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

      Regardless of local or systemic therapies used in conjunction with implant removal, bacterial culture and susceptibility testing is recommended following implant removal. While a positive culture may not indicate the need for antimicrobial treatment, it allows for proper selection of the antimicrobial if treatment is determined to be clinically indicated. A positive culture result has been reported following implant removal in 72–80% of cases [18, 23]. However, sonication of implants may aid in improved bacterial recovery when considering culture and susceptibility testing [33]. As sonication is not likely to be performed routinely for culture and susceptibility testing, this may play a role in identification of negative culture results following implant removal for SSI. Alternatively, preoperative treatment with antimicrobial therapy targeted at the known microorganisms may be sufficient to eradicate or significantly reduce the microbial burden, such that a negative culture result is achieved post implant removal [13, 18, 23].

3.4 Follow‐Up

Following diagnosis of an SSI, continued frequent communication is necessary to ensure response to therapy. If empirical therapy is instituted without improvement of clinical signs, bacterial culture and susceptibility testing is recommended to guide therapy, if this is not already under way. Duration of antimicrobial therapy is controversial but should reflect the level of the infection, such that a superficial SSI receives a shorter course of antimicrobial therapy than a deep or organ/space SSI. At any time that antimicrobial therapy has been discontinued and clinical signs of SSI recur, implant removal should be considered to remove the largest burden of disease associated with a likely biofilm‐associated implant infection. Following discontinuation of antimicrobial therapy or implant removal, active surveillance protocols to acquire follow‐up information regarding resolution or recurrence of clinical signs should be implemented. Setting in place an infection control plan in your hospital to determine annual SSI rates in general, but specifically associated with surgically implanted devices, will be beneficial to document and monitor trends, thus allowing earlier interventions when SSI rates are increasing.

References

      1 1. Centers for Disease Control and Prevention (2020). Centers for disease control and prevention: surgical site infection (SSI) event.

      2 2. Wolf, R.E., Scavelli, T.D., Hoelzler, M.G. et al. (2012). Surgical and postoperative complications associated with tibial tuberosity advancement for cranial cruciate ligament rupture in dogs: 458 cases (2007–2009). J. Am. Vet. Med. Assoc. 240 (12): 1481–1487.

      3 3. Frey, T.N., Hoelzler, M.G., Scavelli, T.D. et al. (2010). Risk factors for surgical site infection‐inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005–2006). J. Am. Vet. Med. Assoc. 236 (1): 88–94.

      4 4. Turk, R., Singh, A., and Weese, J.S. (2015). Prospective surgical site infection surveillance in dogs. Vet. Surg. 44: 2–8.

      5 5. Löfqvist, K., Kjelgaard‐Hansen, M., and Nielsen, M.B.M. (2018). Usefulness of C‐reactive protein and serum amyloid a in early detection of postoperative infectious complications to tibial plateau leveling osteotomy in dogs. Acta Vet. Scand. 60 (30): 1–8.

      6 6. Bonham, P.A. (2009). Swab cultures for diagnosing wound. J. Wound Osto. Cont. Nurses. Soc. 36 (August): 389–395.

      7 7. 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.

      8 8. Belo, L., Serrano, I., Cunha, E. et al. (2018). Skin asepsis protocols as a preventive measure of surgical site infections in dogs: chlorhexidine – alcohol versus povidone‐iodine. BMC Vet. Res. 14 (95): 1–6.

      9 9. 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.

      10 10. Costa, M., Craig, D., Cambridge, T. et al. (2017). Major complications of tibial tuberosity advancement in 1613 dogs. Vet. Surg. 46: 494–500.

      11 11. 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.

      12 12. Gallagher, A.D. and Mertens, W.D. (2012). Implant removal rate from infection after tibial plateau leveling osteotomy in dogs. Vet. Surg. 41: 705–711.

      13 13. Brown, G., Maddox, T., and Siles, M.M.B. (2016). Client‐assessed long‐term outcome in dogs with surgical site infection following tibial plateau levelling osteotomy. Vet. Rec. 179: 409.

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

      15 15. Nazarali, A., Singh, A., and Weese, J.S. (2014). Perioperative administration of antimicrobials during tibial plateau leveling osteotomy. Vet. Surg. 43: 966–971.

      16 16. Stull, J.W. (2015). Hospital‐associated infections in small animal practice. Vet. Clin. North Am. Small Anim. Pract. 45 (2): 217–233.

      17 17. 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.

      18 18. Thompson, A.M., Bergh, M.S., Wang, C., and Wells, K. (2011). Tibial plateau levelling osteotomy implant removal: a retrospective analysis of 129 cases. Vet. Comp. Orthop. Traumatol. 24: 450–456.

      19 19. Casale, S.A. and McCarthy, R.J. (2009). Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997–2005). J. Am. Vet. Med. Assoc. 234: 229–235.

      20 20. Yap, F.W., Calvo, I., Smith, K.D., and Parkin, T. (2015). Perioperative risk factors for surgical site infection in tibial tuberosity advancement: 224 stifles. Vet. Comp. Orthop. Traumatol. 28: 199–206.

      21 21. Serratore, V.R. and Barnhart, M.D. (2018). Results and complications after removal of tibial tuberosity advancement cage for treatment of surgical site infections: a retrospective study. Vet. Surg. 47: 768–773.

      22 22. Frederick, S.W. and Cross, A.R. (2017). Modified cranial closing wedge osteotomy for treatment of cranial cruciate ligament insufficiency in dogs with excessive tibial plateau angles: technique and complications in 19 cases. Vet. Surg. 46: 403–411.

      23 23. 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.

      24 24. Kaplan, J.B. (2009). Therapeutic potential of biofilm‐dispersing enzymes. Int. J. Artif. Organs 32 (9): 545–554.

      25 25. Hagen, C., Singh, A., Weese, J.S. et al. (2020). in vitro elution of amikacin and dispersin B from a polymer hydrogel. Vet. Surg. 49: 1035–1042.

      26 26. Hayes, G., Moens, N., and Gibson, T. (2013). A review of local antibiotic implants and applications to veterinary orthopaedic surgery. Vet. Comp. Orthop. Traumatol. 26: 251–259.

      27 27. 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.

      28 28. Thomas, L.A., Bizikova, T., and Minihan, A.C. (2011). in vitro elution and antibacterial activity of clindamycin, amikacin, and vancomycin from R‐gel polymer. Vet. Surg. 40: 774–780.

      29 29. Reed, T.P., Thomas, L.A., Weeren, F.R. et al. (2016). A novel dextran polymer hydrogel local antimicrobial therapy in dogs: a pilot study. Can. J. Vet. Res. 57: 189–195.

      30 30. Hayes, G., Gibson, T., Moens, N.M.M. et al. (2016). Intra‐articular implantation of gentamicin impregnated collagen sponge causes joint inflammation and impaired renal function in dogs. Vet. Comp. Orthop. Traumatol. 29: 159–163.

      31 31. Owen, M.R., Moores, A.P., and Coe, R.J. (2004). Management of MRSA septic arthritis in a dog using a gentamicin‐impregnated collagen sponge. J. Small Anim. Pract. 45: 609–612.

      32 32.