在狗的清洁骨科和神经外科手术中，抗菌预防被认为足以保持可接受的手术部位感染率。
Antimicrobial prophylaxis is considered sufficient to preserve an acceptable surgical site infection rate in clean orthopaedic and neurosurgeries in dogs.
机构信息
Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, Viikintie 49, 00014, Helsinki, Finland.
Small Animal Hospital, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, Viikintie 49, 00014, Helsinki, Finland.
出版信息
Acta Vet Scand. 2020 Sep 17;62(1):53. doi: 10.1186/s13028-020-00545-z.
BACKGROUND
Surgical 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.
RESULTS
Nearly 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; CI 0.4-5.0). Several risk factors for SSI were identified, including methicillin-resistant Staphylococcus pseudintermedius carriage (P = 0.02; OR 9.0; CI 1.4-57.9) and higher body temperature (P = 0.03; OR 1.69; CI 1.0-2.7; mean difference + 0.4 °C compared to dogs without SSI).
CONCLUSIONS
Antimicrobial 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.
背景
手术部位感染（SSI）与发病率和死亡率增加有关。为了降低 SSI 的发生率，在人类和兽医患者中，某些类型的手术前 30-60 分钟给予抗菌预防。然而，由于对抗菌药物耐药性的日益关注，需要调查在清洁骨科和神经外科手术中抗菌预防的益处。本回顾性横断面研究的目的是回顾 2012-2016 年在一家兽医教学医院中狗的 SSI 发生率，并评估抗菌指南的依从性。此外，还评估了 SSI 的可能危险因素。
结果
几乎所有狗（377/406；92.9%）都接受了抗菌预防。29 只狗（7.1%）未接受任何抗生素治疗，只有 4 只（1.1%）接受了术后抗生素治疗。关于预防性抗菌药物（头孢唑啉）的选择，内部和国家方案的依从性极好，但在预防给药时间方面仍有改进的余地。89.4%（363/406）的狗可获得随访数据。平均随访时间为 464 天（范围：3-2600 天）。总的 SSI 发生率为 6.3%：骨科手术为 6.7%，神经外科手术为 4.2%。外囊修复颅十字韧带断裂、尺骨切除术、股骨头和颈部切除术、关节切开术和股髋关节脱位修复的 SSI 发生率最低（0%）。关节融合术的 SSI 发生率最高（25.0%）。未使用抗生素不会增加 SSI 的风险（P=0.56；OR 1.7；CI 0.4-5.0）。确定了几个 SSI 的危险因素，包括耐甲氧西林金黄色葡萄球菌（Staphylococcus pseudintermedius）携带（P=0.02；OR 9.0；CI 1.4-57.9）和体温升高（P=0.03；OR 1.69；CI 1.0-2.7；与无 SSI 的狗相比，平均差异为+0.4°C）。
结论
在不使用术后抗生素的情况下进行抗菌预防，足以使整体 SSI 发生率保持在与犬类清洁骨科和神经外科手术公布数据相似的水平。
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