Prophylactic use of antibiotics in surgery

"Sound and careful surgery is the sine qua non of wound management; antimicrobials are adjunctive." The key to successful use of prophylactic antibiotics in surgery is careful selection of cases and medication. There are no final rule or formulas that will always give optimal results. Listed below are some guidelines that may assis the clinician in determining the need and form of antimicrobial use. 1. The operation must carry a significant risk of bacterial contamination. Refined-clean and clean procedures should not be given prophylactic antibiotics. 2. Bacterial cultures should be taken when possible, and the medication used for prophylaxis should be effective against the organisms expected to be encountered. 3. Narrow spectrum antibiotics should be used to conserve the body's normal flora. Broad spectrum antibiotics needed to combat resistant infections should not be used for prophylaxis. 4. The antibiotic should be present in the wound in effective concentrations at the time of the incision and be maintained only as long as the risk of new bacterial contamination exists.     

The Association of Propofol Usage With Postoperative Wound Infection Rate in Clean Wounds: A Retrospective Study

OBJECTIVE: To determine if the use of propofol influences the postoperative infection rate of clean surgical wounds in dogs and cats. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: 863 dogs and cats undergoing clean surgical procedures. METHODS: Medical and anesthetic records of surgical cases used as part of a previously described epidemiologic study on postoperative wound infection rates were reviewed. The records of all animals with clean surgical wounds were reviewed to determine if propofol had been used for anesthetic induction or maintenance during the procedure. To determine the effect of propofol use on wound infection rate, data were analyzed using Fisher's exact test, followed by multiple logistic regression to adjust for various factors, including surgery time, time from clipping to surgery, antibiotic usage, coexisting distant infection, endocrine disease, and the use of immunosuppressive drugs in the perioperative period. RESULTS AND CONCLUSIONS: Of 863 dogs and cats with clean surgical wounds, 46 received propofol as part of the anesthetic protocol. A total of 6 of 46 animals (13%) receiving propofol developed postoperative wound infections, compared with 33 of 817 animals (4%) not receiving propofol (P = .014; % difference = 9%; 95% CI = 0.5% to 24%). Adjusting for all other factors evaluated, animals receiving propofol were 3.8 times more likely to develop postoperative wound infections compared to animals not given propofol (95% CI = 1.5-9.9). CLINICAL IMPLICATIONS: Propofol is a lipid-based emulsion capable of supporting microbial growth. Administration of a potentially contaminated solution may contribute to surgical wound infection or other patient morbidity or mortality. Strict aseptic technique in the preparation of the solution and prompt disposal of unused drug are imperative to curtail the potential for extrinsic contamination.     

Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: A retrospective study of 239 dogs and cats

OBJECTIVE: To evaluate risk factors for development of postoperative wound infections in clean-contaminated wounds. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Two hundred thirty-nine dogs and cats that had clean-contaminated surgical procedures. METHODS: Records of animals that had a clean-contaminated surgical procedure and were prospectively monitored for development of postoperative wound infection were reviewed. Prospective data included signalment, nutritional status, body weight, duration of surgery, surgical procedures, wound classification, surgical site clip time before surgery, hypotension during surgery, the presence of an active distant infection, endocrinopathy, administration of an immunosuppressive agent, administration of antibiotics, and the type of antibiotic used. Additional retrieved data included total anesthesia time, temperature variables, blood loss, and suture material used. RESULTS: Intact males (P =.008) and animals with concurrent endocrinopathy (P =.008) were at a higher risk of development of postoperative wound infection. Total surgery time (P =.02) and total anesthesia time (P =.04) were longer in animals that developed postoperative wound infection. No other factors were statistically significant. CONCLUSIONS: Intact males and animals with a concurrent endocrinopathy were at higher risk of postoperative wound infection after clean-contaminated surgical procedures. CLINICAL RELEVANCE: Time under anesthesia and duration of surgery should be minimized to reduce the risk of wound infection in clean-contaminated surgical procedures.     

Antibiotic use and resistance in animal farming: a quantitative and qualitative study on knowledge and practices among farmers in Khartoum, Sudan

Antibiotic resistance is a major emerging global public health threat. Farmers in the Khartoum state are believed to misuse antibiotics in animal farming leading to daily exposure to resistant bacteria and antibiotic residues. Hence, farmers are at potential risk exposure to bacteria, zoonotic infection and toxicity. We hypothesized that farmers' misuse of antibiotics could be due to their ignorance of the importance of optimal use of antibiotics, the potential health hazards and the economical waste associated with antibiotic misuse practices. In the present study, we investigated knowledge and practices among farmers regarding antibiotic use and resistance. For this purpose, a cross-sectional study was conducted in Khartoum state where data were collected from 81 farmers using structured interviews. Data were analysed both quantitatively and qualitatively. Fifty-two per cent of farmers were uneducated or had studied for < 6 years. The majority reported antibiotic use for treatment and prevention while only 5% stated use for growth promotion. Antibiotic group treatment for both sick and healthy animals was commonly practiced among most farmers. The most commonly used group of antibiotics was the quinolones, which was reported by one-third. Only 30% of the farmers had heard of antibiotic resistance and provided their definition. Almost half were not aware of the commonly transferred zoonotic infections between humans and animals. The farmers consume 1-2 meals/day from their own farm products. A significant association between low education, poor knowledge of farmers on antibiotic use, antibiotic resistance and zoonotic infections was found. This association may play a vital role in the present practiced misuse of antibiotics. Our findings on farmers' practices could be used as baseline information in defining the gaps related to antibiotic use and resistance in animal farming in Sudan. It can thus serve as a foundation for future interventions.     

Retrospective Identification of Bacterial Isolates From Emergency Laparotomy Surgical Site Infections in Horses

Surgical site infection (SSI) with multiresistant bacteria is an important cause of postoperative morbidity after laparotomy in horses. The objective of this study was to identify bacteria isolates and their antibiotic resistance patterns associated with the development of wound infection in horses after laparotomy. This is a retrospective case series. Medical records of horses that underwent ventral midline exploratory laparotomy in a four-year period at one equine hospital were reviewed. Results of microbiologic culture and susceptibility testing are described. The study group consisted of 183 (100%) horses that recovered from anesthesia after laparotomy. The prevalence of infection was 19% (24/124) after first surgery and 83% (19/23) after relaparotomy. The most common microbial isolates were bacteria of the family Enterobacteriaceae followed by Staphylococcus ssp., Enterococcus ssp., Streptococcus ssp., and Bacteroides ssp. Bacteria from the family Enterobacteriaceae showed the lowest resistance to amphenicols, cephalosporins, and quinolones groups of antibiotics. Coagulase-positive Staphylococci were sensitive to amphenicols and only 33% were resistant to trimethoprim/sulfamethoxazole. The most commonly used perioperative and postoperative antibiotics were gentamicin and amoxicillin. Limitations include poor control over exposure factors, covariates, and potential confounders during the surgery, recovery time, or period of hospitalization; relying on others for accurate outcome assessment and recordkeeping; lack of follow-up information once animals were discharged from the hospital. Despite 5 days of antibiotic prophylaxis, the rate of incisional infection is still high. The most common isolates from SSI belong to the family Enterobacteriaceae and the genus Staphylococcus, which showed high resistance to the antibiotics used before the gastrointestinal surgery.     

Surgical Wound Infection Rates in Dogs and Cats Data from a Teaching Hospital

Two thousand sixty-three surgical procedures were performed on 1992 patients (1715 dogs and 277 cats). In a retrospective analysis, the procedures were categorized according to the expected degree of wound contamination, and corresponding wound infection rates were determined. The number of procedures in each category and the percent that became infected were as follows: clean (1100, 2.5%), clean-contaminated (554, 4.5%), contaminated (172, 5.8%), and dirty (237, 18.1%). The administration of antibiotics significantly reduced the frequency of wound infection in clean surgical procedures performed by senior veterinary students (p less than 0.05), but not in clean elective procedures performed by faculty or resident surgeons that required 90 minutes or less to complete. There was a significant correlation between elevation of rectal temperature postoperatively and increased duration of the surgical procedure. However, the rectal temperature measured the day after surgery was not an accurate predictor of wound infection.     

The use of antibiotics on small dairy farms in rural Peru

Very little is known about the use of antibiotics on small dairy farms in lower/middle-income countries. The use of these drugs can have profound impacts on animal health, farmer income and public health. A survey of 156 farmers was conducted in Cajamarca, a major dairy-producing center in the highlands of Peru characterized by small farms (<15 cows) to assess patterns and determinants of antibiotic use and farmers’ knowledge of antibiotics. The reported incidence of disease on these farms was relatively low (0.571 episodes of disease per cow-year), but more than 83% of the reported episodes were treated with antibiotics. The most commonly used antibiotics were oxytetracycline, penicillin and trimethoprim-sulfamethoxazole drugs; antiparasitic drugs were also used to treat what were likely bacterial infections. An increased incidence of treated disease was significantly associated with smaller farm size, lower farmer income, the previous use of the Californian Mastitis test on the farm and antibiotic knowledge. Farmers’ knowledge of antibiotics was assessed with a series of questions on antibiotics, resulting in a “knowledge score”. Increased knowledge was significantly associated with the use of antibiotics for preventative reasons, the purchase of antibiotics from feed-stores, the experience of complications in animals after having administered antibiotics, the number of workers on the farm and the educational level of the farmer. Overall, antibiotics appeared to be used infrequently, most likely because therapeutic interventions were sought only when the animal had reached an advanced stage of clinical disease. Few farmers were able to define an antibiotic, but many farmers understood that the use of antibiotics carried inherent risks to their animals and potentially to the consumers of dairy products from treated animals. The results of this study are useful for understanding the patterns of antibiotic use and associated management, demographic and knowledge factors of farmers on small dairy farms in rural Peru.     

The management and treatment of environmental streptococcal mastitis.

Environmental streptococci are responsible for at least one third of all cases of clinical mastitis, with the proportion varying widely between herds. Each dairy farmer should know the etiology of mastitis in the herd to allow for appropriate management. Control requires lowering the prevalence of infection, and includes shortening the duration of and preventing new infections. Prompt and aggressive treatment of clinical cases may achieve a high clinical and bactriologic rate of cure. Dry-cow treatment remains highly effective in eliminating infection. Prophylactic dry-cow treatment remains of substantial benefit in preventing new intramammary infections and clinical mastitis. An internal teat sealant has shown a comparable effect in uninfected cows in field studies. Management of exposure to environmental streptococci is essential and requires assessment of the risk of exposure (especially in bedding and other lying areas), reduction of teat-end contamination, and good hygienic milking practices. The key is in the quality of application of management.     

Methicillin-resistant Staphylococcus pseudintermedius among dogs admitted to a small animal hospital

The aim of this study was to determine the frequency of carriage of methicillin-resistant Staphylococcus pseudintermedius (MRSP) among dogs admitted to a small animal hospital during a 17-month period, to characterize these isolates and to initially screen for possible factors associated with MRSP carriage. Swabs were taken from the nose/pharynx and the perineum as well as from wounds and skin infections (if present) of 814 dogs before entering the small animal hospital. A questionnaire for background information was completed. The staphylococcal species and methicillin resistance were confirmed pheno- and genotypically. The identified MRSP isolates were characterized by SCCmec typing, testing for susceptibility to 25 antimicrobial agents and SmaI-directed pulsed-field gel electrophoresis. A first screening for possible risk factors for MRSP carriage was performed by means of unifactorial contingency tables and CART analysis. Sixty (7.4%) dogs were positive for MRSP. All MRSP isolates harboured a type II-III SCCmec cassette and showed extended resistance to antimicrobial agents. Fifteen different SmaI patterns were observed. The major factors that clustered with MRSP carriage were former hospitalization and antibiotic treatment within the last six months before sampling. This study showed that only a minor part of the sampled dogs carried multi-resistant MRSP isolates. The facts that prior hospitalization and/or antibiotic therapy are potential associated factors for MRSP carriage underline the necessity of a judicious use of antibiotics in small animal medicine.     

Current British veterinary attitudes to the use of perioperative antimicrobials in small animal surgery

A questionnaire was sent to 2951 mixed and small animal veterinary practices to examine the use of perioperative antimicrobials in cats and dogs in the UK. The percentage of respondents who always used antimicrobials in two surgical procedures classified according to NRC criteria as 'clean' was 25.3 per cent for removal of a 1 cm cutaneous mass and 32.1 per cent for routine prescrotal castration. Factors considered important in decision-making about when to use antimicrobial agents included immunosuppression, presence of a drain, degree of wound contamination, potential for spillage of visceral contents and implantation of prosthesis. The most common antimicrobial agents mentioned were potentiated amoxicillin (98.0 per cent), amoxicillin (60.5 per cent), clindamycin (21.8 per cent), enrofloxacin (21.7 per cent), cephalexin (18.6 per cent) and metronidazole (12.7 per cent). Forty-three per cent of all responding veterinarians listed a long-acting preparation for perioperative use. The routes used were subcutaneous (76.1 per cent), intravenous (25.8 per cent), intramuscular (19.8 per cent), oral (13.5 per cent) and topical (7.7 per cent). Antimicrobials were given before surgery (66.6 per cent), during surgery (30.2 per cent), immediately after surgery (12.0 per cent) and after surgery (6.3 per cent). This survey has identified the suboptimal use of perioperative antimicrobials in small animal surgery with improvements needed with respect to timing, duration, choice of antimicrobial and a more prudent selection of surgical cases requiring prophylaxis.     

Human health aspects of antibiotic use in food animals: a review

Antibiotic use not only selects for resistance in pathogenic bacteria, but also in the commensal flora of exposed individuals. Veterinary surgeons regularly prescribe antibiotics for food animals to treat bacterial infections just as doctors do for human patients. In addition, however, animal feeds contain added antibiotics not for therapy but for economic reasons: to enhance the growth rate of these animals. Several of the antibiotics used as growth promoters are analogues of and fully cross resistant with important antibiotics used in human medicine. As a result of this high exposure to antibiotics, the prevalence of resistant bacteria in the faecal flora of these animals is high. These resistant bacteria can be directly and indirectly, via foods of animal origin, transferred to humans and either colonize the human intestinal tract or exchange their resistance genes with commensal bacteria of humans. As the intestinal flora functions as a reservoir of resistance genes for pathogenic bacteria and because many bacterial species of the intestinal flora are potential pathogens, the efficacy of antibiotic therapy in human medicine may be jeopardized.     

Contamination of multiple-dose vials in a veterinary hospital

Bacterial contamination of multiple-dose saline bottles and medication vials in a veterinary teaching hospital was evaluated. Bacterial contamination was identified in 16/88 (18%) containers, with no difference in contamination between the large animal clinic, small animal clinic, and ruminant ambulatory clinic. Contamination of multiple-dose containers containing substances for injection was common, and potential pathogens were present in many situations. While the clinical significance is not resolved at this point, infection control practices should address this potential source of nosocomial infection.     

Infection rates in clean surgical procedures with and without prophylactic antibiotics

One hundred calves with an uncomplicated umbilical hernia were included in a prospective study. The frequency of wound infection and recurrence of herniation were compared in animals operated on either with or without prophylactic antibiotics. In 90 calves operated on for the first time (60 without antibiotics and 30 with antibiotics) there were no infections and only one hernia recurred. In 10 calves operated on for the second time (seven without antibiotics and three with antibiotics) there were two infections and one hernia recurred in the group not receiving antibiotics.     

Modeling the relationship between food animal health and human foodborne illness

To achieve further reductions in foodborne illness levels in humans, effective pre-harvest interventions are needed. The health status of food animals that are destined to enter the human food supply chain may be an important, although often overlooked, factor in predicting the risk of human foodborne infections. The health status of food animals can potentially influence foodborne pathogen levels in three ways. First, diseased animals may shed higher levels of foodborne pathogens. Second, animals that require further handling in the processing plant to remove affected parts may lead to increased microbial contamination and cross-contamination. Finally, certain animal illnesses may lead to a higher probability of mistakes in the processing plant, such as gastrointestinal ruptures, which would lead to increased microbial contamination and cross-contamination. Consequently, interventions that reduce the incidence of food animal illnesses might also help reduce bacterial contamination on meat, thereby reducing human illness. Some of these interventions, however, might also present a risk to human health. For example, the use of antibiotics in food animals can reduce rates of animal illness but can also select for antibiotic-resistant bacteria which can threaten human treatment options. In this study, we present a mathematical model to evaluate human health risks from foodborne pathogens associated with changes in animal illness. The model is designed so that potential human health risks and benefits from interventions such as the continued use of antibiotics in animal agriculture can be evaluated simultaneously. We applied the model to a hypothetical example of Campylobacter from chicken. In general, the model suggests that very minor perturbations in microbial loads on meat products could have relatively large impacts on human health, and consequently, small improvements in food animal health might result in significant reductions in human illness.     

哈尔滨市鲜肉中单核细胞增生性李斯特菌的分离鉴定及耐药性分析

为了解哈尔滨市单核细胞增生性李斯特茵(Lm)的污染状况及耐药状况.在哈尔滨市市场随机采集158份鲜肉样品,采用显色培养基分离,API试剂条和PCR鉴定等方法对样品中的Lm进行分离鉴定,并通过Kirby-Barer法测定分离菌株对24种抗生素的耐药性.结果从鲜肉中共分离到Lm 23株,检出率为14.56%,其中鲜猪肉检出率最高,达20.00%(14/70);23株分离菌株中耐药菌株为22株,耐药率高达95.65%.这表明哈尔滨市鲜肉中存在一定程度的Lm污染,并且分离菌株存在较严重的耐药现象.应加强控制动物饲料亚治疗抗生素的使用并严格遵守休药期,防止耐药菌株产生进而控制食源性疾病的发生.     

The management of open joint injuries

The prognosis for returning horses with open joint injuries to athletic function is most closely related to the duration of the injury prior to treatment. Prompt diagnosis and appropriate therapy should yield a favorable result. Delayed diagnosis or inappropriate therapy that allow the wound to progress to an infected state makes the likelihood of return to athletic function poor. Refractory joint infection can occur despite early diagnosis and prompt appropriate therapy. The development of these infections is undoubtedly increased by tissue loss and gross contamination. Appropriate antibiotics given long term probably play the most significant role in resolving joint sepsis. When the refractory nature of the infection is accompanied by cartilage loss and bone proliferation, aggressive treatment by open drainage, synovectomy, and arthrodesis of the joint should be considered.     

A review of topical therapy for skin infections with bacteria and yeast

Background – Cutaneous infections with bacteria and yeasts are common in small animal practice. Treatment with systemic antibiotics or antifungal agents may not be ideal, because of the increasing development of multiresistant organisms, the cost and the possible adverse effects. Topical antimicrobials may be used as adjunctive therapy to systemic treatment or as sole therapy instead of systemic treatment. Objective – This literature review evaluated studies on topical antimicrobial treatment of skin infections. Methods – In vitro and in vivo studies evaluating topical antimicrobial agents were identified using a number of electronic and manual searches of textbooks and articles. Studies were evaluated, and the evidence for or against the use of the topical agents was extracted. Results – There is good evidence for the efficacy of chlorhexidine and, to a lesser degree, benzoyl peroxide in canine bacterial skin infections. There is limited evidence for the efficacy of silver sulfadiazine and medical honey against bacterial skin infections in the dog, and for the efficacy of hydrogen peroxide and stannous fluoride in the horse. Good evidence supports the use of a combination of chlorhexidine and miconazole in dogs with cutaneous Malassezia infections. There is insufficient evidence to recommend any other topical therapy for use in cutaneous infections. Conclusions and clinical importance – Although many antimicrobial topicals are marketed in veterinary dermatology, the efficacy has been reported for only a minority of agents. Randomized controlled trials evaluating various topical treatments are therefore urgently needed.     

The effects of cancer and cancer therapies on wound healing

Based on experimental evidence in rodents, most of the antineoplastic agents will affect wound healing. With most of the agents, this impairment is not sufficient to produce increased morbidity based on the clinical reports in humans. Radiation therapy appears to inhibit healing in both experimental animals and during clinical trials. In spite of this, it is reported that wounds in animals will heal when they are receiving radiation therapy after surgery. Based on the information presented here and experience at the University of Missouri, the decision to use adjuvant therapy should depend on the surgery performed. With a single incision that had no increased tension, there should be no hesitation to use adjuvant therapy. If removal of the tumor required reconstructive surgery, no radiation or chemotherapy should be used until the wound has healed.     

Nosocomial infections.

Nosocomial infections and antimicrobial resistance are topics that have been intensely studied in human medicine because of their significant impact on human health. In recent years, concerns have been raised that the use of antibiotics in veterinary medicine, animal husbandry, and agriculture may be contributing to the development of resistance in common bacterial species affecting human beings. Although there is inadequate proof at this time that the resistance is transmitted from animals to people, if antibiotics continue to be used indiscriminately in veterinary medicine, veterinarians may find themselves facing regulations restricting the use of some antibiotics. Nosocomial infections have been reported in veterinary medicine and are likely to increase in prevalence with the increase in intensive care practices in many hospitals. Prolonged hospitalization and the use of invasive devices and procedures increase the risk of nosocomial disease. As in human medicine, organisms isolated in the nosocomial infections reported in veterinary patients have an increasingly broad spectrum of antimicrobial resistance. Despite these findings, the use of empiric and prophylactic antibiotic therapy is still widespread in veterinary medicine. Nosocomial infections and antimicrobial resistance may have a serious impact on the future of [table: see text] veterinary medicine, because the cost and ability to treat our patients may be affected by the loss of access to or effectiveness of antimicrobial drugs. Despite the millions of dollars spent on research to reduce the incidence of nosocomial infections in human patients, the strategies that have consistently proven successful are simple and inexpensive to implement. The most important factor in preventing nosocomial infections is improving the hygiene practices of health care providers. Hand-washing or the use of disposable gloves can dramatically reduce the transmission of bacteria between patients. Aseptic technique should be used in the placement and management of all invasive devices. All staff members should be educated on the risks and symptoms associated with nosocomial infections so that cases can be detected early and treated appropriately. We in the veterinary profession have the opportunity to learn from the experiences of the human medical profession and can take steps to prevent the escalation of nosocomial infections and their impact on our profession.