Antibiotics and SSIs Flashcards
Baker SA, Van-Balen J, Lu B, Hillier A, Hoet AE. Antimicrobial drug use in dogs prior to admission to a veterinary teaching hospital. J Am Vet Med Assoc. 2012 Jul 15;241(2):210–7.
- 55.6 % of dogs admitted to Ohio State University had received antibiotics in the last 12 months
- dogs who were referred were twice as likely to have received Abx than dogs who were not referred
- B-lactams were the most common Abx to have received
SSI rates from Tobias:
Clean 2.0 – 4.8
Clean-contam 3.5 - 5.0
Contaminated 4.6 - 12.0
Dirty 6.7 – 18.1
Papich MG. Ciprofloxacin pharmacokinetics and oral absorption of generic ciprofloxacin tablets in dogs. Am J Vet Res. 2012 Jul;73(7):1085–91.
- intro: unknown whether generic cipro has good oral absorption in dogs
- intro: poor oral absorption in cats (25%) and horses (10%)
- beagles given oral tabs, oral solution, and IV solution
- results:
- generic tab bioavailability ranged from 29-98% (variable)
- absorption of liquid was more reliable
- recommended dose based on these results = 25 mg/kg SID
(but some dogs with this dose still won’t achieve enough absorption)
(higher than previously recommended 5-15 mg/kg q 12)
Weese JS, Faires MC, Frank LA, Reynolds LM, Battisti A. Factors associated with methicillin-resistant versus methicillin-susceptible Staphylococcus pseudintermedius infection in dogs. J Am Vet Med Assoc. 2012 Jun 15;240(12):1450–5.
- Dogs with MRSP vs MSSP pyoderma, otitis, and SSI’s
- significant association btwn recent (within 30 days) Abx treatment and MRSP infection
- from disc: B-lactams and flouroquinolones are the ones that have been blamed for association with MRSP in previous studies
KuKanich KSK, Ghosh AA, Skarbek JVJ, Lothamer KMK, Zurek LL. Surveillance of bacterial contamination in small animal veterinary hospitals with special focus on antimicrobial resistance and virulence traits of enterococci. J Am Vet Med Assoc. 2012 Feb 15;240(4):437–45.
- 10 small animal vet hospitals swabbed - 3 swabs q 4 mo (8 month period)
- looking for enterics and enterococcus
- cage, stethoscope, rectal thermometer, mouth gags
- results: almost no enterics
- enterococcus on cage doors, stethoscopes, thermometers
- scrubbing mouth gags and then soaking in disinfectant seems to be effective
- 53 % of enterococcus faecium were MDR
Hamilton E, Kaneene JB, May KJ, Kruger JM, Schall W, Beal MW, et al. Prevalence and antimicrobial resistance of Enterococcus spp and Staphylococcus spp isolated from surfaces in a veterinary teaching hospital. J Am Vet Med Assoc. 2012 Jun 15;240(12):1463–73.
- Lots of different surfaces at MSU swabbed over 3 years
- E faecium increased resistance over the 3 year period
- the scale was the most likely surface to isolate Staph and Enterococcus
- cages and treatment area floors were also important
Mayhew PD, Freeman L, Kwan T, Brown DC. Comparison of surgical site infection rates in clean and clean-contaminated wounds in dogs and cats after minimally invasive versus open surgery: 179 cases (2007-2008). J Am Vet Med Assoc. 2012 Jan 15;240(2):193–8.
open surgery vs MIS
- clean and clean-contaminated procedures only!
- Results:
- MIS 1.7 %
- Open surgery 5.5%
- univariate analysis – significant difference
- multivariate analysis – no difference – confounding factors
- open group had longer surgeries
- open group were more likely to be clipped before anesthesia
- every 90 minutes of surgery doubled the risk of SSI
- conclusion: this study unable to show decreased infection rate with MIS
- humans: decreased infection rate has been shown with MIS
Faires MCM, Tater KCK, Weese JSJ. An investigation of methicillin-resistant Staphylococcus aureus colonization in people and pets in the same household with an infected person or infected pet. J Am Vet Med Assoc. 2009 Sep 1;235(5):540–3.
- The same strains were sometimes isolated from people and pets in the same households
- conclusion: suggests that interspecies transmission of MRSA is possible
Weese JS, Faires M, Brisson BA, Slavic D. Infection with methicillin-resistant Staphylococcus pseudintermedius masquerading as cefoxitin susceptible in a dog. J Am Vet Med Assoc. 2009 Nov 1;235(9):1064–6.
- labs use cefoxitin to see if Staph is methicillin resistant, but unlike S.aureus, S.pseudintermedius might not express its resistance gene when interacting with certain Abx in vitro
- If a Staph. Pseudintermedius is MDR, suspect methicillin resistant (and all B-lactam resistant) even if MIC says otherwise
Owen LJ, Gines JA, Knowles TG, Holt PE. Efficacy of adhesive incise drapes in preventing bacterial contamination of clean canine surgical wounds. Vet Surg. 2009 Aug 1;38(6):732–7.
- measuring wound contamination in 100 dogs with clean surgeries (OVH or stifle)
- 14 % overall contamination rate (staph)
- no difference with or without incise drape (not ioban) (would take 1000 cases)
- disc: Cochrane review for humans also shows no benefit
Stenske KA, Bemis DA, Gillespie BE, D’Souza DH, Oliver SP, Draughon FA, et al. Comparison of clonal relatedness and antimicrobial susceptibility of fecal Escherichia coli from healthy dogs and their owners. Am J Vet Res. 2009 Sep 1;70(9):1108–16.
- do dogs and their owners share the same clones of E.coli?
- humans (both owners and non-owner control humans) had more MDR bugs than dogs
- conclusion: some in-house sharing is possible – direct contact and/or environment
Vince KJ, Lascelles BDX, Mathews KG, Altier C, Roe SC. Evaluation of wraps covering the distal aspect of pelvic limbs for prevention of bacterial strike-through in an ex vivo canine model. Vet Surg. 2008 Jun 1;37(4):406–11.
- cadaveric study simulating stifle surgery – investigating coverage of the foot
- Vetrap and Coban (human vetrap – sterile) do not prevent bacterial strike-through
- Vetrap and impermeable layer (latex glove or UltraGard drape) prevented strike-thru
Boothe DM, Boeckh A, Boothe HW. Evaluation of the distribution of enrofloxacin by circulating leukocytes to sites of inflammation in dogs. Am J Vet Res. 2009 Jan 1;70(1):16–22.
- conclusion: WBC’s bring Baytril to site of inflammation
- problem – baytril was not given orally
Weese JS. A review of post-operative infections in veterinary orthopaedic surgery. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):99–105.
- classification of SSI’s (superficial incisional, deep incisional, organ/space)
- SSI within 30 day of surgery or within 1 year of implant
- “Flash” sterilization must never be used for implants
- infection rates in vet med from Vasseur 1988 (n=1100)
- clean: 2.5 %
- clean-contam: 4.5 %
- contaminated: 5.8 %
- dirty: 18.1 %
- infection rates in vet med from THRs: 1.3 – 10 %
- infection rates in vet med from cruciate surgeries: 2.6 – 3.6 %
- infection rates in vet med from clean orthopedic procedures: 7.1 %
- overall infection rates in vet med: 5.9 %
- overall infection rates in vet med for clean surgery: 4.5 %
Landmark – Brown DC, et al. Epidemiologic evaluation of postoperative wound infections in dogs and cats. JAVMA 1997
- 1547 wounds in 1255 dogs & cats (no mention of ortho surgeries)
- SSI definition: purulent discharge within 14 days (probably no implants)
- Infection rates:
- overall: 5.5%
- clean: 4.7 %
- clean-contam: 5.0 %
- contaminated: 12.0 %
- dirty: 10.1%
- regarding use of antibiotics for CLEAN surgeries:
- no Abx: 4.4%
- only periop Abx: 2.2 % (not different from no Abx)
- postop Abx: 6.3%
- only postop Abx: 8.2 % (significantly higher than no Abx)
- Other risk factors:
- shaving for induction = 3 x risk. (didn’t matter whether > 4 hrs or < 4 hrs)
- Surgical time
- 90 min sx twice the risk of a 60 minute sx
- from disc: in human med every hour doubles risk
- not significant:
- age, endocrinopathy, infection elsewhere, overweight, hypotension
