systemic antibiotics were administered 1-3 days (15/54, 27.8%) or > 3 days (39/54, 72.2%). Antibiotic protocols included cefazolin/gentamicin (20/54, 37%), cefazolin/gentamicin/doxycycline (14/54, 25.9%) and potassium penicillin/gentamicin (10/54, 18.5%). Regional limb perfusion was performed preoperatively 31/54 (57.4%) and postoperatively 7/54 (13%). Survival to dismissal was 98.1% (53/54 horses) with one horse euthanized due to support limb laminitis. No association was identified between antibiotic selection or duration (1-3 vs. > 3 days), pre-operative regional antibiotic perfusion, intraoperative antibiotic lavage or anaesthetic time ( 3 h) and SSI; however, modelling was complicated by quasi-complete or complete separation of the data. Bayesian analysis (but not frequentist analysis) indicated an association between post-operative regional antibiotic perfusion and SSI. Limitations include the retrospective nature of data collection and the low rate of infection overall. The prevalence of SSI in this population was lower than that in previous reports of equine orthopaedic internal fixation. There was no difference in SSI rate in cases administered systemic antibiotics for 1-3 days or >3 days, or for those horses that did or did not receive preoperative regional antibiotic perfusion.
© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.
Get Full Text
Publication Date: 2022-05-20 PubMed ID: 35594487PubMed Central: PMC9297777DOI: 10.1002/vms3.839Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
LinkedInCopy
  • Journal Article
  • Research Support
  • Non-U.S. Gov't
  • Research Support
  • N.I.H.
  • Extramural

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This study looked at surgical site infection (SSI) in horses after undergoing proximal interphalangeal joint (PIPJ) arthrodesis. It sought to identify factors influencing the likelihood of SSI, with a particular focus on the role of different antibiotic protocols. The findings suggest that antibiotic duration and pre-operative regional antibiotic perfusion don’t significantly affect infection rates, but Bayesian analysis indicates a possible link between post-operative regional antibiotic perfusion and SSI.

Research Methodology

  • The researchers analyzed medical records of horses undergoing PIPJ arthrodesis from 2010 to 2019.
  • Various factors were recorded including: patient’s details, supervising surgeon, reason for surgery, limb treated, implants placed, anaesthetic time, postoperative casting/coaptation duration, antibiotic regimen, and incidence/onset of SSI.
  • For the analysis, both Bayesian and frequentist logistic regressions were used to calculate the contribution of each factor to the occurrence of infection.

Findings

  • In total, 54 PIPJ arthrodeses were performed, with SSI occurring in only 2 cases (3.7%).
  • Most common reasons for arthrodesis were osteoarthritis (61.1%), fracture (20.4%), and subluxation (9.3%).
  • Antibiotics were administered systematically, either for 1-3 days (27.8% of cases) or for more than 3 days (72.2% of cases). The antibiotic protocols included cefazolin/gentamicin, cefazolin/gentamicin/doxycycline, and potassium penicillin/gentamicin.
  • Regional limb perfusion was performed preoperatively in 57.4% of horses and postoperatively in only 13%.
  • Almost all horses (98.1%) survived until they were discharged, except for one that was euthanized due to support limb laminitis.

Analysis and Conclusions

  • There was no seen association between SSI and factors like antibiotic selection, duration of antibiotic administration (1-3 vs. more than 3 days), pre-operative regional antibiotic perfusion, intraoperative antibiotic lavage, and anaesthetic time.
  • However, data analysis was complicated by quasi-complete or complete separation of data.
  • Interestingly, Bayesian (but not frequentist) analysis pointed towards a potential link between post-operative regional antibiotic perfusion and SSI.
  • It’s important to consider the study’s limitations, particularly the retrospective nature of data collection and the overall low rate of infection, which could affect the analysis.
  • The prevalence of SSI in this study was lower compared to previous reports of equine orthopaedic surgeries involving internal fixation.
  • The study concluded that there was no difference in SSI rate in cases administered systemic antibiotics for 1-3 days or more than 3 days, or for those horses that did or did not receive preoperative regional antibiotic perfusion.

Cite This Article

APA
Daniels A, Pezzanite LM, Griffenhagen GM, Hendrickson DA. (2022). Evaluation of factors associated with surgical site infection in equine proximal interphalangeal joint arthrodesis: 54 cases (2010-2019). Vet Med Sci, 8(4), 1478-1488. https://doi.org/10.1002/vms3.839

Publication

Veterinary medicine and science
ISSN: 2053-1095
NlmUniqueID: 101678837
Country: England
Language: English
Volume: 8
Issue: 4
Pages: 1478-1488

Researcher Affiliations

Daniels, Alyssa
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Pezzanite, Lynn M
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Griffenhagen, Gregg M
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Hendrickson, Dean A
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.

MeSH Terms

  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Arthrodesis / methods
  • Arthrodesis / veterinary
  • Bayes Theorem
  • Cefazolin
  • Forelimb
  • Gentamicins
  • Horse Diseases / epidemiology
  • Horse Diseases / surgery
  • Horses
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / veterinary

Grant Funding

  • TL1 TR002533 / NCATS NIH HHS
  • 5T32OD010437-19 / NIH HHS
  • 5TL1TR002533-02 / NCATS NIH HHS
  • T32 OD010437 / NIH HHS

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

References

This article includes 45 references
  1. Adams P, Honnas CM, Fortd TS. Arthrodesis of a subluxated proximal interphalangeal joint in a horse. Equine Practice 17, 26–31.
  2. Agarwal P, Agrawal PK, Sharma D, Baghel KD. Intravenous infusion for the treatment of diabetic and ischaemic non-healing pedal ulcers.. J Eur Acad Dermatol Venereol 2005 Mar;19(2):158-62.
    pubmed: 15752282doi: 10.1111/j.1468-3083.2005.01058.xgoogle scholar: lookup
  3. Ahern BJ, Richardson DW, Boston RC, Schaer TP. Orthopedic infections in equine long bone fractures and arthrodeses treated by internal fixation: 192 cases (1990-2006).. Vet Surg 2010 Jul;39(5):588-93.
    pubmed: 20459481doi: 10.1111/j.1532-950x.2010.00705.xgoogle scholar: lookup
  4. Biasutti SA, Cox E, Jeffcott LB, Dart AJ. A review of regional limb perfusion for distal limb infections in the horse. Equine Veterinary Education 33, 263–277.
  5. Caron JP, Fretz PB, Bailey JV, Barber SM. Proximal interphalangeal arthrodesis in the horse. A retrospective study and a modified screw technique.. Vet Surg 1990 May-Jun;19(3):196-202.
    pubmed: 2349775doi: 10.1111/j.1532-950x.1990.tb01167.xgoogle scholar: lookup
  6. Caston S, McClure S, Beug J, Kersh K, Reinertson E, Wang C. Retrospective evaluation of facilitated pastern ankylosis using intra-articular ethanol injections: 34 cases (2006-2012).. Equine Vet J 2013 Jul;45(4):442-7.
    doi: 10.1111/evj.12012pubmed: 23253080google scholar: lookup
  7. Colahan PT, Wheat JD, Meagher DM. Treatment of middle phalangeal fractures in the horse.. J Am Vet Med Assoc 1981 Jun 1;178(11):1182-5.
    pubmed: 7275757
  8. Curtiss AL, Stefanovski D, Richardson DW. Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008-2016).. Vet Surg 2019 Jul;48(5):685-693.
    pubmed: 30993777doi: 10.1111/vsu.13216google scholar: lookup
  9. Finsterbush A, Weinberg H. Venous perfusion of the limb with antibiotics for osteomyelitis and other chronic infections.. J Bone Joint Surg Am 1972 Sep;54(6):1227-34.
    pubmed: 4652053
  10. Heinze G, Ploner M, Jiricka L. logistf: Firth's Bias‐Reduced Logistic Regression. R package version 1.24.
  11. Goodrich B, Gabry J, Ali I, Brilleman S. rstanarm: Bayesian applied regression modeling via Stan. R package version 2.21.1.
  12. Herdan CL, Acke E, Dicken M, Archer RM, Forsyth SF, Gee EK, Pauwels FE. Multi-drug-resistant Enterococcus spp. as a cause of non-responsive septic synovitis in three horses.. N Z Vet J 2012 Sep;60(5):297-304.
    pubmed: 22506887doi: 10.1080/00480169.2011.651702google scholar: lookup
  13. Herthel TD, Rick MC, Judy CE, Cohen ND, Herthel DJ. Retrospective analysis of factors associated with outcome of proximal interphalangeal joint arthrodesis in 82 horses including Warmblood and Thoroughbred sport horses and Quarter Horses (1992-2014).. Equine Vet J 2016 Sep;48(5):557-64.
    pubmed: 26289294doi: 10.1111/evj.12503google scholar: lookup
  14. Hicks RB, Glass KG, Watkins JP. Proximal interphalangeal locking compression plate for pastern arthrodesis in horses.. Equine Vet J 2021 Jun 1;.
    doi: 10.1111/evj.13476pubmed: 34060117google scholar: lookup
  15. Knox PM, Watkins JP. Proximal interphalangeal joint arthrodesis using a combination plate-screw technique in 53 horses (1994-2003).. Equine Vet J 2006 Nov;38(6):538-42.
    pubmed: 17124844doi: 10.2746/042516406x154840google scholar: lookup
  16. Lazzarini L, Novelli A, Marzano N, Timillero L, Fallani S, Viola R, de Lalla F. Regional and systemic prophylaxis with teicoplanin in total knee arthroplasty: a tissue penetration study.. J Arthroplasty 2003 Apr;18(3):342-6.
    pubmed: 12728428doi: 10.1054/arth.2003.50053google scholar: lookup
  17. Levine DG, Richardson DW. Clinical use of the locking compression plate (LCP) in horses: a retrospective study of 31 cases (2004-2006).. Equine Vet J 2007 Sep;39(5):401-6.
    pubmed: 17910263doi: 10.2746/042516407x196555google scholar: lookup
  18. Lischer CJ, Auer JA. Arthrodesis techniques. Equine surgery 5th ed., pp 1374–1398.
  19. Loncaric I, Künzel F, Licka T, Simhofer H, Spergser J, Rosengarten R. Identification and characterization of methicillin-resistant Staphylococcus aureus (MRSA) from Austrian companion animals and horses.. Vet Microbiol 2014 Jan 31;168(2-4):381-7.
    pubmed: 24332703doi: 10.1016/j.vetmic.2013.11.022google scholar: lookup
  20. MacDonald DG, Morley PS, Bailey JV, Barber SM, Fretz PB. An examination of the occurrence of surgical wound infection following equine orthopaedic surgery (1981-1990).. Equine Vet J 1994 Jul;26(4):323-6.
    pubmed: 8575401doi: 10.1111/j.2042-3306.1994.tb04394.xgoogle scholar: lookup
  21. MacLellan KN, Crawford WH, MacDonald DG. Proximal interphalangeal joint arthrodesis in 34 horses using two parallel 5.5-mm cortical bone screws.. Vet Surg 2001 Sep-Oct;30(5):454-9.
    pubmed: 11555821doi: 10.1053/jvet.2001.25873google scholar: lookup
  22. Mallardo K, Nizza S, Fiorito F, Pagnini U, De Martino L. A comparative evaluation of methicillin-resistant staphylococci isolated from harness racing-horses, breeding mares and riding-horses in Italy.. Asian Pac J Trop Biomed 2013 Mar;3(3):169-73.
    pmc: PMC3631744pubmed: 23620832doi: 10.1016/s2221-1691(13)60044-1google scholar: lookup
  23. Martin GS, McIlwraith CW, Turner AS, Nixon AJ, Stashak TS. Long-term results and complications of proximal interphalangeal arthrodesis in horses.. J Am Vet Med Assoc 1984 May 1;184(9):1136-40.
    pubmed: 6725132
  24. McCormick JD, Watkins JP. Double plate fixation for the management of proximal interphalangeal joint instability in 30 horses (1987-2015).. Equine Vet J 2017 Mar;49(2):211-215.
    pubmed: 27037918doi: 10.1111/evj.12578google scholar: lookup
  25. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing.
  26. Richardson DW, Ahern BJ. Synovial and osseous infections. Equine surgery 4th edn., pp. 1189–1200.
  27. Rick MC, Herthel D, Boles C. Surgical management of middle phalangeal fractures and high ringbone in the horse. A review of 16 cases. Proceedings of the American Association of Equine Practice 31, 315–321.
  28. Rubio‐Martinez LM. Antimicrobial regional limb perfusion: Does it really fight infection?. Equine Veterinary Education 33, 220–224.
  29. Sakai RR, Goodrich LR, Katzman SA, Moorman VJ, Leise BS, Kawcak CE, Galuppo LD. Use of a locking compression plate for equine proximal interphalangeal joint arthrodesis: 29 cases (2008-2014).. J Am Vet Med Assoc 2018 Dec 1;253(11):1460-1466.
    pubmed: 30451612doi: 10.2460/javma.253.11.1460google scholar: lookup
  30. Schaer TP, Bramlage LR, Embertson RM, Hance S. Proximal interphalangeal arthrodesis in 22 horses.. Equine Vet J 2001 Jul;33(4):360-5.
    doi: 10.2746/042516401776249552pubmed: 11469768google scholar: lookup
  31. Schneider RK, Bramlage LR, Hardy J. Arthrodesis of the distal interphalangeal joint in two horses using three parallel 5.5-mm cortical screws.. Vet Surg 1993 Mar-Apr;22(2):122-8.
    doi: 10.1111/j.1532-950x.1993.tb01685.xpubmed: 8511845google scholar: lookup
  32. Schneider JE, Carnine BL, Guffy MM. Arthrodesis of the proximal interphalangeal joint in the horse: a surgical treatment for high ringbone.. J Am Vet Med Assoc 1978 Nov 15;173(10):1364-9.
    pubmed: 365842
  33. Seidel C, Bühler-Singer S, Tacke J, Hornstein OP. [Therapeutic superiority of regional retrograde venous antibiotic pressure infusion versus systemic venous infusions in diabetic patients with infected neuropathic plantar ulcers].. Hautarzt 1994 Feb;45(2):74-9.
    pubmed: 8150634doi: 10.1007/pl00013260google scholar: lookup
  34. Sod GA, Riggs LM, Mitchell CF, Martin GS. A mechanical comparison of equine proximal interphalangeal joint arthrodesis techniques: an axial locking compression plate and two abaxial transarticular cortical screws versus an axial dynamic compression plate and two abaxial transarticular cortical screws.. Vet Surg 2011 Jul;40(5):571-8.
    pubmed: 21521241doi: 10.1111/j.1532-950x.2011.00830.xgoogle scholar: lookup
  35. Steenhaut M, Verschooten F, De Moor A. Arthrodesis of the pastern joint in the horse.. Equine Vet J 1985 Jan;17(1):35-40.
    pubmed: 3979371doi: 10.1111/j.2042-3306.1985.tb02036.xgoogle scholar: lookup
  36. Stöckle SD, Failing K, Koene M, Fey K. Postoperative complications in equine elective, clean orthopaedic surgery with/without antibiotic prophylaxis.. Tierarztl Prax Ausg G Grosstiere Nutztiere 2018 Apr;46(2):81-86.
    pubmed: 29727872doi: 10.15653/tpg-170491google scholar: lookup
  37. Theelen MJ, Wilson WD, Edman JM, Magdesian KG, Kass PH. Temporal trends in prevalence of bacteria isolated from foals with sepsis: 1979-2010.. Equine Vet J 2014 Mar;46(2):169-73.
    pubmed: 23808819doi: 10.1111/evj.12131google scholar: lookup
  38. Van den Eede A, Martens A, Lipinska U, Struelens M, Deplano A, Denis O, Haesebrouck F, Gasthuys F, Hermans K. High occurrence of methicillin-resistant Staphylococcus aureus ST398 in equine nasal samples.. Vet Microbiol 2009 Jan 1;133(1-2):138-44.
    pubmed: 18701224doi: 10.1016/j.vetmic.2008.06.021google scholar: lookup
  39. Van den Eede A, Hermans K, Van den Abeele A, Floré K, Dewulf J, Vanderhaeghen W, Crombé F, Butaye P, Gasthuys F, Haesebrouck F, Martens A. Methicillin-resistant Staphylococcus aureus (MRSA) on the skin of long-term hospitalised horses.. Vet J 2012 Aug;193(2):408-11.
    pubmed: 22264643doi: 10.1016/j.tvjl.2011.12.004google scholar: lookup
  40. Vehtari A, Gelman A, Gabry J. Practical Bayesian model evaluation using leave‐one‐out cross‐validation and WAIC. Statistics and Computing 27, 1413–1432.
    doi: 10.1007/s11222-016-9696-4google scholar: lookup
  41. Vehtari A, Gabry J, Magnusson M, Yao Y, Bürkner P, Paananen T, Gelman A. loo: Efficient leave‐one‐out cross‐validation and WAIC for Bayesian models. R package version 2.4.1.
  42. Watkins JP. Fractures of the middle phalanx. Equine fracture repair pp 133–145.
  43. Watts AE, Fortier LA, Nixon AJ, Ducharme NG. A technique for laser-facilitated equine pastern arthrodesis using parallel screws inserted in lag fashion.. Vet Surg 2010 Feb;39(2):244-53.
    pubmed: 20210975doi: 10.1111/j.1532-950x.2009.00627.xgoogle scholar: lookup
  44. Weese JS. A review of post-operative infections in veterinary orthopaedic surgery.. Vet Comp Orthop Traumatol 2008;21(2):99-105.
    pubmed: 18545710doi: 10.3415/vcot-07-11-0105google scholar: lookup
  45. Whitehair KJ, Adams SB, Toombs JP, Parker JE, Prostredny JM, Whitehair JG, Aiken SW. Arthrodesis for congenital flexural deformity of the metacarpophalangeal and metatarsophalangeal joints.. Vet Surg 1992 May-Jun;21(3):228-33.
    pubmed: 1626399doi: 10.1111/j.1532-950x.1992.tb00051.xgoogle scholar: lookup

Citations

This article has been cited 2 times.
  1. Guo Y, Feng H, Du L, Yu Z. Patterns of antibiotic resistance genes and virulence factor genes in the gut microbiome of patients with osteoarthritis and rheumatoid arthritis. Front Microbiol 2024;15:1427313.
    doi: 10.3389/fmicb.2024.1427313pubmed: 39633808google scholar: lookup
  2. Mita H, Kuroda T, Niwa H, Tamura N, Fukuda K, Ohta M. Incidence of surgical site infection after internal fixation of the first phalangeal bone and the third metacarpal/metatarsal bone fractures in Thoroughbred racehorses. J Equine Sci 2023 Sep;34(3):61-66.
    doi: 10.1294/jes.34.61pubmed: 37781565google scholar: lookup
Subscribe to our newsletter
Join 99,075 horse owners like you who receive our email updates on horse health and nutrition.