Department of Small Animal Medicine and Surgery, University of Georgia, Athens, Georgia.
Department of Comparative Physiology and Pharmacology, University of Georgia, Athens, Georgia.
Vet Surg. 2021 May;50(4):729-739. doi: 10.1111/vsu.13603. Epub 2021 Mar 11.
A systematic review of published data to determine whether postoperative antibiotic use after tibial plateau leveling osteotomy (TPLO) decreases infection rates.
Systematic review.
A broad bibliographic search was performed in three online databases through March 2020 for publications on postoperative antibiotic use after TPLO in dogs. Search terms included dog, canine, TPLO, tibial plateau leveling osteotomy, infection, antibiotic, and antimicrobial. Articles that met inclusion criteria were evaluated for level of evidence (LoE) by a modified Oxford Level of Evidence (mOLE) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) classification and evaluation.
Thirteen studies met the inclusion criteria. Effect of antibiotic use was the primary question in four studies. Among those, 50% (2/4) were assigned a mOLE of 1b and a GRADE of moderate, while the other 50% (2/4) were assigned a mOLE of 4b or 4c with a GRADE of low. The two studies with the highest LoE did not provide evidence of the benefit of antibiotic usage. Results of only one study provided evidence to support the use of postoperative antibiotics. The remaining nine studies provided evaluation of antibiotic use secondarily and were all assigned a low LoE. Among these, 78% (7/9) provided evidence to support the use of postoperative antibiotics.
We found little evidence to support the use of postoperative antibiotics to reduce the risk of surgical site infections in dogs after TPLO. The answer to this clinical question is complicated by the lack of prospective studies and inconsistent treatment protocols in the evaluated studies.
The clinical impact of postoperative antibiotic administration on infection rates after TPLO is uncertain.
系统回顾已发表的数据，以确定胫骨平台平整截骨术（TPLO）后使用术后抗生素是否会降低感染率。
系统回顾。
通过 2020 年 3 月前在三个在线数据库中进行广泛的文献检索，查找有关犬 TPLO 术后使用抗生素的文献。检索词包括狗、犬、TPLO、胫骨平台平整截骨术、感染、抗生素和抗菌药。符合纳入标准的文章通过改良牛津证据等级（mOLE）和 GRADE（推荐评估、制定与评价）分类和评估来评估证据水平（LoE）。
符合纳入标准的研究有 13 项。其中 4 项研究的主要问题是抗生素的使用效果。其中，50%（2/4）的研究被归类为 mOLE 1b 和 GRADE 中等级，而另外 50%（2/4）的研究被归类为 mOLE 4b 或 4c 和 GRADE 低等级。两项具有最高 LoE 的研究没有提供抗生素使用益处的证据。只有一项研究的结果提供了支持术后使用抗生素的证据。其余 9 项研究次要评估了抗生素的使用，均被归类为低 LoE。其中，78%（7/9）的研究提供了支持术后使用抗生素的证据。
我们几乎没有发现证据支持使用术后抗生素来降低犬 TPLO 后手术部位感染的风险。评估研究中缺乏前瞻性研究和不一致的治疗方案使得这个临床问题的答案变得复杂。
术后抗生素给药对 TPLO 后感染率的临床影响尚不确定。
