Abstract
BackgroundSurgical 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 cross-sectional 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.ResultsNearly 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; CI95% 0.4–5.0). Several risk factors for SSI were identified, including methicillin-resistant Staphylococcus pseudintermedius carriage (P = 0.02; OR 9.0; CI95% 1.4–57.9) and higher body temperature (P = 0.03; OR 1.69; CI95% 1.0–2.7; mean difference + 0.4 °C compared to dogs without SSI).ConclusionsAntimicrobial 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.
Highlights
Surgical site infections (SSI) are associated with increased morbidity and mortality
All dogs were classified as American Society of Anesthesiologists (ASA) class 2
Screening for MDR bacteria had been preoperatively performed on 26 dogs, of which six were found to be carriers of methicillin-resistant Staphylococcus pseudintermedius (MRSP)
Summary
Surgical site infections (SSI) are associated with increased morbidity and mortality. 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. 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 death [2,3,4]. According to the most recent Centers for Disease Control and Prevention (CDC) guideline for SSI prevention, the recommendation is to administer the surgical prophylactic antimicrobial in time to allow the chosen drug to reach sufficient tissue concentrations at the surgical site before the incision is made [1]. Preor postoperative antimicrobial administration is not suggested unless given for other reasons such as treatment of a concurrent infection [1, 6]
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