Complications in Canine Cranial Cruciate Ligament Surgery. Ron Ben-Amotz

Widmer, A.F., Rotter, M., Voss, A. et al. (2010). Surgical hand preparation: state‐of‐the‐art. J. Hosp. Infect. 74 (2): 112–122.

      62 62. Meakin, L.B., Gilman, O.P., Parsons, K.J. et al. (2016). Colored indicator undergloves increase the detection of glove perforations by surgeons during small animal orthopedic surgery: a randomized controlled trial. Vet. Surg. 45: 709–714.

      63 63. Hayes, G.M., Reynolds, D., Moens, N.M.M. et al. (2014). Investigation of incidence and risk factors for surgical glove perforation in small animal surgery. Vet. Surg. 43: 400–404.

      64 64. Stine, S.L., Odum, S.M., and Daniel Mertens, W. (2018). Protocol changes to reduce implant‐associated infection rate after tibial plateau leveling osteotomy: 703 dogs, 811 TPLO (2006–2014). Vet. Surg. 47: 481–489.

      65 65. Boothe, H.W. (2017). Instrument and tissue handling techniques. In: Veterinary Surgery, 2e (eds. S.A. Johnston and K.M. Tobias), 733. St Louis, MO: Elsevier.

      66 66. Cadman, C. (2016). The impact of surgical safety checklists on theatre departments: a critical review of the literature. J. Perioper. Pract. 26 (4): 62–71.

      67 67. Haynes, A., Weiser, T., Berry, W. et al. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. N. Engl. J. Med. 360: 491–499.

      68 68. Verwilghen, D. and Singh, A. (2015). Fighting surgical site infections in small animals: are we getting anywhere? Vet. Clin. North Am. Small Anim. Pract. 45 (2): 243–276.

      69 69. Gatineau, M., El‐warrak, A.O., Bolliger, C. et al. (2012). Effects of sterilization with hydrogen peroxide gas plasma, ethylene oxide, and steam on bioadhesive properties of nylon and polyethylene lines used for stabilization of canine stifle joints. Am. J. Vet. Res. 73: 1665–1659.

      70 70. Solano, M.A., Danielski, A., Kovach, K. et al. (2015). Locking plate and screw fixation after tibial plateau leveling osteotomy reduces postoperative infection rate in dogs over 50 kg. Vet. Surg. 44: 59–64.

      71 71. Singh, A., Walker, M., Rousseau, J., and Weese, J.S. (2013). Characterization of the biofilm forming ability of Staphylococcus pseudintermedius from dogs. BMC Vet. Res. 9: 93.

      72 72. Donlan, R.M. (2001). Biofilm formation: a clinically relevant microbiological process. Clin. Infect. Dis. 33: 1387–1392.

      73 73. Walker, M., Singh, A., Nazarali, A. et al. (2016). Evaluation of the impact of methicillin‐resistant Staphylococcus pseudintermedius biofilm formation on antimicrobial susceptibility. Vet. Surg. 45: 968–971.

      74 74. Azab, M.A., Allen, M.J., and Daniels, J.B. (2016). Evaluation of a silver‐impregnated coating to inhibit colonization of orthopaedic implants by biofilm forming methicillin‐resistant Staphylococcus pseudintermedius. Vet. Comp. Orthop. Traumatol. 29 (6): 347–350.

      75 75. Arciola, C.R., Campoccia, D., Speziale, P. et al. (2012). Biofilm formation in Staphylococcus implant infections. A review of molecular mechanisms and implications for biofilm‐resistant materials. Biomaterials 33 (26): 5967–5982.

      76 76. Konig, L., Klopfleisch, R., Kershaw, O., and Gruber, A.D. (2015). Prevalence of biofilms on surgical suture segments in wounds of dogs, cats, and horses. Vet. Pathol. 52 (2): 295–297.

      77 77. McCagherty, J., Yool, D.A., Paterson, G.K. et al. (2020). Investigation of the in vitro antimicrobial activity of triclosan‐coated suture material on bacteria commonly isolated from wounds in dogs. Am. J. Vet. Res. 81 (1): 84–90.

      78 78. Morrison, S., Singh, A., Rousseau, J. et al. (2015). Impact of polymethylmethacrylate additives on methicillin‐resistant Staphylococcus pseudintermedius biofilm formation in vitro. Am. J. Vet. Res. 76 (5): 395–401.

      79 79. Boothe, D.M. and Boothe, H.W. Jr. (2015). Antimicrobial considerations in the perioperative patient. Vet. Clin. North Am. Small Anim. Pract. 45 (3): 585–608.

      80 80. Anderson, M.E.C. (2015). Contact precautions and hand hygiene in veterinary clinics. Vet. Clin. North Am. Small Anim. Pract. 45 (2): 343–360.

      81 81. Bratzler, D. (2005). Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgery Infection Prevention Project. Am. J. Surg. 189: 395–404.

      82 82. Whittem, T.L., Johnson, A.L., Smith, C. et al. (1999). Effect of perioperative prophylactic antimicrobial treatment in dogs undergoing elective orthopedic surgery. J. Am. Vet. Med. Assoc. 215: 212–216.

      83 83. Weese, J.S. and Halling, K.B. (2006). Perioperative administration of antimicrobials associated with elective surgery in dogs: 83 cases (2003–2005). J. Am. Vet. Med. Assoc. 229 (1): 92–95.

      84 84. Hagen, C.R.M., Singh, A., Weese, J.S. et al. (2020). Contributing factors to surgical site infection after tibial plateau leveling osteotomy: a follow‐up retrospective study. Vet. Surg. 49: 930–939.

      85 85. Burgess, B.A. (2019). Prevention and surveillance of surgical infections: a review. Vet. Surg. 48: 284–290.

      86 86. Stickney, D.N.G. and Mankin, K.M.T. (2018). The impact of postdischarge surveillance on surgical site infection diagnosis. Vet. Surg. 47: 66–73.

      87 87. Centers for Disease Control and Prevention (2020). Surgical Site Infection (Event). Atlanta, GA: CDC.

      88 88. Nicoll, C., Singh, A., and Weese, J.S. (2014). Economic impact of tibial plateau leveling osteotomy surgical site infection in dogs. Vet. Surg. 43: 899–902.

3 Identification, Addressing, and Following Up on Surgical Site Infection After Cranial Cruciate Ligament Stabilization

      Katie L. Hoddinott, J. Scott Weese, and Ameet Singh

3.1 Introduction

      Prompt and accurate diagnosis of surgical site infections (SSIs) is important for patient management and facility infection control. Identifying infections promptly allows for early intervention. Differentiation of SSI from inflammation helps avoid unnecessary treatment. A good understanding of infection rates and early identification of increases in infection rates can allow for an earlier investigation and intervention. Therefore, SSI surveillance is a critical area for any surgeon, surgical team, and facility.

3.2 Identification of Surgical Site Infections

      A superficial incisional SSI is confined to the skin and subcutaneous tissues of the incision and must be differentiated from cellulitis. The Centers for Disease Control and Prevention (CDC) defines cellulitis as localized redness, heat, and swelling, without purulent discharge or identification of microorganisms [1]. The clinical features associated with cellulitis are often identified in postoperative wounds and presumed to indicate SSI without performing diagnostic testing to identify a causative organism, thus confirming an active SSI [2, 3]. Subsequently, when reviewing the literature, a category such as “infection‐inflammation” may be reported, making it difficult to accurately detect and report SSI rates based on CDC definitions [2, 3]. One such study including the infection‐inflammation category defines infection‐inflammation as the presence of purulent discharge, a localized abscess or fistulous tract associated with the incision or the presence of three or more of the following: redness, swelling, heat, pain, serous discharge, and dehiscence [3]. While some of the cases collected in this category may appropriately represent an SSI, it does not distinguish SSI from cellulitis and as such may be falsely increasing the reported SSI rates. Other studies have reported SSI rates based on CDC definitions including positive culture results, while also reporting an infection‐inflammation rate to encompass those patients presenting with abnormal incisions [4].

Early detection and intervention for SSIs is critical. Löfqvist et al. identified marked elevations of serum C‐reactive protein (CRP) and serum amylase A (SAA) 6 days following tibial plateau leveling osteotomy (TPLO) [5]. The cut‐off values reported (CRP >43.9 mg/L, SAA >63.8 mg/L) may be used for patients both with and without clinical evidence of an active SSI and may therefore lead to earlier detection of subclinical SSIs [5]. While these