Abstract
PICO question
 In horses, does treatment with intra-articular antimicrobials concurrently with intra-articular corticosteroids reduce the risk of iatrogenic synovial sepsis compared to intra-articular corticosteroids alone?
 Clinical bottom line
 From the current literature, there is no evidence showing that intra-articular injection of antibiotics in conjunction with corticosteroids reduces the risk of synovial sepsis. However, the intra-articular injection of polysulphated glycosaminoglycans (PSGAGs) in combination with corticosteroids was noted as a risk factor for developing iatrogenic synovial sepsis and therefore concurrent antibiotic injection when administering PSGAGs may be warranted. The reported frequency of infection following intra-articular injections was very low (0.02–0.08%). An overall prevalence of iatrogenic synovial sepsis following all intra-articular injections based on data from all included studies was calculated as 0.02% (CI 0.02–0.03%). However, due to the paucity of literature on the topic, further studies are required in this field to determine more accurate clinical recommendations.
Highlights
Control group included all horses given intra-articular medication (IAM) on the same day, day before or the day after septic cases (224 control horses with 13 infected joint cases – no specific data was provided on injections for each case)
Betamethasone had a lower risk of septic arthritis than dexamethasone
The current literature suggests that the frequency of infection following all intra-articular injections is very low and equates to roughly one case per 1000 or 2364 injections, according to Steel et al (2013) and Smith et al (2018) respectively
Summary
An overall prevalence of iatrogenic synovial sepsis following all intra-articular injections based on data from all included studies was calculated as 0.02% (CI 0.02–0.03%). Clinical Scenario Antimicrobials such as amikacin sulphate or gentamicin sulphate are often added to corticosteroid preparations when performing intra-articular injections in horses This summary aims to determine whether the risk of iatrogenic synovial sepsis increases in the absence of these antimicrobials and to consider whether injecting them concurrently with intra-articular corticosteroids is necessary. The evidence Of the three studies examined, only two studies directly evaluated the prevalence of iatrogenic synovial sepsis following intra-articular injection. The risk of septic arthritis following intra-articular injection was one case per 1279 injections or 7.8 per 10,000 joints (prevalence 0.08% [CI 0.05–0.13%]). Betamethasone had a lower risk of septic arthritis than dexamethasone
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