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MIZUGUCHI Y, KATO A, AIZU M. Regional antibiotic perfusion through the lateral saphenous vein in two horses with septic calcaneal osteitis. J Vet Med Sci 2023; 85:55-61. [PMID: 36418075 PMCID: PMC9887219 DOI: 10.1292/jvms.22-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In this case report, two horses with chronic refractory infections in the tuber calcanei were successfully managed via intravenous antibiotic regional limb perfusion through the lateral saphenous vein after failure of conventional treatment approaches, including surgery and intravenous regional limb perfusion using the cranial branch of the medial saphenous vein. Surgical delay in these cases may have allowed the development of chronic infection, which prevented the conventional regional perfusion from working effectively. The spatial difference of the vessels relative to the tuber calcanei possibly contributed to the treatment outcome in these horses. This report describes a novel approach for regional antimicrobial perfusion to the equine plantar hock region using the lateral saphenous vein.
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Affiliation(s)
- Yuya MIZUGUCHI
- Hidaka Horse Breeders’ Association, Hokkaido, Japan,Correspondence to: Mizuguchi Y: , Hidaka Horse Breeders’ Association, 39-6 Midorimachi,
Hidaka, Hokkaido 059-2122, Japan
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2
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de Souza Garcia AF, Ribeiro G, de Assis Arantes J, Reginato GM, Xavier NV, Carregaro AB, Silva TJF, Grigoletto R, de Freitas SH, Dória RGS. Evaluation of totally implantable catheters in healthy horses. BMC Vet Res 2021; 17:339. [PMID: 34702265 PMCID: PMC8549289 DOI: 10.1186/s12917-021-03052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background For horses requiring prolonged daily cephalic intravenous regional limb perfusion (IVRLP), the use of a totally implantable catheter (TIC) could be indicated to reduce complications associated with frequent venipuncture or external catheterization. This study aims to evaluate the implantation technique of the TIC in the cephalic vein of horses for IVRLP, describe the complications associated with the device’s placement and use, and assess its viability up to 60 days after implantation. Totally implantable catheters, cut to 15 cm (n = 5) and 46 cm (n = 5) in length, were implanted into one cephalic vein in ten adult horses (n = 10). Twenty-four hours following placement, IVRLP with contrast was performed via the TIC and evaluated with radiography. Physical examinations, lameness evaluation, hematologic assessment, and the catheter patency tests were performed at scheduled intervals for the duration of catheterization (7–60 days). Results Catheters were implanted without difficulty and allowed for IVRLP 24 h post implantation. Complications resulted in removal of the catheters, with four maintained for 7 days, three in place for 15 days, and three catheters maintained for 60 days. Complications included lameness, limb swelling, catheter kinking, and venous thrombosis. Conclusions The implantation technique of the TIC in the cephalic vein of horses is feasible and requires minimal technical effort. Although TIC allows venous access without the need for repeated venipuncture, its long-term use presents complications. For horses requiring prolonged daily cephalic IVRLP, the use of a TIC could be indicated. However, the high incidence of venous thrombosis may limit clinical application.
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Affiliation(s)
| | - Gesiane Ribeiro
- United Metropolitan Colleges, Rua Ministro Nelson Hungria, 541, Vila Tramontano, São Paulo, São Paulo, 05690-050, Brazil
| | - Julia de Assis Arantes
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Gustavo Morandini Reginato
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Nathalia Villaca Xavier
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Adriano Bonfim Carregaro
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Thiago Jhonatha Fernandes Silva
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Renan Grigoletto
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Silvio Henrique de Freitas
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil
| | - Renata Gebara Sampaio Dória
- Department of Veterinary Medicine, Faculty of Animal Science and Food Engineering, University of São Paulo, Rua Duque de Caxias Norte, 225, Jardim Elite, 13.635-900, Pirassununga, São Paulo, Brazil.
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3
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Slack‐Smith V, Davies HMS, Hilbert BJ. Long bone failure after intraosseous regional perfusion. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- V. Slack‐Smith
- Veterinary Clinical Centre Charles Sturt University Wagga Wagga New South Wales Australia
| | - H. M. S. Davies
- Department of Veterinary Biosciences University of Melbourne Parkville Victoria Australia
| | - B. J. Hilbert
- Veterinary Clinical Centre Charles Sturt University Wagga Wagga New South Wales Australia
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Merkatoris P, Schleining J, Krull A, Borts D, Fajt V. In vitro Elution of Penicillin, Ampicillin, Tetracycline, Tulathromycin, and Florfenicol From Plaster of Paris Beads. Front Vet Sci 2020; 7:585423. [PMID: 33330710 PMCID: PMC7734027 DOI: 10.3389/fvets.2020.585423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/04/2020] [Indexed: 11/13/2022] Open
Abstract
The objectives of this study were to report a recipe for making antibiotic impregnated Plaster of Paris (AI-PoP) beads using penicillin, ampicillin, tetracycline, tulathromycin, and florfenicol and to determine the in vitro elution rates of those antibiotics in the beads. The AI-PoP beads were made using Plaster of Paris powder, antibiotic, and water, cured for 24 h, sterilized by ethylene oxide, and stored up to 5 months before testing. For each antibiotic, 20 beads were combined with bovine serum in sterile tubes and incubated at 37°C on a rocker. Serum was replaced at intervals over the 14 days study period, and antibiotic concentrations were determined by high pressure liquid chromatography with mass spectrometry. Separately, in a proof-of-concept study, the growth of E. coli and T. pyogenes in eluent from 10 beads for each antibiotic was quantified by flow cytometry. Antibiotic was detected in AI-PoP bead eluent for 14 days for all but the ampicillin beads, for which antibiotic was detected for 8 days. The concentration of antibiotic in eluent was greater than the minimum inhibitory concentration (MIC) of tested bacteria for the entire study period for penicillin, tetracycline, tulathromycin, and florfenicol. The concentration of ampicillin remained greater than the MIC of E. coli for 4 days and T. pyogenes for 6 days. The colony forming units (CFU)/ml of live E. coli and T. pyogenes was reduced over a 72-h period by 1-3 log10 CFU, with the exception of tetracycline, which reduced CFU/ml of T. pyogenes by
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Affiliation(s)
- Paul Merkatoris
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Jennifer Schleining
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, United States
| | - Adam Krull
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - David Borts
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, United States
| | - Virginia Fajt
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX, United States
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5
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Comparison of plasma and intra-articular gentamicin levels after intravenous administration in healthy horses. ACTA VET BRNO 2020. [DOI: 10.2754/avb202089030225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Septic arthritis is considered one of the most severe disorders that affect horses’ joints. Therapy is intended to eliminate the microorganisms that cause this infection. The intravenous administration of antibiotics is an easily performed technique, but there is no guarantee that the antibiotics will reach the joint milieu at high concentrations and remain elevated for a certain period of time. This study aimed to determine and compare the levels of gentamicin in the plasma and synovial fluid of healthy horses after intravenous administration for seven days. Five horses received 6.6 mg/kg intravenous gentamicin every 24 h for seven consecutive days. Blood and synovial fluid samples were collected from the right metacarpal-phalangeal joint before the start of the treatment (T0) and after 6 h (T6), 12 h (T12), and every 24 h during antibiotic therapy for seven days (D1 to D7). The levels of gentamicin in serum and synovial fluid were quantified by Enzyme-Linked Immunosorbent Assay (ELISA). The intravenous administration of 6.6 mg/kg of gentamicin, in horses, after a period of 24 h, promotes synovial fluid concentrations below the MIC of the drug, in spite of reaching high plasma concentrations of gentamicin, daily mean serum concentration which was 29-fold higher than the minimum inhibitory concentration (MIC) of the drug. The intravenous administration every 24 h during seven consecutive days did not cause systemic side effects, such as hepatic or renal injury.
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Biasutti SA, Cox E, Jeffcott LB, Dart AJ. A review of regional limb perfusion for distal limb infections in the horse. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. A. Biasutti
- Research and Clinical Training Unit University Veterinary Teaching Hospital Camden University of Sydney New South Wales Australia
| | - E. Cox
- Research and Clinical Training Unit University Veterinary Teaching Hospital Camden University of Sydney New South Wales Australia
| | - L. B. Jeffcott
- Research and Clinical Training Unit University Veterinary Teaching Hospital Camden University of Sydney New South Wales Australia
| | - A. J. Dart
- Research and Clinical Training Unit University Veterinary Teaching Hospital Camden University of Sydney New South Wales Australia
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Shivapour SK, Jackson ND, Schleining JA, Kreuder AJ, Miles KG, Jeffery ND. Surgical intervention for vertebral osteomyelitis in a calf. Vet Surg 2019; 48:1064-1070. [PMID: 31219189 DOI: 10.1111/vsu.13251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/08/2019] [Accepted: 05/18/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To report the surgical treatment and outcome of a non-ambulatory calf with cervical vertebral ostoeomyelitis. STUDY DESIGN Clinical report. SAMPLE POPULATION One 3.5-month-old female mixed-breed calf with tetraparesis of 3 months duration. METHODS After computed tomography-guided bone biopsy, a bacterial osteolytic lesion within the body of the fourth cervical vertebrae (C4) and resultant pathologic compression fracture clinically resulting in full tetraparesis was diagnosed in the calf. Culture results from the lesion within C4 confirmed a diagnosis of Trueperella pyogenes. RESULTS Poor response to medical management justified surgical debridment of the lesion in C4 and subsequent stabilization of the cervical vertebral column. A three-part procedure was performed including (1) debridement of the C4, (2) bilateral ventral vertebral stabilization from C3 to C5, and (3) placement of ampicillin-impregnated plaster of Paris beads within the body of C4. With postoperative physical rehabilitation, the calf regained full ambulatory function. At 1-month follow-up, the calf remained ambulatory with mild proprioceptive ataxia and no evidence of implant failure. At annual recheck, the calf had gained 208 kg and remained fully ambulatory with no residual neurologic deficits. CONCLUSION Surgical intervention and use of antibiotic-impregnated implants offered a viable alternative to long-term medical management of vertebral osteomyelitis in the calf reported here. CLINICAL SIGNIFICANCE This case identifies surgical intervention as a potential means for improving outcomes in a historically fatal condition of production animals.
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Affiliation(s)
- Sara K Shivapour
- Department of Veterinary Clinical Sciences, Royal Veterinary College, North Mymms, United Kingdom
| | | | - Jennifer A Schleining
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, Texas
| | - Amanda J Kreuder
- Department of Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, Iowa.,Department of Veterinary Microbiology and Preventative Medicine, Iowa State University, Ames, Iowa
| | - Kristina G Miles
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
| | - Nicholas D Jeffery
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas
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8
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Godfrey JL, Hardy J, Cohen ND. Effects of regional limb perfusion volume on concentrations of amikacin sulfate in synovial and interstitial fluid samples from anesthetized horses. Am J Vet Res 2017; 77:582-8. [PMID: 27227495 DOI: 10.2460/ajvr.77.6.582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the effect of volume of IV regional limb perfusion (IVRLP) on amikacin concentrations in synovial and interstitial fluid of horses. ANIMALS 8 healthy adult horses. PROCEDURES Each forelimb was randomly assigned to receive IVRLP with 4 mL of amikacin sulfate solution (250 mg/mL) plus 56 mL (total volume, 60 mL) or 6 mL (total volume, 10 mL) of lactated Ringer solution. Horses were anesthetized, and baseline synovial and interstitial fluid samples were collected. A tourniquet was placed, and the assigned treatment was administered via the lateral palmar digital vein. Venous blood pressure in the distal portion of the limb was recorded. Additional synovial fluid samples were collected 30 minutes (just before tourniquet removal) and 24 hours after IVRLP began; additional interstitial fluid samples were collected 6 and 24 hours after IVRLP began. RESULTS 30 minutes after IVRLP began, mean amikacin concentration in synovial fluid was significantly greater for the large-volume (459 μg/mL) versus small-volume (70 μg/mL) treatment. Six hours after IVRLP, mean concentration in interstitial fluid was greater for the large-volume (723 μg/mL) versus small-volume (21 μg/mL) treatment. Peak venous blood pressure after large-volume IVRLP was significantly higher than after small-volume IVRLP, with no difference between treatments in time required for pressure to return to baseline. CONCLUSIONS AND CLINICAL RELEVANCE Study findings suggested that large-volume IVRLP would deliver more amikacin to metacarpophalangeal joints of horses than would small-volume IVRLP, without a clinically relevant effect on local venous blood pressure, potentially increasing treatment efficacy.
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Rafael L, Rodrigues C, Evangelista F, Ramires C, Rodrigues M, Pizzigatti D, Perri S, Hussni C. Avaliação do efeito trombogênico da perfusão regional intravenosa com gentamicina em equinos. ARQ BRAS MED VET ZOO 2014. [DOI: 10.1590/1678-6708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A extremidade distal dos equinos é frequentemente afetada por processos sépticos de difícil tratamento. A perfusão regional intravenosa de antimicrobianos é uma opção de tratamento para esses processos, pois aumenta a concentração do fármaco no local mediante pequenas doses. Entretanto, apesar de ser muito utilizada recentemente, ainda apresenta várias questões. O objetivo deste trabalho foi avaliar as possíveis complicações da técnica, com o uso da gentamicina na dose de 2,2mg/kg na veia cefálica de equinos. Utilizaram-se 15 equinos hígidos divididos aleatoriamente em três grupos de cinco animais: grupo somente com torniquete (GT), grupo que recebeu 40mL de solução fisiológica (GSF) e grupo que recebeu gentamicina na dose de 2,2mg/kg, acrescida de solução fisiológica até completar o volume de 40mL (GSG). O membro perfundido foi avaliado por termografia e ultrassonografia duplex em cores ao longo do tempo. Os dados foram submetidos à análise pelos testes de Tukey e de Dunnett, e o nível de significância adotado foi de P<0,05. Todos os grupos apresentaram escore trombótico zero, e não houve diferença significativa entre os grupos quanto ao diâmetro médio da veia e da temperatura dos membros. A antibiose intravenosa regional com 2,2mg/kg de gentamicina, em dose única, não acarretou o desenvolvimento de trombose na veia cefálica.
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Kelmer G, Tatz AJ, Famini S, Bdolah-Abram T, Soback S, Britzi M. Evaluation of regional limb perfusion with chloramphenicol using the saphenous or cephalic vein in standing horses. J Vet Pharmacol Ther 2014; 38:35-40. [PMID: 25073920 DOI: 10.1111/jvp.12140] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 05/14/2014] [Indexed: 11/28/2022]
Abstract
Regional limb perfusion (RLP) significantly decreases morbidity and mortality associated with distal limb injuries in horses. There is an urgent need for finding additional effective antimicrobial drugs for use in RLP. In this study, we tested the pharmacokinetics (PK) of chloramphenicol in RLP. Eight horses participated in the study, which was approved by the University Animal Care and Use Committee. The cephalic and the saphenous veins were used to perfuse the limbs. Synovial samples were collected from the metacarpo/metatarsophalangeal (MCP/MTP) joint. The Friedman Test was applied for assessing change in PK concentration over time, for all time points. The Wilcoxon Signed Ranks Test was used to test the difference between PK concentration in joint & serum as well as concentration in joint vs. MIC. The comparison of measurements between measurements taken on hind vs. front legs was carried out using the Mann-Whitney Test. A P-value of 5% or less was considered statistically significant. After RLP, the concentration of chloramphenicol in the synovial fluid of the MCP/MTP joint using either the cephalic or the saphenous vein was initially far above the minimal inhibitory concentration (MIC) of most susceptible pathogens and remained above the MIC for approximately 6 h. The results indicate that performing RLP using the cephalic and saphenous veins enables reaching concentrations of chloramphenicol in the MCP/MTP joint that are well above the MIC of most susceptible pathogens. The chloramphenicol concentrations achieved in the synovial fluid of the MCP/MTP joint in the current study were between 1.5 (MTP) and 7 (MCP) times the MIC of MRSA in horses. These results are encouraging since MRSA infections are becoming far more common, causing considerable morbidity. To the best of our knowledge, this is the first study to evaluate the pharmacokinetics of chloramphenicol following RLP in the horse and the results are positive.
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Affiliation(s)
- G Kelmer
- Department of Large Animal Medicine and Surgery, Veterinary Teaching Hospital, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
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Zantingh AJ, Schwark WS, Fubini SL, Watts AE. Accumulation of Amikacin in Synovial Fluid After Regional Limb Perfusion of Amikacin Sulfate Alone and in Combination With Ticarcillin/Clavulanate in Horses. Vet Surg 2014; 43:282-8. [DOI: 10.1111/j.1532-950x.2014.12119.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 11/01/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Alanna J. Zantingh
- Department of Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca New York
| | - Wayne S. Schwark
- Department of Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca New York
| | - Susan L. Fubini
- Department of Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca New York
| | - Ashlee E. Watts
- Department of Clinical Sciences, College of Veterinary Medicine; Cornell University; Ithaca New York
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Young SW, Zhang M, Freeman JT, Mutu-Grigg J, Pavlou P, Moore GA. The Mark Coventry Award: Higher tissue concentrations of vancomycin with low-dose intraosseous regional versus systemic prophylaxis in TKA: a randomized trial. Clin Orthop Relat Res 2014; 472:57-65. [PMID: 23666589 PMCID: PMC3889447 DOI: 10.1007/s11999-013-3038-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In response to increasing antibiotic resistance, vancomycin has been proposed as an alternative prophylactic agent in TKA. However, vancomycin requires a prolonged administration time, risks promoting further antibiotic resistance, and can cause systemic toxicity. Intraosseous regional administration (IORA) is known to achieve markedly higher antibiotic concentrations than systemic administration and may allow the use of a lower vancomycin dose. QUESTIONS/PURPOSES We assessed whether low-dose IORA vancomycin can achieve tissue concentrations equal or superior to those of systemic administration in TKA and compared complications between patients treated with IORA and intravenous vancomycin. METHODS We randomized 30 patients undergoing primary TKA to receive 250 or 500 mg vancomycin via IORA or 1 g via systemic administration. IORA was performed as a bolus injection into a tibial intraosseous cannula below an inflated thigh tourniquet immediately before skin incision. Subcutaneous fat and bone samples were taken during the procedure and antibiotic concentrations measured. RESULTS The overall mean tissue concentration of vancomycin in subcutaneous fat was 14 μg/g in the 250-mg IORA group, 44 μg/g in the 500-mg IORA group, and 3.2 μg/g in the systemic group. Mean concentrations in bone were 16 μg/g in the 250-mg IORA group, 38 μg/g in the 500-mg IORA group, and 4.0 μg/g in the systemic group. One patient in the systemic group developed red man syndrome during infusion. CONCLUSIONS Low-dose IORA vancomycin results in tissue concentrations equal or superior to those of systemic administration. IORA optimizes timing of vancomycin administration, and the lower dose may reduce the risk of systemic side effects while providing equal or enhanced prophylaxis in TKA.
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Affiliation(s)
- Simon W. Young
- />Department of Orthopaedics, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, 0740 New Zealand
| | - Mei Zhang
- />Clinical Pharmacology, Department of Medicine, University of Otago, Christchurch, New Zealand , />Toxicology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Joshua T. Freeman
- />Clinical Microbiology, Auckland City Hospital, Auckland, New Zealand
| | - John Mutu-Grigg
- />Department of Orthopaedics, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, 0740 New Zealand
| | - Paul Pavlou
- />Department of Orthopaedics, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, 0740 New Zealand
| | - Grant A. Moore
- />Toxicology, Canterbury Health Laboratories, Christchurch, New Zealand
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Mahne AT, Rioja E, Marais HJ, Villarino NF, Rubio-Martinez LM. Clinical and pharmacokinetic effects of regional or general anaesthesia on intravenous regional limb perfusion with amikacin in horses. Equine Vet J 2013; 46:375-9. [PMID: 23789781 DOI: 10.1111/evj.12125] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 06/14/2013] [Indexed: 11/28/2022]
Abstract
REASONS FOR PERFORMING STUDY Antimicrobial i.v. regional limb perfusion (IV-RLP) is clinically performed on anaesthetised or sedated horses with or without regional anaesthesia. To date, no scientific data are available on the clinical and pharmacokinetic effects of these anaesthetic protocols on antimicrobial IV-RLP, which is believed to result in better tourniquet efficiency due to decreased movement. OBJECTIVE To determine the effects of regional or general anaesthesia on the clinical and synovial pharmacokinetic parameters of amikacin administered by IV-RLP to horses. STUDY DESIGN Experimental crossover study. METHODS Eight healthy horses received 4 treatments of amikacin IV-RLP in a randomised, blinded, crossover design: standing sedation without regional anaesthesia (CNT); standing sedation with i.v. regional anaesthesia; standing sedation with perineural regional anaesthesia (PNA); or general anaesthesia. Synovial fluid amikacin concentrations were measured over 24 h and regional pharmacokinetic parameters calculated. Heart and respiratory rates, visual analogue scale of discomfort, number of times the limb was lifted and number of additional sedations administered were recorded. Analysis of variance crossover analysis was applied with significance level at P < 0.05. RESULTS Amikacin concentrations and regional pharmacokinetic parameters did not differ significantly among treatments. Visual analogue scores (mean ± s.d.) were significantly lower with PNA (19 ± 15) vs. i.v. regional anaesthesia (69 ± 36) or CNT (81 ± 13; P < 0.001). Significantly less lifting of the limb (mean ± s.d.) occurred with PNA (20 ± 20) vs. CNT (54 ± 22; P < 0.04). CONCLUSIONS Perineural regional anaesthesia before IV-RLP was most effective in providing comfort to standing, sedated horses without significantly affecting the regional pharmacokinetic parameters of amikacin. High variability of synovial amikacin concentrations was present. The use of general anaesthesia for IV-RLP is not justified based on this study.
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Affiliation(s)
- A T Mahne
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, South Africa
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14
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Rubio-Martínez LM, Elmas CR, Black B, Monteith G. Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999-2009). J Am Vet Med Assoc 2013; 241:1650-8. [PMID: 23216042 DOI: 10.2460/javma.241.12.1650] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the clinical use of regional limb perfusion with antimicrobials (A-RLP), complications, and outcome in a large series of patients. DESIGN Retrospective case series. ANIMALS 174 horses. PROCEDURES Medical records of horses treated with A-RLP between 1999 and 2009 were reviewed. Signalment, primary complaint, horse use, etiology, duration of clinical signs, previous treatment, structures involved, concurrent conditions, A-RLP characteristics, additional treatments, complications, and outcome were recorded. At long-term follow-up, 2 outcomes were investigated: survival rate and return to previous use at the same or higher level. Univariate and multivariate logistic regression analyses were conducted. RESULTS Group 1 (96 horses) included septic synovitis. Group 2 (50 horses) included extrasynovial lacerations (23 horses) and fresh, minimally contaminated intrasynovial lacerations without evidence of established synovial infection (27 horses). Group 3 (28 horses) included miscellaneous other conditions. Only minor complications were reported in 12.26% of horses that received IV (n = 155) and 33% of horses that received intraosseous (27) A-RLP. Horses with septic synovitis had a lower survival rate (53.43%) than did horses with lacerations (91.89%). Within group 2, no significant differences in short- or long-term outcomes were found between horses with extrasynovial and fresh, minimally contaminated intrasynovial lacerations. For the horses returning to previous use, 80% of horses with septic synovitis and 72.72% of horses with lacerations were performing at the same or higher level at the time of follow-up. CONCLUSIONS AND CLINICAL RELEVANCE The results of the present study indicated that A-RLP is a safe technique with minimal adverse effects. The IV route presented fewer complications than intraosseous injection. Horses with infection of synovial structures had a lower survival rate than did those with acute, minimally contaminated intrasynovial lacerations. The latter had a similar prognosis for horses with extrasynovial lacerations treated with A-RLP.
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Affiliation(s)
- Luis M Rubio-Martínez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada.
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Medullary decompression of the radius as treatment for lameness in a horse. Vet Comp Orthop Traumatol 2013; 26:311-7. [PMID: 23612719 DOI: 10.3415/vcot-12-09-0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/29/2013] [Indexed: 11/17/2022]
Abstract
Increased intraosseous pressure (IOP) is a well-characterized source of pain in humans that can be successfully treated by medullary decompression. This report describes the clinical and diagnostic findings, treatment and successful outcome of a horse with a four week long, non-weight bearing lameness secondary to suspected traumatically-induced increased IOP in the left radius. Scintigraphic examination characterized by severe increase in radiopharmaceutical uptake within the affected radius aided in the initial localization of the source of lameness. Decompression of the affected radius was performed by drilling two 3.2 mm tracts through the lateral bone cortex into the medullary cavity. Intramedullary pressure in the radius was measured (37-39 mmHg). Dramatic clinical improvement was observed after surgical decompression of the affected bone and the horse showed full recovery and returned to previous exercise use by 12 months after treatment. Gradual decrease in radial radiopharmaceutical uptake was observed during the following year. Increased IOP should be considered as a cause of lameness in horses and scintigraphic examination may aid in its diagnosis. Medullary decompression may be a successful treatment in some cases.
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Abstract
BACKGROUND Prophylactic antibiotics reduce the risk of deep infection after primary TKA. However, conventional systemic dosing may not provide adequate tissue concentrations against more resistant organisms such as coagulase-negative staphylococci. Regional intravenous administration of antibiotics after tourniquet inflation achieves far higher tissue concentrations but requires foot vein cannulation. The intraosseous route may offer a rapid and reliable method of regional administration. QUESTIONS/PURPOSES We compared tissue concentrations of cefazolin achieved with systemic versus regional intraosseous administration. METHODS Twenty-two patients undergoing primary TKA were randomized into two groups. Group 1 received 1 g cefazolin systemically 10 minutes before tourniquet inflation. Group 2 received 1 g cefazolin intraosseously in 200 mL of normal saline through a tibial cannula after tourniquet inflation and before skin incision. Subcutaneous fat and femoral bone samples were taken at set intervals during the procedure and antibiotic concentrations measured using a validated technique involving high-performance liquid chromatography. RESULTS The overall mean tissue concentration of cefazolin in subcutaneous fat was 186 ug/g in the intraosseous group and 11 ug/g in the systemic group. The mean tissue concentration in bone was 130 ug/g in the intraosseous group and 11 ug/g in the systemic group. These differences were consistent across all sample time points throughout the procedure. CONCLUSIONS Intraosseous regional administration can achieve concentrations of antibiotic in tissue an order of magnitude higher than systemic administration. Further work is required to determine if this translates into increased efficacy in preventing infection, particularly against coagulase-negative staphylococci.
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Kelmer G, Martin-Jimenez T, Saxton AM, Catasus C, Elliot SB, Lakritz J. Evaluation of regional limb perfusion with erythromycin using the saphenous, cephalic, or palmar digital veins in standing horses. J Vet Pharmacol Ther 2012; 36:434-40. [DOI: 10.1111/jvp.12028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 11/02/2012] [Indexed: 11/26/2022]
Affiliation(s)
- G. Kelmer
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - T. Martin-Jimenez
- Comparative Medicine; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - A. M. Saxton
- Department of Animal Science; College of Agricultural Sciences and Natural Resources; University of Tennessee; Knoxville TN USA
| | - C. Catasus
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - S. B. Elliot
- Large Animal Clinical Sciences; College of Veterinary Medicine; University of Tennessee; Knoxville TN USA
| | - J. Lakritz
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; The Ohio State University; Columbus OH USA
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KELMER G, BELL GC, MARTIN-JIMENEZ T, SAXTON AM, CATASUS C, ELLIOT SB, MEIBOHM B. Evaluation of regional limb perfusion with amikacin using the saphenous, cephalic, and palmar digital veins in standing horses. J Vet Pharmacol Ther 2012; 36:236-40. [DOI: 10.1111/j.1365-2885.2012.01414.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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de Laat MA, Pollitt CC, Walsh DM, McGowan CM, Sillence MN. Persistent digital hyperthermia over a 48 h period does not induce laminitis in horses. Vet J 2011; 192:435-40. [PMID: 22023851 DOI: 10.1016/j.tvjl.2011.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 09/05/2011] [Accepted: 09/22/2011] [Indexed: 10/16/2022]
Abstract
Persistent digital hyperthermia, presumably due to vasodilation, occurs during the developmental and acute stages of insulin-induced laminitis. The objectives of this study were to determine if persistent digital hyperthermia is the principal pathogenic mechanism responsible for the development of laminitis. The potent vasodilator, ATP-MgCl(2) was infused continuously into the distal phalanx of the left forefoot of six Standardbred racehorses for 48 h via intra-osseous infusion to promote persistent digital hyperthermia. The right forefoot was infused with saline solution and acted as an internal control. Clinical signs of lameness at the walk were not detected at 0 h, 24h or 48 h post-infusion. Mean ± SE hoof wall temperatures of the left forefoot (29.4 ± 0.25°C) were higher (P<0.05) than those on the right (27.5 ± 0.38°C). Serum insulin (15.0 ± 2.89 μIU/mL) and blood glucose (5.4 ± 0.22 mM) concentrations remained unchanged during the experiment. Histopathological evidence of laminitis was not detected in any horse. The results demonstrated that digital vasodilation up to 30°C for a period of 48 h does not trigger laminitis in the absence of hyperinsulinaemia. Thus, although digital hyperthermia may play a role in the pathogenesis of laminitis, it is not the sole mechanism involved.
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Affiliation(s)
- Melody A de Laat
- Australian Equine Laminitis Research Unit, School of Veterinary Science, The University of Queensland, Gatton, Queensland 4343, Australia.
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PARKER RA, CLEGG PD, TAYLOR SE. The in vitro effects of antibiotics on cell viability and gene expression of equine bone marrow-derived mesenchymal stromal cells. Equine Vet J 2011; 44:355-60. [DOI: 10.1111/j.2042-3306.2011.00437.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levine DG, Epstein KL, Ahern BJ, Richardson DW. Efficacy of three tourniquet types for intravenous antimicrobial regional limb perfusion in standing horses. Vet Surg 2010; 39:1021-4. [PMID: 20880139 DOI: 10.1111/j.1532-950x.2010.00732.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine (1) if clinically useful concentrations of amikacin sulfate can be obtained in synovial fluid during regional limb perfusion (RLP) performed above the carpus in standing sedated horses and (2) to determine the efficacy of 3 tourniquet types (narrow rubber [NR], wide rubber [WR], pneumatic [PN]). ANIMALS Horses (n=9). METHODS Bilateral forelimb RLP with amikacin sulfate (2.5 g) were administered through the cephalic vein in standing sedated horses. Limbs were randomly assigned to the 3 tourniquet types (NR, WR, PN) applied above the carpus. Metacarpophalangeal synovial fluid was obtained 0.5 hour after perfusion. Amikacin concentration in the synovial fluid was detected using fluorescence polarization immunoassay. RESULTS Mean synovial concentrations of amikacin in the PN (mean 236 μg/mL; range 23-913 μg/mL) and WR (mean 64.2 μg/mL; range 7-315 μg/mL) were significantly higher (P=.000 and .032, respectively) than the NR tourniquet (mean 2.1 μg/mL; range 0.9-3.3 μg/mL). CONCLUSIONS The PN tourniquet resulted in the highest synovial fluid amikacin concentrations in all horses, although administration with PN and WR tourniquets achieved adequate amikacin concentrations. NR tourniquet is ineffective and should not be used for RLP above the carpus in the standing horse.
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Affiliation(s)
- David G Levine
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, PA 19348-1692, USA.
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Robert MP, Olive J, Gangl MC. What is your diagnosis? Osteomyelitis with internal sequestration. J Am Vet Med Assoc 2010; 237:629-30. [PMID: 20839981 DOI: 10.2460/javma.237.6.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Mickaël P Robert
- Equine Department, VetAgro Sup, Veterinary Campus of Lyon, 1 Ave Bourgelat, Marcy L'Etoile, France.
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Stewart AA, Goodrich LR, Byron CR, Evans RB, Stewart MC. Antimicrobial delivery by intrasynovial catheterisation with systemic administration for equine synovial trauma and sepsis. Aust Vet J 2010; 88:115-23. [PMID: 20402698 DOI: 10.1111/j.1751-0813.2010.00553.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present the technique for intra-articular catheter placement and report the clinical outcomes of 38 cases of equine synovial trauma and/or infection treated with broad-spectrum antimicrobials administered via an intrasynovial catheter (ISC). DESIGN Retrospective study. PROCEDURE Medical records of 38 horses treated for synovial trauma and sepsis with frequent antimicrobial administration through an ISC from 1995 to 2008 were reviewed. Follow-up information was obtained via clinical re-evaluation or telephone contact with the owners. RESULTS The majority of horses (84%) received amikacin and Timentin(R) four times daily. In addition, synovial lavage through the ISC was carried out in 27 horses (71%). Only radiological evidence of osteolysis had a significant negative impact on both lameness at the time of hospital discharge and the long-term outcome. In total, 92% of horses treated with frequent antimicrobial administration through an ISC had clinical resolution of infection. Catheter obstruction occurred in three cases, necessitating replacement or removal, and two synovial fistulae developed at sites of open drainage. The majority of horses treated had a favourable outcome, with 86% being at least pasture sound and 43% returned to riding. CONCLUSION Septic synovial structures treated with frequent antimicrobial administration through an ISC had a good prognosis for survival and 43% returned to riding, which is consistent with the results of other studies. The use of a simple ISC should be considered when broad-spectrum intrasynovial antimicrobial administration and lavage of a septic synovial structure are indicated.
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Affiliation(s)
- A A Stewart
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana-Champaign, Illinois, USA.
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Parker RA, Bladon BM, McGovern K, Smith KC. Osteomyelitis and Osteonecrosis after Intraosseous Perfusion with Gentamicin. Vet Surg 2010; 39:644-8. [DOI: 10.1111/j.1532-950x.2010.00685.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nourian AR, Mills PC, Pollitt CC. Development of intraosseous infusion of the distal phalanx to access the foot lamellar circulation in the standing, conscious horse. Vet J 2010; 183:273-7. [DOI: 10.1016/j.tvjl.2009.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 04/06/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
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Kelmer G, Elliot SB, Catasus CT, Saxton AM. Evaluation of indwelling intravenous catheters for the regional perfusion of the limbs of horses. Vet Rec 2009; 165:496-501. [DOI: 10.1136/vr.165.17.496] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - C. T. Catasus
- College of Veterinary Medicine; University of Tennessee; 2407 River Drive Knoxville TN 37996 USA
| | - A. M. Saxton
- Department of Animal Science; College of Agricultural Sciences and Natural Resources; University of Tennessee; 2505 River Drive Knoxville TN 37996 USA
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CARON JOHNP, BOLIN CAROLEA, HAUPTMAN JOSEPHG, JOHNSTON KIMBERLYA. Minimum Inhibitory Concentration and Postantibiotic Effect of Amikacin for Equine Isolates of Methicillin-ResistantStaphylococcus aureusIn Vitro. Vet Surg 2009; 38:664-9. [DOI: 10.1111/j.1532-950x.2009.00551.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Errico JA, Trumble TN, Bueno ACD, Davis JL, Brown MP. Comparison of two indirect techniques for local delivery of a high dose of an antimicrobial in the distal portion of forelimbs of horses. Am J Vet Res 2008; 69:334-42. [DOI: 10.2460/ajvr.69.3.334] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cruz AM, Rubio-Martinez L, Dowling T. New antimicrobials, systemic distribution, and local methods of antimicrobial delivery in horses. Vet Clin North Am Equine Pract 2007; 22:297-322, vii-viii. [PMID: 16882477 DOI: 10.1016/j.cveq.2006.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The local delivery of antimicrobials is a valuable therapeutic tool with a low morbidity, is practical to use, and is well tolerated by horses. Clinically, its use has allowed equine practitioners to achieve better results when treating musculoskeletal infections, and it represents an extremely useful tool in the practitioner's armamentarium against these types of infections. The technique is indicated to combat orthopedic infections involving bones, joints, physes, tendon sheaths, and foot tissues. Optimal treatment must include other approaches, such as systemic antimicrobial therapy and surgical debridement and lavage, and monitoring of the clinical progression of the patient can help to determine the ideal protocol for each patient.
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Affiliation(s)
- Antonio M Cruz
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1.
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Lugo J, Gaughan EM. Septic Arthritis, Tenosynovitis, and Infections of Hoof Structures. Vet Clin North Am Equine Pract 2006; 22:363-88, viii. [PMID: 16882480 DOI: 10.1016/j.cveq.2006.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infectious diseases of synovial and hoof structures in horses can be devastating to soundness and can result in life-threatening complications. Timely diagnosis and early aggressive treatment can result in successful outcomes and resumption of athletic careers; however, delays in recognition and therapy can be the most costly reasons for failure. Sterilization of affected compartments and tissues requires removal of microorganisms and compromised tissue. Debridement, lavage, and appropriate antimicrobial drug use are the most reliable avenues of treatment. Antimicrobial drugs can be administered by local, regional, and systemic routes. Lavage techniques and debridement typically require surgical manipulations.
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Affiliation(s)
- Joel Lugo
- J.T. Vaughan Large Animal Hospital, Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA
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Keys GJ, Berry DB, Pleasant RS, Jones JC, Freeman LE. Vascular distribution of contrast medium during intraosseous regional perfusion of the distal portion of the equine forelimb. Am J Vet Res 2006; 67:1445-52. [PMID: 16881860 DOI: 10.2460/ajvr.67.8.1445] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the vascular distribution pattern of contrast medium during intraosseous regional perfusion (IORP) of the distal portion of the equine forelimb. SAMPLE POPULATION 13 cadaveric forelimbs from 12 horses without forelimb diseases. PROCEDURES Serial lateromedial radiographic views were taken of the distal portion of 10 heparinized cadaveric forelimbs at 0, 1, 2, 6, 15, and 30 minutes during IORP of the third metacarpal bone (MCIII) by use of iodinated contrast medium and a tourniquet placed over the proximal portion of MCIII. Vascular regions of interest (ROI) were created for each radiograph. Reviewers identified the presence or absence of contrast medium-induced opacified vessels in all ROI on radiographs. This information was summarized to identify vessel-filling patterns over time. Vessel identification was verified by use of computed tomography angiography and latex perfusion studies on the distal portion of separate cadaveric forelimbs. RESULTS During IORP, contrast medium filled the medullary cavity of the MCIII; exited via transcortical vessels; and diffused distally to the remaining arteries and veins of the forelimb, distal to the tourniquet. Maximum vessel and soft tissue opacification occurred in most specimens at 6 and 30 minutes, respectively. Serial radiography vessel patterns matched those of computed tomography images and dissected specimens. CONCLUSIONS AND CLINICAL RELEVANCE IORP provides a repeatable pattern of vascular distribution in the distal portion of the equine forelimb. To our knowledge, our study provides the first documentation of arterial perfusion by use of IORP; results of previous reports indicate that IORP delivers medications to only the venous vessels of the perfused forelimb.
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Affiliation(s)
- Graham J Keys
- Department of Large Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, 24061-0442, USA
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Meagher DT, Latimer FG, Sutter WW, Saville WJA. Evaluation of a balloon constant rate infusion system for treatment of septic arthritis, septic tenosynovitis, and contaminated synovial wounds: 23 cases (2002–2005). J Am Vet Med Assoc 2006; 228:1930-4. [PMID: 16784388 DOI: 10.2460/javma.228.12.1930] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE-To determine clinical findings and outcome in horses treated by means of a balloon constant rate infusion system. DESIGN-Retrospective case series. ANIMALS-23 horses. PROCEDURES-Medical records of horses examined at The Ohio State University veterinary teaching hospital from 2002 to 2005 that had septic arthritis, septic tenosynovitis, or penetration of a synovial structure and in which treatment involved a balloon constant rate infusion system were searched. Information pertaining to signalment, history, physical examination findings, clinicopathologic data, treatment, and duration of hospitalization was recorded. RESULTS-Mean+/- SD duration of hospitalization was 11.5+/-5.26 days. No correlation between duration of clinical signs and duration of hospitalization or duration of infusion pump use was detected, but correlations between WBC count and duration of hospitalization and WBC and duration of infusion-pump use were observed. All horses survived to discharge. Follow-up information was obtained on 17 horses, 16 of which were alive at the time of follow-up. Twelve of 13 horses for which followup information was available for at least 5 months were alive 5 months or longer after discharge. Thirteen of the 16 horses alive at follow-up were reported by owners as not lame, whereas the remaining 3 were mildly lame or intermittently moderately lame or had developed angular limb deformity in the contralateral limb. CONCLUSIONS AND CLINICAL RELEVANCE-Balloon constant rate infusion systems may be used effectively in treatment of septic arthritis, septic tenosynovitis, and contaminated synovial wounds. Clinical response and long-term outcome appeared to be comparable to results obtained with other techniques.
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Affiliation(s)
- Daniel T Meagher
- Department of Veterinary Clinical Science, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
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Abstract
Regional limb perfusion involves administration of an antimicrobial solution into the vasculature of a selected portion of the limb that has been isolated from the systemic circulation by controlled application of a tourniquet. The technique provides high antimicrobial concentrations in the region of interest and greatly contributes to the elimination of infection.
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Affiliation(s)
- Luis M Rubio-Martínez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada
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Lescun TB, Ward MP, Adams SB. Gentamicin concentrations in synovial fluid and joint tissues during intravenous administration or continuous intra-articular infusion of the tarsocrural joint of clinically normal horses. Am J Vet Res 2006; 67:409-16. [PMID: 16506901 DOI: 10.2460/ajvr.67.3.409] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare gentamicin concentrations achieved in synovial fluid and joint tissues during IV administration and continuous intra-articular (IA) infusion of the tarsocrural joint in horses. ANIMALS 18 horses with clinically normal tarsocrural joints. PROCEDURE Horses were assigned to 3 groups (6 horses/group) and administered gentamicin (6.6 mg/kg, IV, q 24 h for 4 days; group 1), a continuous IA infusion of gentamicin into the tarsocrural joint (50 mg/h for 73 hours; group 2), or both treatments (group 3). Serum, synovial fluid, and joint tissue samples were collected for measurement of gentamicin at various time points during and 73 hours after initiation of treatment. Gentamicin concentrations were compared by use of a Kruskal-Wallis ANOVA. RESULTS At 73 hours, mean +/- SE gentamicin concentrations in synovial fluid, synovial membrane, joint capsule, subchondral bone, and collateral ligament of group 1 horses were 11.5 +/- 1.5 microg/mL, 21.1 +/- 3.0 microg/g, 17.1 +/- 1.4 microg/g, 9.8 +/- 2.0 microg/g, and 5.9 +/- 0.7 microg/g, respectively. Corresponding concentrations in group 2 horses were 458.7 +/- 130.3 microg/mL, 496.8 +/- 126.5 microg/g, 128.5 +/- 74.2 microg/g, 99.4 +/- 47.3 microg/g, and 13.5 +/- 7.6 microg/g, respectively. Gentamicin concentrations in synovial fluid, synovial membrane, and joint capsule of group 1 horses were significantly lower than concentrations in those samples for horses in groups 2 and 3. CONCLUSIONS AND CLINICAL RELEVANCE Continuous IA infusion of gentamicin achieves higher drug concentrations in joint tissues of normal tarsocrural joints of horses, compared with concentrations after IV administration.
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Affiliation(s)
- Timothy B Lescun
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47909-1248, USA
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Rubio-Martínez LM, López-Sanromán J, Cruz AM, Santos M, Andrés MS, Román FS. Evaluation of safety and pharmacokinetics of vancomycin after intravenous regional limb perfusion in horses. Am J Vet Res 2005; 66:2107-13. [PMID: 16379655 DOI: 10.2460/ajvr.2005.66.2107] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate clinical variables, regional concentrations, and pharmacokinetics of vancomycin in the synovial fluid of distal forelimb joints of horses after IV regional limb perfusion. ANIMALS 6 horses. PROCEDURE Vancomycin was administered via IV regional limb perfusion to the distal portion of the forelimbs of anesthetized horses. Drug (300 mg of vancomycin hydrochloride in 60 mL of saline [0.9% NaCl] solution) was infused into 1 forelimb, whereas the contralateral limb served as a control and was perfused with 60 mL of saline solution. Solutions were injected into the lateral digital vein after digital exsanguination. Synovial fluid from the metacarpophalangeal (MTCP) and distal interphalangeal (DIP) joints and systemic blood were collected prior to perfusion and 15, 30, 45, 65, and 90 minutes after initiation of the infusion. Synovial fluid from the MTCP joint and blood were also obtained at 4, 8, 12, and 24 hours after infusion. Plasma urea and creatinine concentrations, degree of lameness, and certain clinical variables involving the MTCP joint and infusion site were assessed for 7 days. Results were compared between the vancomycin treatment and control groups. RESULTS No complications or significant differences in renal function, lameness, or clinical variables were observed between groups. Vancomycin concentrations exceeded 4 microg/mL in MTCP joints for approximately 20 hours. Higher concentrations were reached in DIP joints than in MTCP joints. CONCLUSIONS AND CLINICAL RELEVANCE IV regional limb perfusion with 300 mg of vancomycin as a 0.5% solution was safe and may be useful in horses as treatment for distal limb infections.
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Affiliation(s)
- Luis M Rubio-Martínez
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Complutense University of Madrid, Avenida Puerta de Hierro SN, 28040 Madrid, Spain
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Rubio-Martínez L, López-Sanromán J, Cruz AM, Santos M, San Román F. Medullary Plasma Pharmacokinetics of Vancomycin After Intravenous and Intraosseous Perfusion of the Proximal Phalanx in Horses. Vet Surg 2005; 34:618-24. [PMID: 16343150 DOI: 10.1111/j.1532-950x.2005.00096.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the pharmacokinetics of vancomycin in plasma obtained from the medullary sinusoids of the proximal phalanx (P1) after intravenous (IV) and intraosseous (IO) regional limb perfusion (RLP). STUDY DESIGN Experimental study. ANIMALS Twelve horses. METHODS IV and IO RLP were performed in 2 groups (n = 6) of horses. Vancomycin hydrochloride (300 mg in 60 mL 0.9% NaCl) was randomly infused in 1 front limb, with the contralateral limb as control (60 mL 0.9% NaCl). A hole was drilled in the lateral cortex of P1, and blood samples from the medullary sinusoids of P1 were collected before infusion, and 15, 30, 45, 65, and 90 minutes after beginning infusion. Samples were centrifuged and plasma vancomycin concentrations determined. Vancomycin concentrations were compared over time and between routes using a 2-way repeated measures ANOVA. Pharmacokinetic variables were compared with a Kolmogorov-Smirnov test. Significance was set at P<.05. RESULTS No vancomycin-induced clinical side effects such as lameness or swelling were observed. Both techniques, IV and IO, produced high vancomycin concentrations in the sinusoidal plasma of the P1, which remained above the minimum inhibitory concentration value for methicillin-resistant Staphylococcus aureus (MRSA) during the 90 minutes study. Concentrations and pharmacokinetic variables were not significantly different comparing both routes. CONCLUSIONS IV and IO routes produced similar antimicrobial perfusion of the medullary cavity of P1. CLINICAL RELEVANCE Either IV or IO routes for perfusion are likely to be equally selected when planning RLP with vancomycin.
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Affiliation(s)
- Luis Rubio-Martínez
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universidad Complutense de Madrid, Spain.
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Mattson SE, Pearce SG, Bouré LP, Dobson H, Hurtig MB, Black WD. Comparison of intraosseous and intravenous infusion of technetium Tc 99m pertechnate in the distal portion of forelimbs in standing horses by use of scintigraphic imaging. Am J Vet Res 2005; 66:1267-72. [PMID: 16111168 DOI: 10.2460/ajvr.2005.66.1267] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe and compare the distribution of technetium Tc 99m (99mTc) pertechnate following intraosseous or i.v. injection (with or without use of a tourniquet) in the distal portion of the forelimb in standing horses. ANIMALS 4 horses. PROCEDURE Each horse received 4 forelimb treatments in random sequence: intraosseous infusion with tourniquet application (IOT), intraosseous infusion without tourniquet application, i.v infusion with tourniquet application (IVT), and i.v. infusion without tourniquet application. Dynamic nuclear scintigraphic imaging of the third metacarpal bone, proximal and middle phalanges, and distal phalanx was performed from the start of each treatment until 1 hour after infusion was completed. Radionuclide activity was compared within and between treatment groups. RESULTS Tourniquet application was necessary to maintain high levels of radionuclide activity in the distal portion of the forelimb after intraosseous or i.v. infusion with 99mTc pertechnate; IVT and IOT treatments resulted in similar radionuclide activity in the proximal and middle phalanges and distal phalanx. Of the 4 treatments, there was significantly higher radionuclide activity in the distal aspect of the third metacarpal bone after the IOT treatment. CONCLUSIONS AND CLINICAL RELEVANCE By use of a tourniquet, radionuclide administration via the intraosseous or i.v. routes resulted in effective perfusion of the distal portion of the forelimb and similar distribution of the agent in the phalanges of horses. Further studies are required to ascertain whether these findings apply to delivery of therapeutic agents in infected tissues via IOT or IVT.
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Affiliation(s)
- Shawn E Mattson
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada
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Abstract
Antimicrobial medication should be considered an adjunct to the general care of wounds rather than a substitute for lavage, drainage, or other physical care intended to promote healing. Judicious use is based on results of diagnostic procedures and the professional judgment of the attending veterinarian. Organisms that contaminate or infect wounds of horses are similar to those that can affect human patients, such that personal hygiene and protection are important when caring for these equine patients, because attendants can easily be exposed to them. Although those organisms are considered to be ubiquitous, the inoculum that may be present on or in an infected wound may be substantially greater than that encountered during other daily activities of the veterinarian. Proper disposal of the bandage materials and personal protective clothing is important. Bacterial resistance is one of many "survival tactics" of bacteria and has been an important clinical consideration for physicians and veterinarians since antimicrobial drugs were discovered. Controversies and insufficient understanding of bacterial resistance abound, however. The entirety of the subject is beyond the scope of this article, but it is important to the veterinary profession and for the formulation of wound management in horses. We and our animal patients live in a world populated by microbial organisms of various types. Resistance among bacteria is likely to continue to be a clinical consideration in the future as it has been during the past 60 to 70 years. As veterinarians, we must recognize the zoonotic nature of resistance and implement biosecurity procedures to protect ourselves, other people in contact with those pathogens, and our patients. We must also recognize the merits of judicious targeted use of antimicrobial drugs and apply appropriate principles during the course of professional care for the well-being of our animal patients.
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