Clinical use of antimicrobial regional limb perfusion in adult horses diagnosed with synovial sepsis or penetrating synovial wounds at a single equine referral hospital in the Midwest United States-163 cases (2010-2020).
Authors: Loppnow Zach, Kersh Kevin, Wang Chong, Spaethe Sienna, Troy Jarrod
Journal: Frontiers in veterinary science
Summary
# Editorial Summary: Antimicrobial Regional Limb Perfusion for Equine Synovial Sepsis and Penetrating Wounds Intravenous regional limb perfusion (IVRLP) with antimicrobial agents remains a critical therapeutic option for horses with synovial infections, yet clinical outcome data had not been comprehensively reported in over a decade. This retrospective analysis of 163 adult horses treated at a single Midwestern referral centre between 2010–2020 compared short-term (hospital discharge) and long-term (≥1 year) survival rates between horses with established synovial sepsis (56 cases) and those with minimally contaminated penetrating synovial wounds (100 cases). Established sepsis carried substantially worse prognosis, with 88.9% short-term and 65.1% long-term survival compared to 99.0% and 83.6% respectively in the wound group; notably, increasing the total number of IVRLP treatments during hospitalisation was associated with reduced likelihood of discharge survival (odds ratio 0.47), suggesting that repeated perfusions may indicate progressive disease rather than therapeutic benefit. Gentamicin dominated antimicrobial choice across 94% of cases, though the study did not identify specific drug variables influencing survival outcomes. These findings support cautious optimism regarding IVRLP efficacy whilst highlighting the prognostic weight of infection status at presentation and reinforcing that clinical judgment around treatment frequency remains essential—practitioners should carefully weigh the benefits of additional perfusions against indicators of deterioration or treatment resistance.
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Practical Takeaways
- •Intravenous regional limb perfusion is an effective treatment for synovial sepsis and wounds, with good short-term outcomes (89-99% survival to discharge), though long-term survival is lower (65-84%)
- •Gentamicin remains the first-line antimicrobial choice for IVRLP in these cases, used successfully in the vast majority of treatments
- •Horses requiring multiple IVRLP treatments have worse outcomes—this may indicate more severe initial disease or treatment failure, so consider early referral and aggressive initial management
Key Findings
- •Short-term survival (hospital discharge) was 88.9% for established synovial sepsis and 99.0% for synovial wounds
- •Long-term survival (≥1 year) was 65.1% for synovial sepsis and 83.6% for synovial wounds
- •Gentamicin was used in 93.9% of cases (153/163) as the IVRLP antimicrobial agent
- •Increased number of IVRLP treatments during hospitalization was associated with reduced survival to discharge (p=0.01)