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1.
Vet Surg ; 49(5): 930-939, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32359005

RESUMO

OBJECTIVE: To identify factors associated with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective case series. ANIMALS: Dogs (n = 541) that underwent TPLO (n = 659). METHODS: Medical records of dogs that underwent TPLO from 2011-2018 were reviewed. Data collected included perioperative and postoperative antimicrobial administration, stifle inspection, duration of surgery and anesthesia, comorbidities, and development of SSI including timing, microbiological investigation, and implant removal. Referring veterinarians were contacted for all dogs without a recorded return visit. Risk factors for SSI were assessed by using a multivariable logistic regression model built by using a stepwise approach. RESULTS: Surgical site infection was documented in 71 of 659 (11%) TPLO, with methicillin-resistant Staphylococcus pseudintermedius accounting for 20 of 71 (28%) infections. Protective factors against SSI included administration of postoperative antimicrobials (odds ratio [OR] 0.263; 95% CI = 0.157, 0.442) and timing of preoperative antimicrobial administration. Preoperative antimicrobial timing was protective against SSI when it was administered more than 60 minutes before the first incision compared with administration within 30 minutes (OR 0.275; 95% CI = 0.112, 0.676) or within 60 minutes (OR 0.419; 95% CI = 0.189, 0.929) of the first incision. CONCLUSION: Early administration of perioperative antimicrobials and postoperative antimicrobial administration were protective against SSI after TPLO. CLINICAL SIGNIFICANCE: Antimicrobials can influence the risk of SSI after TPLO. Perioperative and postoperative antimicrobial administration timing should be considered to reduce SSI.


Assuntos
Doenças do Cão/etiologia , Osteotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Animais , Antibacterianos/uso terapêutico , Remoção de Dispositivo , Doenças do Cão/cirurgia , Cães , Feminino , Seguimentos , Masculino , Osteotomia/efeitos adversos , Período Pós-Operatório , Registros , Estudos Retrospectivos , Fatores de Risco , Staphylococcus , Joelho de Quadrúpedes/cirurgia , Tíbia/cirurgia
2.
Vet Surg ; 49(2): 321-328, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31664719

RESUMO

OBJECTIVE: To compare the effect of three methods of subcutaneous tissue closure on postoperative incisional complications and pain in cats. STUDY DESIGN: Single-center, randomized, blinded, controlled trial conducted in a veterinary teaching hospital. ANIMALS: Two hundred ninety-seven cats undergoing midline celiotomy for ovariohysterectomy (n = 280) or other abdominal procedure (n = 17). METHODS: Cats (n = 297) were assigned to one of three subcutaneous closure methods: simple continuous apposition with tacking to the rectus fascia (n = 108, quilting [Q] group); simple continuous apposition (SC; n = 94); no subcutaneous closure (NC; n = 95). Primary outcomes were incidence of seroma formation, postoperative pain, and surgical site infection or dehiscence. Active follow-up was obtained at 10 and 30 days postoperatively. RESULTS: Baseline characteristics did not differ between groups. Seroma was less common in the Q group (13.0%) than in the NC (27.3%) and SC (25.9%) groups (P = .03). Compared with the other two groups, the relative risk of seroma formation in the Q group was 0.49 (95% CI = 0.28-0.86, P = .01). Median mechanical pain thresholds were higher (indicating greater comfort) in cats with subcutaneous sutures (Q and SC = 1.23 [interquartile range (IQR), 0.2-2.6 N], NC = 0.83 [IQR, 0-1.87 N], P = .04) on the day after surgery. CONCLUSION: Closing subcutaneous tissues with a quilting closure pattern reduced seroma formation in cats undergoing celiotomy. CLINICAL SIGNIFICANCE: Placing a quilting suture pattern in the subcutaneous tissues after celiotomy is a simple low-cost measure that reduces seromas in cats. Abstaining from subcutaneous closure cannot be recommended because of increased seroma formation and pain.


Assuntos
Dor Pós-Operatória/veterinária , Complicações Pós-Operatórias/veterinária , Técnicas de Sutura/veterinária , Suturas , Técnicas de Fechamento de Ferimentos/veterinária , Abdome , Animais , Gatos , Feminino , Laparotomia/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/veterinária , Seroma/etiologia , Seroma/veterinária , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/veterinária , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos
3.
Vet Surg ; 49(1): 106-113, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31664725

RESUMO

OBJECTIVE: To determine the influence of prophylactic administration of oral antimicrobial medications after tibial plateau leveling osteotomy (TPLO) on surgical site infections (SSI) and antimicrobial-resistant infections. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Dogs treated with unilateral TPLO (n = 308) between January 2013 and December 2015. METHODS: Medical records were reviewed for signalment, surgically treated limb, duration of surgery and anesthesia, postoperative administration of antimicrobial medications, antibiotic agent, surgeon, and development of SSI. Statistical analyses included descriptive statistics, simple linear regression, analysis of variance, Fisher's protected least significant difference, and χ2 testing. RESULTS: Data were collected from records of 31 dogs that did not receive antimicrobial medications and 277 dogs that did receive oral antimicrobial medications for 14 days after TPLO. Superficial incisional SSI was detected in two of 31 dogs that did not receive antimicrobial medications and in 48 of 277 dogs that did receive antimicrobial medications (P = .1194). Deep incisional SSI occurred in two of 31 dogs that did not receive antimicrobial medications and in 27 of 277 dogs that did receive antimicrobial medications (P = .5513). Antibiotic-resistant deep incisional SSI occurred in two of 31 dogs that did not receive antimicrobial medications and in 18 of 277 dogs that did receive antimicrobial medications (P = .9920). Body weight correlated with deep incisional SSI and resistant infections. Prolonged duration of surgery and anesthesia were associated with superficial incisional SSI, deep incisional SSI, and antibiotic resistance. Surgeons influenced deep incisional SSI. CONCLUSION: Previously reported predisposing factors for infection were confirmed, but postoperative administration of antimicrobial medications was not protective against SSI nor did it predispose to antibiotic resistance in our clinical setting. CLINICAL SIGNIFICANCE: This study does not provide evidence to support administration of prophylactic oral antimicrobial medications after unilateral TPLO.


Assuntos
Anti-Infecciosos/uso terapêutico , Cães/lesões , Osteotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Tíbia/cirurgia , Administração Oral , Animais , Anti-Infecciosos/administração & dosagem , Cães/cirurgia , Feminino , Masculino , Período Pós-Operatório , Registros/veterinária , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
4.
Vet Surg ; 49 Suppl 1: O148-O155, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31814138

RESUMO

OBJECTIVE: To determine the frequency and types of paramedian incisional complications after prophylactic laparoscopy-assisted gastropexy (LAG) in dogs and to evaluate potential risk factors for complications. STUDY DESIGN: Multi-institutional retrospective study. ANIMALS: Client-owned dogs (N = 411). METHODS: Records for dogs that underwent single-incision-port laparoscopy-assisted gastropexy (SIPLAG) or multiple-port laparoscopy-assisted gastropexy (MPLAG) at five veterinary referral hospitals were reviewed. Information regarding signalment, surgical procedures, perioperative care, and incisional complications was collected. Follow-up information was obtained by review of medical records and/or communication with owners. Potential risk factors for complications were examined statistically. RESULTS: Paramedian incisional complications were observed in 78 of 411 (19%) dogs. The most common complication was seroma formation, which occurred in 51 (12.4%) dogs. Surgical site infections were observed in 16 (3.9%) dogs, and dehiscence or development of excessive scar tissue at the incision site were each observed in nine (2.2%) dogs. Complications resolved with conservative treatment in 75 of 78 (96.2%) dogs and with surgical treatment in three of 78 (3.8%) dogs. The odds of complications were approximately twice as high in dogs undergoing SIPLAG than in dogs undergoing MPLAG (odds ratio, 2.03; P = .006). CONCLUSION: Minor paramedian incisional complications, particularly seroma formation, were frequently observed after LAG. Most complications were successfully managed conservatively. Single-incision-port laparoscopy-assisted gastropexy was associated with a higher complication rate compared with MPLAG. CLINICAL SIGNIFICANCE: Owners should be informed that there is a relatively high rate of minor paramedian incisional complications after LAG. The risk of complications appears to be higher for SIPLAG than for MPLAG.


Assuntos
Doenças do Cão/cirurgia , Gastropexia/veterinária , Laparoscopia/veterinária , Volvo Gástrico/veterinária , Infecção da Ferida Cirúrgica/veterinária , Animais , Cães , Feminino , Gastropexia/métodos , Humanos , Laparoscopia/efeitos adversos , Masculino , Razão de Chances , Assistência Perioperatória , Estudos Retrospectivos , Fatores de Risco , Seroma/etiologia , Volvo Gástrico/cirurgia , Ferida Cirúrgica , Infecção da Ferida Cirúrgica/etiologia
5.
Vet Surg ; 48(7): 1211-1217, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407819

RESUMO

OBJECTIVE: To compare surgical site infection (SSI) rates after double locking plate and screw fixation (DLP), standard locking plate and screw fixation (LP), and conventional nonlocking plate and screw fixation (NLP) in dogs weighing >50 kg undergoing tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective study (January 2003-October 2017). ANIMALS: Two hundred seventy-five dogs weighing >50 kg with cranial cruciate ligament disease treated with TPLO. METHODS: Medical records of dogs weighing >50 kg that underwent TPLO by DLP, LP, and NLP with a minimum follow-up period of 12 months were included. Data collected included signalment, details of any concurrent surgical procedure, type of implant used, use of postoperative antibiotic therapy, occurrence of perioperative complications, and presence of postoperative infection. The probability, risk difference, and relative risk of SSI were estimated for each fixation with a marginal model. RESULTS: Nonlocking plate and screw fixation was used in 114 (41.5%) dogs, LP was used in 128 (46.5%) dogs, and DLP was used in 33 (12%) dogs. Surgical site infection was diagnosed in 48 of 275 (17.5%) dogs. Postoperative antibiotic therapy was used in 74 (64.9%) dogs, 62 (48.4%) dogs, and 32 (97.0%) dogs in the NLP, LP, and DLP groups, respectively. Dogs with NLP, LP, and DLP had postoperative infection rates of 24.5%, 13.3%, and 9.1%, respectively. There were no risk differences for the three groups (Holm-adjusted P > .05). CONCLUSION: No difference in infection rates was detected between DLP, LP, or NLP for TPLO in these dogs weighing >50 kg. CLINICAL SIGNIFICANCE: Fixation of TPLO with DLP in dogs weighing >50 kg does not seem to increase the risk of SSI compared with LP and NLP.


Assuntos
Placas Ósseas/veterinária , Parafusos Ósseos/veterinária , Doenças do Cão/etiologia , Osteotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Animais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/veterinária , Antibacterianos , Doenças do Cão/cirurgia , Cães , Feminino , Masculino , Osteotomia/efeitos adversos , Osteotomia/métodos , Estudos Retrospectivos , Joelho de Quadrúpedes/cirurgia , Tíbia/cirurgia
6.
J Vet Intern Med ; 33(5): 2014-2019, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31294877

RESUMO

BACKGROUND: Esophagostomy feeding tubes (E-tubes) are an essential tool for management of hyporexic patients' acute and chronic nutritional requirements. Despite their routine use, limited information is available regarding E-tube complications, especially in the recent veterinary literature. OBJECTIVE: To provide an updated descriptive account of E-tube complications in cats and dogs, and to evaluate potential prognostic factors to determine if certain patients are at increased risk for complications. ANIMALS: One hundred two dogs and 123 cats. METHODS: Retrospective study evaluating patients that had E-tubes placed between March 2014 and March 2017. RESULTS: One hundred patients (44.4%) experienced a complication related to tube placement, with a similar complication rate among dogs (43.1%) and cats (45.5%). Twenty-two cats (17.8%) and 14 dogs (13.7%) developed signs of infection at the E-tube site, with 5 cats (22.7%) and 5 dogs (35.7%) requiring surgical debridement. Regurgitation of food through the E-tube stoma was noted in 7 dogs and 1 cat. Three patients were euthanized as a result of tube-related complications. CONCLUSIONS AND CLINICAL IMPORTANCE: We have provided an updated descriptive review of complications associated with E-tube placement in a large population of dogs and cats at a tertiary referral center. Although E-tubes are essential tools that generally are safe and well tolerated, several complications can occur. We did not identify any specific factors that increase patient risk for these complications, and therefore it is important that all patients are closely monitored and clients are educated to pursue prompt veterinary assessment when such complications arise.


Assuntos
Doenças do Gato/cirurgia , Doenças do Cão/cirurgia , Esofagostomia/efeitos adversos , Complicações Pós-Operatórias/veterinária , Animais , Gatos , Cães , Nutrição Enteral/veterinária , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/cirurgia , Infecção da Ferida Cirúrgica/veterinária , Vômito/veterinária
7.
Vet Surg ; 48(5): 700-706, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31168817

RESUMO

OBJECTIVE: To report the use and long-term outcome of dogs with surgical site infection (SSI) after tibial plateau leveling osteotomy (TPO), treated with an amikacin-infused collagen sponge and implant removal. STUDY DESIGN: Retrospective study. ANIMALS: Thirty-one client-owned dogs. METHODS: Medical records were reviewed for dogs with SSI after a TPLO that were treated with surgical implant removal and concurrent implantation of an amikacin-infused collagen sponge. Relevant clinical and surgical data were recorded. The TPLO implants were routinely removed; the surgical site was swabbed for culture. The sponge was aseptically infused with amikacin prior to implantation. Postprocedure examinations consisted of visual inspection of the incision by the surgeon and lameness scoring. RESULTS: Thirty-one dogs met all inclusion criteria. Median follow-up time was 687 days. Short-term examination after implant removal and sponge implantation revealed uneventful incisional healing in 24 dogs. Six (19.4%) dogs exhibited inflamed incision sites a median of 4 days (range, 3-9) postoperatively that resolved without additional treatment. One (3.2%) dog required empirical antibiotic treatment 7 days postoperatively but was lost to long-term follow-up. Long-term follow-up examination revealed no clinical evidence of SSI recurrence and no lameness in the remaining 30 cases. CONCLUSION: Surgical implant removal and implantation of an absorbable collagen sponge infused with amikacin alone was an effective treatment for postoperative TPLO SSI. CLINICAL SIGNIFICANCE: This procedure had a 96.8% long-term resolution of SSI. It should be considered as a treatment option for TPLO SSI.


Assuntos
Amicacina/uso terapêutico , Remoção de Dispositivo/veterinária , Doenças do Cão/cirurgia , Osteotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Amicacina/administração & dosagem , Animais , Antibacterianos/uso terapêutico , Bandagens , Colágeno , Doenças do Cão/tratamento farmacológico , Cães , Feminino , Masculino , Osteotomia/efeitos adversos , Período Pós-Operatório , Estudos Retrospectivos , Tíbia/cirurgia , Resultado do Tratamento
8.
J Am Vet Med Assoc ; 254(12): 1441-1447, 2019 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-31149883

RESUMO

OBJECTIVE To assess incidence of incisional infection in horses following management with 1 of 3 protective dressings after exploratory celiotomy for treatment of acute signs of abdominal pain (ie, colic) and determine the risk of complications associated with each wound management approach. DESIGN Prospective, randomized, controlled study. ANIMALS 85 horses. PROCEDURES Horses were assigned to 3 groups. After standardized abdominal closure, a sterile cotton towel (group 1) or polyhexamethylene biguanide-impregnated dressing (group 2) was secured over the incision site with 4 or 5 cruciate sutures of nonabsorbable monofilament, or sterile gauze was placed over the site and secured with an iodine-impregnated adhesive drape (group 3). Demographic and clinicopathologic data, intraoperative and postoperative variables, and development of complications were recorded and compared among groups by statistical methods. Follow-up information was collected 30 and 90 days after surgery. Incidence and odds of incisional complications were calculated. RESULTS 75 horses completed the study. Group 3 typically had dressing displacement necessitating removal during anesthetic recovery; dressings were in place for a mean of 44 and 31 hours for groups 1 and 2, respectively. Purulent or persistent serosanguinous incisional discharge (ie, infection) was detected in 11 of 75 (15%) horses (2/24, 0/26, and 9/25 from groups 1, 2, and 3, respectively). Odds of incisional complications were significantly greater for group 3 than for groups 1 or 2. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that risk of infection after celiotomy for treatment of colic is lower for incisions covered with sterile towels or polyhexamethylene biguanide-impregnated dressings secured with sutures than for incisions covered with gauze secured with iodine-impregnated adhesive drapes.


Assuntos
Cólica/veterinária , Doenças dos Cavalos/cirurgia , Infecção da Ferida Cirúrgica/veterinária , Animais , Bandagens , Cólica/cirurgia , Feminino , Cavalos , Masculino , Período Pós-Operatório , Estudos Prospectivos , Infecção da Ferida Cirúrgica/prevenção & controle
9.
N Z Vet J ; 67(5): 270-276, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31234729

RESUMO

AIMS: To report the clinical outcomes and complications after the use of 3.5 mm/2.7 mm locking compression plates (LCP) with additional internal fixation for pancarpal arthrodesis (PCA) in dogs. METHODS: This was a retrospective study using medical records from a single orthopaedic referral hospital between December 2015 and April 2018. The inclusion criteria were the use of a dorsally applied LCP for PCA in dogs with a minimum follow-up period of 12 months. Additional crossed 2.7 or 3.5 mm cortical screws or Kirschner wires were placed in all limbs to further stabilise the joints. A light dressing without external coaptation was applied postoperatively to all limbs. Postoperative lameness assessment was recorded at the last clinical evaluation. RESULTS: Twelve dogs with 13 arthrodesed limbs were included, with carpal hyperextension injury being the most common indication for surgery (4/13; 31%). One dog was recorded with a minor complication, which was a metacarpal fracture distal to the bone plate. Major complications were observed in 4/13 (31%) limbs, with surgical site infection being recorded in all four limbs and screw loosening in one limb. No implant failure was reported. At the final clinical evaluation (43-437 days after surgery), none or mechanical lameness was recorded in 9/13 (69%) limbs, mild lameness in 3/13 (23%) limbs, and moderate lameness in one 1/13 (8%) limb. CONCLUSIONS AND CLINICAL RELEVANCE: Locking plate and screw fixation with additional internal fixation resulted in comparable complication and infection rates in canine PCA to previous published studies using hybrid dynamic compression plates. No implant failure was reported for any of the limbs despite the use of a light dressing without external coaptation.


Assuntos
Artrodese/veterinária , Ossos do Carpo/cirurgia , Doenças do Cão/cirurgia , Coxeadura Animal/cirurgia , Animais , Artrodese/métodos , Placas Ósseas , Parafusos Ósseos , Doenças do Cão/etiologia , Cães/lesões , Feminino , Fraturas Ósseas/cirurgia , Fraturas Ósseas/veterinária , Coxeadura Animal/etiologia , Masculino , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/veterinária , Resultado do Tratamento , Reino Unido/epidemiologia
10.
Vet Surg ; 48(5): 685-693, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30993777

RESUMO

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.


Assuntos
Fixação Interna de Fraturas/veterinária , Doenças dos Cavalos/etiologia , Redução Aberta/veterinária , Infecção da Ferida Cirúrgica/veterinária , Animais , Antibacterianos/uso terapêutico , Artrodese/efeitos adversos , Feminino , Membro Anterior/patologia , Membro Anterior/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Membro Posterior/patologia , Membro Posterior/cirurgia , Doenças dos Cavalos/tratamento farmacológico , Cavalos , Humanos , Fraturas do Úmero , Masculino , Redução Aberta/efeitos adversos , Duração da Cirurgia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologia
11.
Vet Surg ; 48(3): 284-290, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30708396

RESUMO

Optimal patient care cannot be realized without effectively managing risks related to healthcare-associated infections (HAI). Among human hospital admissions in the United States in 2002, there were approximately 4.5 HAI per 100 admissions, with surgical site infections (SSI) accounting for an estimated 20%, or approximately 2 SSI per 100 procedures. When considering the occurrence of disease in a population, it is important to remember that disease does not occur randomly in populations. Therefore, when thinking about managing risks associated with the occurrence of SSI, consideration should be given to key factors in disease development (the agent, the host, and the environment), and a multifaceted approach to prevention efforts should be considered, including the identification of high-risk populations, adherence to aseptic principles, judicious use of antimicrobial drugs, and surveillance targeting SSI to better inform infection control practices within a facility. Although not all HAI are preventable, it is important to focus efforts on the preventable fraction and to take all reasonable precautions to mitigate foreseeable risks.


Assuntos
Controle de Infecções/métodos , Infecção da Ferida Cirúrgica/veterinária , Animais , Humanos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Estados Unidos/epidemiologia , Medicina Veterinária
12.
Vet Comp Orthop Traumatol ; 32(1): 18-25, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30646408

RESUMO

OBJECTIVE: The main aim of this study was to evaluate the efficacy of a topical 2-octyl cyanoacrylate (2OC) tissue adhesive and an adhesive barrier dressing (BD) in minimizing the incidence of surgical site infections (SSI) in dogs undergoing a tibial plateau levelling osteotomy (TPLO). MATERIALS AND METHODS: In a prospective clinical study, 437 client-owned dogs undergoing a TPLO as treatment for cranial cruciate ligament disease with or without concurrent patellar luxations from July 2015 to September 2016 were included. In each dog, the type of postoperative wound dressing was randomly selected as either no dressing (ND), a 2OC tissue adhesive or an adhesive BD. Direct examination by a veterinarian was performed at 14, 30, 60 and 90 days postoperatively. If dogs did not return for direct examination, owners were contacted with a questionnaire for the final follow-up of at least 90 days. RESULTS: The overall rate of SSI was 2.3% (10/437). Methicillin-resistant Staphylococcus pseudintermedius was the most common bacteria isolated in 9/10 cases. Infection was confirmed in 2.76% (4/145) of dogs with ND, 2.01% (3/149) of dogs with 2OC and 2.10% (3/143) of dogs with BD. Of the dogs that developed an SSI, type of dressing was not a significant risk factor (p = 0.5305) for infection. Increasing body weight was the only significant risk factor that increased the risk of overall infection (odds ratio = 1.03 [95% confidence interval: 1.02-1.05]). CLINICAL SIGNIFICANCE: In dogs undergoing a TPLO, there may be no clear benefit in the usage of postoperative wound dressings for the prevention of SSI. Increasing body weight was the only significant factor associated with the development of an SSI.


Assuntos
Bandagens/veterinária , Doenças do Cão/cirurgia , Osteotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Tíbia/cirurgia , Animais , Doenças do Cão/etiologia , Cães , Feminino , Incidência , Masculino , Osteotomia/efeitos adversos , Osteotomia/métodos , Estudos Prospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adesivos Teciduais/uso terapêutico
13.
J Am Assoc Lab Anim Sci ; 58(1): 71-77, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30609948

RESUMO

Mice routinely undergo surgical procedures for use in research; however, studies of skin preparation methods to achieve antisepsis are rare. The present study evaluated 4 skin preparation treatments: depilatory agent followed by povidone-iodine and alcohol scrub; depilatory agent followed by povidone-iodine and saline scrub; electric clippers followed by povidone-iodine and alcohol scrub; and electric clippers followed by povidone-iodine and saline scrub. Swabs for bacterial culture were obtained immediately after hair removal and after scrubbing to measure the reduction in bacterial load. Full-thickness incisions were assigned ASEPSIS wound scores and examined histologically on days 0, 1, and 7 after surgery. Neither bacterial load growth nor ASEPSIS wound scores differed among any of the treatments. Histopathology revealed statistically significant but biologically irrelevant differences. Overall all treatment methods achieved acceptable bacterial load reduction and surgical site healing.


Assuntos
Clorexidina , Povidona-Iodo , Cuidados Pré-Operatórios , Doenças dos Roedores/prevenção & controle , Infecção da Ferida Cirúrgica/veterinária , Animais , Anti-Infecciosos Locais , Assepsia , Etanol , Humanos , Camundongos , Pele/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle
14.
Vet Surg ; 48(3): 299-308, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30666675

RESUMO

OBJECTIVE: To describe the postoperative complications and long-term functional outcome after surgical management of humeral intracondylar fissure (HIF) by transcondylar screw (TCS) placement. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Nineteen dogs (26 elbows) METHODS: Medical records (2000-2009) were reviewed for dogs with a diagnosis of HIF according to results of computed tomography and treated by TCS placement at a single referral institution. Collected data included signalment, surgical technique, surgical duration, surgeon experience, use of antibiotics, and the presence and nature of any complications. Owner questionnaire, orthopedic examination, and pressure platform analysis were used to assess long-term outcome. The relationship between these variables was statistically analyzed. RESULTS: In total, 18 of 26 surgically managed elbows were diagnosed with a postoperative complication; 11 of these consisted of a surgical site infection (SSI). No risk factors for short-term complications or long-term outcome were identified. Dogs with an SSI (n = 11) were 28 times more likely to have an unsatisfactory long-term outcome than dogs without an SSI (n = 8). Symmetry indices (SI) between thoracic and pelvic limbs did not return to published normal values. There was no difference in the SI of dogs with HIF and a surgically repaired contralateral humeral condylar fracture. CONCLUSION: Placement of a TCS was commonly associated with short-term complications, affecting long-term outcome. CLINICAL SIGNIFICANCE: The high complication rate after placement of lateromedial TCS provides evidence to justify the development of alternative strategies to manage HIF.


Assuntos
Parafusos Ósseos/veterinária , Doenças do Cão/cirurgia , Fixação Interna de Fraturas/veterinária , Fraturas do Úmero/veterinária , Infecção da Ferida Cirúrgica/veterinária , Animais , Cães , Feminino , Fraturas do Úmero/cirurgia , Masculino , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
15.
Can Vet J ; 60(1): 67-72, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30651653

RESUMO

Two similar populations of dogs were evaluated in either a retrospective or prospective manner for 2 weeks after gastrointestinal foreign body surgery to determine the impact of a surgical checklist on the surgical site infection (SSI) rate. The medical records of 201 gastrointestinal foreign body surgeries were reviewed to determine the SSI rate without the use of a surgical checklist (SC-) and 101 consecutive gastrointestinal foreign body surgeries were performed using a surgical checklist (SC+). The SSI rate had a significant decrease from 19.9% to 11.9% with the use of the surgical checklist. When combining the cohorts, statistically significant predictors for development of an SSI following gastrointestinal foreign body removal included: a combined gastrotomy and enterotomy, an enterotomy, and known self-trauma.


Assuntos
Lista de Checagem , Doenças do Cão/cirurgia , Corpos Estranhos/veterinária , Trato Gastrointestinal , Infecção da Ferida Cirúrgica/veterinária , Animais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/veterinária , Cães , Feminino , Corpos Estranhos/cirurgia , Masculino , Período Perioperatório , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
16.
Vet Surg ; 48(2): 143-151, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30499192

RESUMO

OBJECTIVE: To determine serum amyloid A (SAA) concentrations in the postoperative (PO) colic horse and its association with PO complications and infection. STUDY DESIGN: Prospective case series. ANIMALS: Fifty-one horses after colic surgery. METHODS: Blood samples from horses undergoing exploratory celiotomy were analyzed for quantitative SAA and fibrinogen concentrations and for neutrophil count at days 0, 1, 2, and 4-6 and at hospital discharge. RESULTS: Complications developed in 35 (69%) horses and included PO colic (n = 13, 25%), PO reflux (n = 11, 22%), intravenous catheter (IVC) complications (n = 11, 22%), low-grade fever (n = 11, 22%); surgical site infection (SSI; n = 9, 18%), high-grade fever (n = 7, 14%), and diarrhea (n = 4, 8%). There was an association between day 2 SAA and PO colic (P = .004), diarrhea (P = .042), IVC complications (P = .008), and PO reflux (P = .008) as well as day 4-6 SAA and PO colic (P = .004) and diarrhea (P = .018). Discharge SAA concentration was associated with SSI (P = .001). Fibrinogen concentrations at days 4-6 and at discharge were associated with PO colic (P = .003), diarrhea (P = .004), IVC complications (P = .002), and PO reflux (P = .023). No differences were seen in SAA, fibrinogen, or neutrophils between horses with PO infection vs those with non-infection-associated complications. CONCLUSION: Serum amyloid A was markedly increased in the PO period in all horses but did not differ between PO infection and noninfection complications. The amount of inflammation associated with PO colic and colic surgery was high and may have affected the predictive value of SAA for early PO infection. CLINICAL SIGNIFICANCE: Although increases occurred earlier, measurement of SAA with a point-of-care analyzer may not be a more sensitive indicator of infection in the early PO colic horse than fibrinogen concentration. Serum amyloid A may help detect SSI in the late PO period.


Assuntos
Cólica/veterinária , Doenças dos Cavalos/cirurgia , Complicações Pós-Operatórias/veterinária , Proteína Amiloide A Sérica/metabolismo , Animais , Biomarcadores , Cólica/cirurgia , Feminino , Fibrinogênio , Cavalos , Inflamação , Laparotomia , Masculino , Complicações Pós-Operatórias/sangue , Período Pós-Operatório , Estudos Prospectivos , Infecção da Ferida Cirúrgica/veterinária
17.
Equine Vet J ; 51(1): 38-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29679416

RESUMO

BACKGROUND: There is limited information about bacterial isolates that are present on the equine midline incision during and following exploratory laparotomy. OBJECTIVES: To investigate the bacterial species cultured from the ventral midline pre-, intra- and post- laparotomy, whether particular bacterial isolates are associated with the development of surgical site infections (SSIs) and to report the antimicrobial resistance phenotypes of these isolates. STUDY DESIGN: Prospective cohort study. METHODS: The ventral midline of 31 horses undergoing exploratory laparotomy was sampled for bacterial culture at set time-points pre, intra and post-operatively. Inclusion criteria were that horses must have undergone exploratory laparotomy within 90 min of the initial colic examination upon hospital admission and must not have been placed in a stable prior to surgery. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration. RESULTS: Seven horses (22.6%) developed a SSI. None of the variables tested were associated with the altered risk of SSI. The prevalence of a positive bacterial culture from the incision increased progressively over time and a variety of bacteria were isolated. A positive intra-operative culture was not a predictor of SSI; and when a SSI did occur, it was due to a different bacterial isolate. MRSA and ESBL-producers were identified in the post-operative period in one and four different horses respectively, but none of these developed a SSI. MAIN LIMITATIONS: Sampling was limited to hospitalisation and no culture results were available for horses developing SSI following hospital discharge. CONCLUSIONS: A variety of bacterial species may be isolated from equine laparotomy incisions peri-operatively without development of SSI. SSI does not appear to be solely related to bacterial contamination of the incision peri-operatively and other mechanisms such as bacteraemia merit further investigation.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/veterinária , Doenças dos Cavalos/microbiologia , Laparotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Ferida Cirúrgica/veterinária , Animais , Bactérias/classificação , Bactérias/efeitos dos fármacos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Carga Bacteriana/veterinária , Bandagens/veterinária , Estudos de Coortes , Farmacorresistência Bacteriana , Inglaterra/epidemiologia , Doenças dos Cavalos/epidemiologia , Cavalos , Período Perioperatório/veterinária , Fenótipo , Prevalência , Estudos Prospectivos , Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Inquéritos e Questionários
18.
Vet Surg ; 47(8): E88-E96, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30303552

RESUMO

OBJECTIVE: To determine the influence of surgical site infection (SSI) on the median disease-free interval (DFI) and median survival time (MST) in dogs after amputation in the curative-intent treatment of appendicular osteosarcoma (OSA). STUDY DESIGN: Multi-institutional retrospective cohort study. ANIMALS: Fifteen dogs with OSA and SSI, and 134 dogs with OSA and no SSI. METHODS: Medical records were reviewed, and dogs were included if the following criteria were met: histologic confirmation of OSA, no evidence of metastasis, ≥1 chemotherapy treatment, and available follow-up data. We used the definition of SSI from the Centers for Disease Control and Prevention. Kaplan-Meier estimates of median DFI and MST for the SSI and non-SSI groups were compared by log-rank test. Univariate and multivariate Cox proportional hazard regression analysis was evaluated for associations with DFI and survival. RESULTS: The median DFI and MST of all OSA dogs were 236 days (95% CI, 181-283) and 283 days (95% CI 237-355), respectively. The median DFI of dogs with SSI (292 days) did not differ from that of dogs without SSI (224 days, P = .156). The MST of dogs with SSI (292 days) did not differ from that of dogs without SSI (280 days, P = .417). Failure to complete chemotherapy was associated with decreased DFI and survival (P < .001). Adjustments for chemotherapy completion found no effect of SSI on survival. CONCLUSION: SSI did not influence the survival of dogs with appendicular OSA treated with amputation and curative-intent treatment. CLINICAL SIGNIFICANCE: The extended survival associated with SSI after limb-spare surgery for OSA does not appear to be present after amputation. Interactions between the canine immune system and OSA warrant additional study.


Assuntos
Neoplasias Ósseas/veterinária , Doenças do Cão/cirurgia , Internato e Residência , Osteossarcoma/veterinária , Infecção da Ferida Cirúrgica/veterinária , Amputação/veterinária , Animais , Neoplasias Ósseas/cirurgia , Estudos de Coortes , Intervalo Livre de Doença , Doenças do Cão/mortalidade , Cães , Feminino , Masculino , Ohio , Ontário , Osteossarcoma/cirurgia , Estudos Retrospectivos , Sociedades Veterinárias , Infecção da Ferida Cirúrgica/mortalidade , Inquéritos e Questionários , Resultado do Tratamento
19.
Vet Surg ; 47(8): 1016-1020, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30267429

RESUMO

OBJECTIVE: To report the surgical management and the short- and long-term follow-up of postcastration spermatic cord infection in horses. STUDY DESIGN: Retrospective case series. ANIMALS: Twenty-three client-owned horses. METHODS: Medical records (2001-2017) of horses that had been surgically treated for spermatic cord stump infection after castration were reviewed. Time from castration to presentation, diagnostic procedures, surgical complications, bacterial culture and ancillary testing, and survival to discharge were collected. Long-term follow-up was obtained by owner survey when possible. Descriptive statistics were used to report results. RESULTS: Horses ranged in age from 2 to 14 years (mean age 4.1) and presented 33 days (median; range, 12-3561) after castration. Five of 23 horses required revision surgery because of hemorrhage (2) or persistent infection (3). All horses survived to discharge. Long-term follow up was available for 16 horses at a mean time of 27.4 months postsurgery (range 6-135). Complete resolution of clinical signs and return to previous use was documented in 14 of 16 horses; 1 horse had persistent purulent drainage and a second horse was retired because he did not return to adequate performance. CONCLUSION: Postcastration infection of the spermatic cord had a favorable prognosis for short- and long-term survival in this population, although complications included postoperative hemorrhage and persistent infection. CLINICAL SIGNIFICANCE: This study describes the treatment of postcastration infection of the spermatic cord which results in a good survival rate.


Assuntos
Doenças dos Cavalos/mortalidade , Cavalos/cirurgia , Orquiectomia/veterinária , Cordão Espermático/cirurgia , Infecção da Ferida Cirúrgica/veterinária , Animais , Doenças dos Cavalos/etiologia , Masculino , Registros Médicos , New York , Orquiectomia/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
20.
Vet Surg ; 47(8): E79-E87, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30267441

RESUMO

OBJECTIVE: To determine the influence of a 7-day course of postoperative antibiotherapy (cefpodoxime) on surgical site infections (SSI) after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Prospective, randomized, double-blinded, placebo-controlled clinical study. SAMPLE POPULATION: One hundred fifty client-owned dogs, with consent. METHODS: Dogs undergoing arthroscopy-assisted TPLO were randomly assigned to 1 of 2 groups, the placebo group receiving perioperative cefazolin and 7 days of placebo medication after surgery or the treatment group receiving perioperative cefazolin and 7 days of postoperative cefpodoxime. Twenty-seven factors were analyzed for association with SSI by using univariate analysis, Fisher's exact test, or Wilcoxon rank-sum test. RESULTS: SSI rates did not differ (P = .34) between the placebo group (17%; 95% confidence level [CL] 7.94%-26.43%) and the treatment group (11% SSI; 95% CL 3.98%-18.88%). The probability that > 23% of dogs would benefit from postoperative antibiotherapy was less than 5%. The only association between the factors tested in this study and SSI involved the body weight (kg), with each 1 unit increase in kilogram weight increasing the odds of developing an SSI by 4.7%. CONCLUSION: Although the wide CL may be consistent with a type II error, a 7-day course of cefpodoxime after arthroscopy-assisted TPLO did not influence postoperative SSI in the population tested here. In addition, only a small proportion of dogs would benefit from postoperative antibiotherapy under the conditions of our study. CLINICAL SIGNIFICANCE: These results should prompt surgeons to reconsider systematic antibiotherapy after TPLO and justify additional studies to determine whether dogs predisposed to infection could benefit from such an approach.


Assuntos
Artroscopia/veterinária , Cães/lesões , Osteotomia/veterinária , Infecção da Ferida Cirúrgica/veterinária , Tíbia/cirurgia , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Artroscopia/efeitos adversos , Cefazolina/administração & dosagem , Cefazolina/uso terapêutico , Cães/cirurgia , Método Duplo-Cego , Feminino , Masculino , Osteotomia/efeitos adversos , Assistência Perioperatória/veterinária , Cuidados Pós-Operatórios/veterinária , Estudos Prospectivos , Distribuição Aleatória , Estatísticas não Paramétricas , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
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