Prospective randomised comparison of different antimicrobial protocols for the prevention of surgical site infections in horses undergoing emergency exploratory celiotomy.
Authors: Christie, Epstein, Tyma, Afonso, Fultz, Giguère
Journal: Equine veterinary journal
Summary
# Editorial Summary Emergency exploratory celiotomy in horses carries significant risk of surgical site infection (SSI), yet uncertainty persists regarding optimal perioperative antimicrobial protocols and duration of post-operative cover. Christie and colleagues conducted a prospective randomised trial comparing two approaches: protocol A (antimicrobials limited to pre- and intra-operative administration only, n=39) versus protocol B (continuing antimicrobials for 72 hours post-operatively, n=37) in adult horses undergoing clean or select clean-contaminated emergency celiotomy at a university teaching hospital between 2013 and 2019, with standardised incisional closure and protection across both groups. During hospitalisation, horses receiving only perioperative antimicrobials experienced substantially higher SSI rates compared with those continued on 72-hour post-operative cover (16% versus 0%, p=0.03), with this difference persisting at borderline significance four weeks post-operatively (22% versus 3%, p=0.05). However, the study fell short of planned enrolment targets, limiting statistical power considerably and necessitating cautious interpretation; the authors emphasise their findings should primarily direct future research rather than immediately reshape clinical practice. For equine professionals involved in post-operative management, these results suggest that extending antimicrobial coverage to 72 hours post-operatively may warrant consideration pending larger, adequately powered trials, particularly given the morbidity associated with SSI following emergency abdominal surgery.
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Practical Takeaways
- •Extended post-operative antimicrobial coverage (72 hours) appears beneficial for reducing surgical site infections in emergency abdominal surgery, despite previous studies suggesting duration may not matter
- •Individual surgeon judgment and owner consent significantly impacted enrollment, suggesting real-world implementation of antimicrobial protocols varies considerably in practice
- •Current evidence suggests 72-hour post-operative antimicrobial protocols may be justified in emergency celiotomy cases, but further research is needed before changing practice protocols
Key Findings
- •Horses receiving antimicrobials for 72 hours post-operatively had significantly lower SSI rates during hospitalization (0% vs 16%, p=0.03) compared to those receiving only pre- and intra-operative antimicrobials
- •At 4 weeks post-operatively, SSI prevalence remained lower in the 72-hour group (3% vs 22%, p=0.05), though borderline significant
- •Study was underpowered due to failure to meet planned enrollment targets, limiting generalizability of findings