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Equine veterinary journal2025; doi: 10.1111/evj.14489

Prospective randomised comparison of different antimicrobial protocols for the prevention of surgical site infections in horses undergoing emergency exploratory celiotomy.

Abstract: Surgical site infection (SSI) is an important complication following emergency celiotomy in the horse. Judicious antimicrobial use is important for the prevention of antimicrobial resistance and the limitation of antimicrobial-associated complications. Previous studies in horses have found no association between SSI and perioperative antimicrobial duration, but the ideal duration of antimicrobial administration in horses undergoing exploratory celiotomy remains unclear. Objective: To compare SSI and describe post-operative complications, survival, duration and cost of hospitalisation in horses receiving one of two antimicrobial protocols following clean or select clean-contaminated emergency exploratory celiotomy. Methods: Prospective randomised clinical study. Methods: Adult horses undergoing clean or selected clean-contaminated emergency celiotomy at The University of Georgia Teaching Hospital (2013-2019) were prospectively enrolled and randomised to protocol A (pre- and intra-operative antimicrobials only, n = 39) or protocol B (antimicrobials continued for 72 h of post-operative administration, n = 37). Incisional closure and protection were standardised. The prevalence of SSI was compared between protocols for horses surviving beyond day five of hospitalisation and additional clinical outcomes were described. Results: Horses in protocol A had an increased prevalence of SSI during hospitalisation compared with protocol B (6/37 [16%] vs. 0/35 [0%]; p = 0.03). The difference was of borderline significance at 4 weeks post-operatively (7/32 [22%] vs. 1/31 [3%]; p = 0.05). Conclusions: Planned enrolment was not met, providing only enough data for a small study. Numbers were limited by inclusion criteria as well as difficulties regarding owner consent and surgeon-determined enrolment. In light of the low statistical power of the study, results should be used to direct further research, and caution must be taken in applying them to clinical practice. Conclusions: The difference in hospitalised SSI between groups and the low prevalence of SSI, particularly in the 72-h post-operative group, supports the need for continued research to determine optimal antimicrobial duration and protocols to reduce SSI in horses undergoing exploratory celiotomy.
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Publication Date: 2025-02-19 PubMed ID: 39972624DOI: 10.1111/evj.14489Google Scholar: Lookup
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Summary

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The study explores the effects of two different antibiotic protocols on surgical site infections (SSIs) in horses undergoing emergency exploratory celiotomy. It found a significant reduction in SSIs in horses that were given antibiotics for 72 hours post-surgery compared to those who only received pre- and intra-operative antibiotics.

Study Design and Methodology

  • The research is a prospective randomised clinical study conducted at The University of Georgia Teaching Hospital from 2013-2019.
  • Adult horses undergoing clean or selected clean-contaminated emergency celiotomy were randomly divided into two groups. In protocol A, the horses received only pre- and intra-operative antibiotics (39 horses). In protocol B, the antibiotics continued for 72 hours post-operatively (37 horses).
  • All surgical procedures were standardized, including incisional closure and protection.
  • The primary comparison was the prevalence of SSIs between the two groups for horses surviving beyond the fifth day of hospitalization.

Results

  • There was an increased prevalence of SSI among the horses in protocol A during hospitalization when compared to protocol B.
  • The difference was significant during hospitalization (16% in protocol A vs. 0% in protocol B), and was of borderline significance at four weeks post-operatively (22% in protocol A vs. 3% in protocol B).

Conclusions

  • The study did not reach its planned enrolment due to a combination of strict inclusion criteria, inability to obtain owner consent, and surgeon-determined enrolment. Consequently, the study had low statistical power, causing the results to be suggestive rather than conclusive.
  • However, the observed difference in SSIs between the two groups supports the need for further research in determining the optimal duration and protocol of antimicrobial administration in horses undergoing exploratory celiotomy.
  • The researchers advise caution in applying the results directly to clinical practice due to the limitations of the study.

Cite This Article

APA
Christie KD, Epstein KL, Tyma JF, Afonso T, Fultz LE, Giguère S. (2025). Prospective randomised comparison of different antimicrobial protocols for the prevention of surgical site infections in horses undergoing emergency exploratory celiotomy. Equine Vet J. https://doi.org/10.1111/evj.14489

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Christie, Katharine D
  • Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA.
Epstein, Kira L
  • Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA.
Tyma, Jesse F
  • Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA.
Afonso, Tiago
  • Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA.
Fultz, Lisa E
  • Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA.
Giguère, Steeve
  • Department of Large Animal Medicine, University of Georgia, Athens, Georgia, USA.

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Citations

This article has been cited 2 times.
  1. Stöckle SD, Kannapin DA, Merle R, Lübke-Becker A, Gehlen H. Comparison of a Single-Shot Antibiotic Protocol Compared to a Conventional 5-Day Antibiotic Protocol in Equine Diagnostic Laparotomy Regarding Pre- and Postoperative Colonization with Multi-Drug-Resistant Indicator Pathogens. Antibiotics (Basel) 2026 Jan 21;15(1).
    doi: 10.3390/antibiotics15010106pubmed: 41594143google scholar: lookup
  2. Southwood LL, Long A, Perez J, Daniel S, Bittinger K, Aitken M, Redding L. Effect of surgical antimicrobial prophylaxis duration for colic surgery on complications and resistome. Equine Vet J 2026 Mar;58(2):390-403.
    doi: 10.1002/evj.70137pubmed: 41369016google scholar: lookup
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