Lucrezia Di Filippo, Amanda Bianchi, Andrea Paolini, Francesco Collivignarelli, Roberto Tamburro, Umberto Maggiolini, Gert W. Niebauer
Simple summary:
Tibial plateau leveling osteotomy (TPLO) is a common surgical pro-
cedure to treat stifle joints affected by cranial cruciate ligament disease in dogs. To avoid
surgical site infection, peri- and postoperative antimicrobial administration is often rou-
tinely used. The effectiveness of such prophylactic protocol remains controversial. Tibial
plateau leveling osteotomy is a clean orthopedic procedure usually performed in dogs free
from other conditions. For these reasons, we hypothesized that perioperative antibiotic
treatment alone may be sufficient to maintain surgical site infections within acceptable
limits. Dogs undergoing TPLO were divided into two groups with respect to the antibiotic
protocol used: in the first group, peri- and postoperative antimicrobial management was
used, while in the second group, only perioperative antibiosis was administered. Results
showed no difference in surgical site infection rates between the two groups, suggest-
ing that extending antibiotic use in the postoperative period is unnecessary. Eliminating
postoperative antibiotic medication in a clean orthopedic procedure such as TPLO helps
to reduce antibiotic resistance and is in line with the generally accepted standards of
antimicrobial stewardship.
Abstract:
(1) Background: Postoperative antibiotic prophylaxis in dogs undergoing tibial
plateau leveling osteotomy (TPLO) is controversial. We evaluated the effect of perioper-
ative antibiotic administration on the incidence of surgical site infection (SSI) and bone
healing in dogs that underwent TPLO procedures and compared this protocol with cases
that received prolonged postoperative antibiotic treatment. (2) Methods: Two different
antibiotic treatment protocols were used. In group A, cefazolin (22 mg/kg IV) was ad-
ministered preoperatively 30–60 min before skin incision and repeated every 90–120 min
intraoperatively. Antimicrobial prophylaxis was extended in the postoperative period
with oral cefazolin (22 mg/kg BID) for 10 days after surgery. In group B, dogs only re-
ceived perioperative treatment, at the same dose used in group A. Dogs were considered
to have SSI in cases of incisional drainage, wound dehiscence, positive bacterial culture,
or evidence of radiographic signs of infection. (3) Results: In group A, SSI was observed
in 3/61 TPLOs (4.9%). In group B, SSI was present in 3/51 TPLOs (5.9%). There was no
difference between the two groups. (4) Conclusions: Our results indicate that perioperative
antibiotic prophylaxis in TPLO procedures is sufficient to maintain overall low rates of SSI.