Meropenem Administered via Intravenous Regional Limb Perfusion for Orthopedic Sepsis in Horses: A Clinical Retrospective Study.
Authors: Mosichuk Allison P, Smith Joseph S, Tatarniuk Dane M, Troy Jarrod R, Kreuder Amanda J
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: Meropenem via IVRLP for Equine Orthopedic Sepsis Septic synovitis demands rapid antibiotic intervention before culture results are available, and whilst meropenem has shown promise in pharmacokinetic studies for intravenous regional limb perfusion (IVRLP), questions remain about its clinical efficacy relative to established agents and the appropriateness of using a critically important human antibiotic in veterinary practice. Researchers at a teaching hospital retrospectively compared outcomes in 23 horses treated with meropenem IVRLP against 37 receiving gentamicin IVRLP for confirmed septic joints, tendon sheaths, or navicular bursae, analysing survival to discharge, post-discharge outcomes, and bacterial susceptibility patterns. Survival rates were similar between groups—91% for meropenem and 84% for gentamicin—with no statistically significant differences in either discharge outcome or long-term prognosis, whilst culture isolates showed high susceptibility to multiple first-line agents (ceftiofur 85%, ampicillin 69%, amikacin 58%) alongside the 92% sensitivity to imipenem (a carbapenem comparable to meropenem). The findings suggest that gentamicin and other conventional IVRLP antibiotics achieve equivalent clinical results to meropenem in this population, supporting more judicious antimicrobial stewardship that reserves carbapenems for cases where susceptibility patterns or clinical deterioration specifically warrant their use rather than employing them as routine first-choice therapy for septic synovitis.
Read the full abstract on PubMed
Practical Takeaways
- •Meropenem and gentamicin IVRLP show similar clinical outcomes (~85-91% survival) for septic synovitis—consider gentamicin or other sensitive antibiotics first to preserve critical human antibiotics
- •Culture and susceptibility testing supports using narrower-spectrum, non-critical antibiotics in most cases; reserve carbapenems for documented resistance or clinical failure
- •IVRLP delivery is effective for joints, tendon sheaths, and navicular bursa infections; choice of antibiotic should be guided by susceptibility results rather than empirical meropenem use
Key Findings
- •Overall survival to discharge was 86% (52/60) with no statistically significant difference between meropenem (91%, 21/23) and gentamicin (84%, 31/37) groups
- •24 of 26 bacterial isolates were sensitive to imipenem (carbapenem); susceptibility to less critical antibiotics was also frequent (ceftiofur 85%, ampicillin 69%, amikacin 58%, gentamicin 46%)
- •Both meropenem and gentamicin via IVRLP proved effective for treating septic synovial structures across joints, tendon sheaths, and navicular bursae
- •Less critical antimicrobials than meropenem may be viable alternatives for septic synovitis treatment while supporting antimicrobial stewardship