Читать книгу Complications in Canine Cranial Cruciate Ligament Surgery - Ron Ben-Amotz - Страница 38

While perioperative antimicrobial prophylaxis is recommended to be discontinued within 24 hours of surgery, a definition of when perioperative prophylaxis ends and postoperative antimicrobial therapy begins remains unknown. In human medicine, it is rare for antimicrobials to be continued beyond 24–48 hours postoperatively, even in the case of transplanted organs. Despite this knowledge, the increased incidence of SSI in clean elective orthopedic procedures has led to an increased use of postoperative antimicrobials. This is a controversial topic amongst veterinary surgeons, with evidence to both support and refute its use. Several studies including mainly TPLO surgeries, fewer TTA surgeries and some broad clean orthopedic procedures have identified a protective effect against SSI when postoperative antimicrobials are used [4, 9, 13, 21, 22, 30, 70, 83]. Fewer studies have identified a lack of effect on alteration of the SSI rate when postoperative antimicrobials are administered [8, 14, 16, 27, 29]. Additional studies identify postoperative antimicrobial use in clean orthopedic procedures including TPLO and the Arthrex Canine Cruciate Ligament Repair Anchor System™, without evaluating their effect on SSI rates [12, 19, 28, 52].

At this time, there are a greater number of studies to support the use of postoperative antimicrobial use following TPLO surgery; however, the duration of treatment has been variable and specific recommendations cannot be made, although short courses of 3–5 days' duration are likely sufficient. Further prospective evaluation of postoperative antimicrobial protocols should be considered. Many factors can contribute to an individual's estimated risk for developing an SSI and these should be considered together before deciding to use postoperative antimicrobials. Postoperative antimicrobials should never be used as a surrogate for aseptic technique and good surgical practices.