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Jimenez Rihuete P, Martin C, Villarino NF, Rubio‐Martínez LM. Effect of silica-sprayed collection tubes on synovial fluid bacterial culture. Vet Med Sci 2024; 10:e1501. [PMID: 38923315 PMCID: PMC11196375 DOI: 10.1002/vms3.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/11/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Silica-sprayed tubes (SSTs) are often used to transport synovial fluid samples in equine practice. They promote the coagulation of the sample. The objective of the study is to evaluate the effect of SST on bacterial culture. MATERIALS AND METHODS The study was divided into two parts: sterile saline (Part A) and synovial fluid (Part B). Four common bacteria associated with equine synovial sepsis were used: Streptococcus pyogenes, Escherichia coli, Staphylococcus aureus and methicillin-resistant S. aureus (MRSA). Three collection tubes were used: STT, plain (no-additives) and brain and heart infusion (BHI) broth. Bacteria were cultured in horse blood agar plates for 48 h. Outcome variables were negative culture, positive culture and total number of colony-forming units (CFUs). Statistical analysis was performed using Mann-Whitney U test, and significance was set at p < 0.05. RESULTS The total number of agar plates read was 1557 (779 saline; 778 synovial fluid). Total negative cultures were 25/779 on saline and 3/778 on synovial fluid. In broth, maximum growth CFU was achieved after 8 h for both saline and synovial fluid for all bacteria. S. pyogenesand E. coli produced a significantly lower number of CFU when in SST compared to plain or broth after 4 h, whereas S. aureus (American Type Culture Collection [ATCC] and MRSA) only after 24 h. DISCUSSION Silica-containing tubes reduced bacterial proliferation, whereas the use of a BHI broth provided the highest bacterial load in the sample. The use of SST may have a negative effect on bacterial proliferation in samples obtained from clinical cases.
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de Souza TC, Burford J, Busschers E, Freeman S, Suthers JM. Multicenter study investigating long-term survival after synovial lavage of contaminated and septic synovial structures in horses presented to 10 UK referral hospitals. Vet Surg 2024. [PMID: 38863154 DOI: 10.1111/vsu.14107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/25/2024] [Accepted: 04/26/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE To report the long-term survival of adult horses that were subjected to synovial lavage for treatment of contaminated and septic synovial structures. STUDY DESIGN Multicenter, prospective observational trial. ANIMALS Horses (n = 240) presented for synovial sepsis at 10 UK referral centers. METHODS Data for horses presented for treatment of synovial sepsis were collected over a 15 month recruitment period. Owners were contacted a minimum of 365 days after surgery using a structured client interview to assess long term survival. Descriptive statistics, and univariable and Cox proportional hazards models for postoperative survival time were developed. RESULTS Survival to discharge was 228/240 (95%) and overall long-term survival was 89.4% (185/207). Unknown cause of injury (p = .017), increasing duration of surgery (p = .003), increasing weight (p = .008), forelimb injuries (p = .027), and type of synovial structure (p = .008) were found to be associated with death using Cox proportional hazards models. CONCLUSION This study provides information on risk factors associated with survival and death after treatment for synovial sepsis at referral hospitals in the UK. Survival to discharge and long-term survival was excellent. Heavier horses, injuries affecting the forelimbs, tendon sheaths and bursae were associated with poorer long term outcomes. Longer duration of surgery was also found to be associated with a worse prognosis. CLINICAL SIGNIFICANCE These findings help to provide prognostic information for owners and veterinarians treating horses with synovial sepsis.
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Affiliation(s)
- Therese C de Souza
- University of Nottingham, Nottingham, UK
- B&W Equine Hospital, Gloucestershire, UK
- Bell Equine Veterinary Clinic, Kent, UK
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Rockow M, Griffenhagen G, Landolt G, Hendrickson D, Pezzanite L. Current Antimicrobial Use in Horses Undergoing Exploratory Celiotomy: A Survey of Board-Certified Equine Specialists. Animals (Basel) 2023; 13:ani13091433. [PMID: 37174470 PMCID: PMC10177570 DOI: 10.3390/ani13091433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
In the past decade, there has been a considerable increase in the recognition of antimicrobial resistance in equine practice. The objective of this study was to survey the current clinical use of antimicrobials for a commonly performed surgical procedure (exploratory celiotomy) with the goal of understanding how recent literature and changes in microbial resistance patterns may have impacted antimicrobial selection practices. An electronic survey was distributed to veterinary professionals within the American College of Veterinary Internal Medicine (ACVIM) and the American College of Veterinary Surgery (ACVS). A total of 113 completed surveys were returned. Practitioners reported antimicrobials were most frequently given 30-60 min preoperatively (63.1%). Two antimicrobial classes were typically administered (95.5%), with gentamicin (98.2%) and potassium penicillin (74.3%) being the most common. Antimicrobials were typically not re-dosed intraoperatively (78.6%). Factors that affected overall treatment length postoperatively included resection (81.4%), bloodwork (75.2%), enterotomy (74.3%), fever (85.0%), incisional complications (76.1%), and thrombophlebitis (67.3%). The most common duration of antimicrobial use was 1-3 d for non-strangulating lesions (54.4% of cases) and inflammatory conditions such as enteritis or peritonitis (50.4%), and 3-5 d for strangulating lesions (63.7%). Peri-incisional and intra-abdominal antimicrobials were used by 24.8% and 11.5% of respondents, respectively. In summary, antimicrobial usage patterns were highly variable among practitioners and, at times, not concordant with current literature.
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Affiliation(s)
- Meagan Rockow
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Gregg Griffenhagen
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Gabriele Landolt
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Dean Hendrickson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
| | - Lynn Pezzanite
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO 80523, USA
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Gillingham J, Mair TS. Surgical treatment of synovial sepsis: Is endoscopy the best approach? EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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A Descriptive Study of the Clinical Presentation, Management, and Outcome of Horses with Acute Soft Tissue Trauma of the Tarsus and the Association with Synovial Involvement. Animals (Basel) 2022; 12:ani12040524. [PMID: 35203232 PMCID: PMC8868076 DOI: 10.3390/ani12040524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary The hock is commonly involved in traumatic injuries in horses and due to the large number of synovial structures located in the region, this frequently results in synovial infection which is a major and potentially life-threatening complication in horses. The aim of this retrospective study was to describe the clinical presentation, diagnostic procedures, management, and outcome of cases with acute soft tissue trauma to the hock and to identify the clinical features that were associated with synovial infection in these cases. This study found that increased synovial effusion, severe lameness on admission, and the persistence of lameness as well as certain wound locations were more commonly associated with a diagnosis of synovial infection. Advanced diagnostic modalities such as radiographs, ultrasonography, and measurements of inflammatory markers aided in establishing the correct diagnosis. The duration of systemic antimicrobial treatment was shorter than previously reported and many cases received local antimicrobial treatment at the site of injury, which may have improved its efficacy. At the time of discharge, while lameness was still present in some cases, the overall survival was excellent. This study describes the clinical features and treatment of these commonly encountered injuries, and this knowledge may benefit clinicians in the future. Abstract The tarsus is one of the most common areas of traumatic injury with associated synovial involvement (SI) in horses. The aim of this retrospective study was to describe the clinical presentation, diagnostic procedures, management (emphasizing the type, duration, and route of antimicrobial administration), and outcome of cases with acute soft tissue trauma to the tarsal region. The presenting clinical features, the results of diagnostic modalities, and the initial response to therapy were assessed for their usefulness to predict SI. Medical records of 72 cases were included and SI was diagnosed in 34 cases (47.2%). Increased synovial effusion, lameness on admission (OR = 4.1; 95%CI 1.0–16.4), persistent lameness (OR = 5.7; 95%CI 1.8–17.9), increased blood SAA values (≥200 mg/L) from initial to second measurement (OR = 4.3; 95%CI 1.2–15.5), and wound location on the plantar/plantarolateral/plantaromedial compared to the lateral aspect of the tarsus (OR = 7.0; 95%CI 1.6–30.9) were associated with SI. Radiographs, ultrasonography, and the use of pressure testing when a wound was present proved to be useful in correctly diagnosing SI. The median duration of systemic antimicrobial administration was 8 (IQR: 5 to 9) days and most horses received local antimicrobial therapy. This study highlights several relevant clinical features and their association with SI and emphasizes the usefulness of local antimicrobial therapy in these cases.
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de Souza TC, Suthers JM, Busschers E, Burford JH, Freeman SL. A scoping review of the current evidence on treatment and outcomes following synovial sepsis. Equine Vet J 2021; 54:467-480. [PMID: 34706106 DOI: 10.1111/evj.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/06/2021] [Accepted: 10/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Synovial sepsis is a frequent cause of morbidity and mortality in horses. Despite advances in diagnostics and treatments, persistent infection or chronic lameness can occur. OBJECTIVES To perform a scoping review to identify and evaluate the current evidence on the factors implicated in the success of treatment for synovial sepsis. STUDY DESIGN Joanna Briggs Institute scoping review. METHODS A protocol was registered, and a systematic literature search was performed on CAB abstracts, Medline, Scopus and Embase. Inclusion and exclusion criteria were developed and studies systematically reviewed against this. Studies relating to factors affecting treatment success following synovial sepsis were retained and data was extracted on study method, population characteristics and factors significantly associated with treatment outcome. RESULTS In total, 2338 studies were identified, and 61 were included to full paper analysis. Eight papers reported significant factors, identifying 15 risk factors associated with two measurements of outcome, either survival and/or return to athletic function. The 15 factors were identified and categorised into pre-, intra- and post-operative factors. Risk factors that were identified included the number or type of synovial structures involved, the presence of pannus, tendon and bone pathology, and the use of systemic antimicrobials. There were many discrepancies in inclusion criteria of cases of synovial sepsis as well as measurement and description of outcome variables. MAIN LIMITATIONS Non-English language studies or conference proceedings were not included. Only small numbers of papers had similar findings. CONCLUSIONS Standardisation of inclusion criteria is essential to enable comparisons and analysis between studies on synovial sepsis. Future studies should use methodologies to reduce bias including multicentre and multinational studies, prospective study design and robust statistical modelling.
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Affiliation(s)
- Therese C de Souza
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | | | | | - John H Burford
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Sarah L Freeman
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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Pezzanite LM, Hendrickson DA, Dow S, Stoneback J, Chow L, Krause D, Goodrich L. Intra-articular administration of antibiotics in horses: Justifications, risks, reconsideration of use and outcomes. Equine Vet J 2021; 54:24-38. [PMID: 34459027 DOI: 10.1111/evj.13502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/02/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022]
Abstract
Antibiotics have been injected intra-articularly by equine veterinarians for decades, either prophylactically when other drugs are administered for osteoarthritis or therapeutically to treat septic arthritis. This route of administration has also more recently gained attention in human orthopaedic clinical practice, particularly as an alternative to systemic antibiotic administration to treat infections following prosthetic arthroplasty. While the rationale for injecting antibiotics intra-articularly has been largely focused on achieving high local drug concentrations, there has been relatively little focus on pharmacokinetic parameters of antibiotics administered by this route, or on the potential for local toxicity. The increasing incidence of antibiotic resistance in veterinary and human medicine prompts reconsideration of off-label antibiotic usage and evaluation of evidence-based dosing strategies. The purpose of this review was to summarise the current literature describing intra-articular antibiotic usage, including specific studies where pharmacokinetics, potential safety and toxicity have been evaluated. This review will advance practitioners' understanding of the use of intra-articularly administered antibiotics, including the overall pros and cons of the approach.
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Affiliation(s)
- Lynn M Pezzanite
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Dean A Hendrickson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Steven Dow
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.,Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jason Stoneback
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lyndah Chow
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Danielle Krause
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Laurie Goodrich
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Kilcoyne I, Nieto JE. Orthopedic Infections-Clinical Applications of Intravenous Regional Limb Perfusion in the Field. Vet Clin North Am Equine Pract 2021; 37:275-291. [PMID: 34243876 DOI: 10.1016/j.cveq.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
For the equine veterinarian, orthopedic emergencies are a common occurrence in clinical practice, with traumatic wounds of the distal limb and penetrating injuries of the hoof being some of the most common medical conditions to affect horses. Intravenous regional limb perfusion is a technique widely used for the treatment of orthopedic infections in horses. The objectives of this review are to discuss some of the clinical applications for this treatment modality in the field and to review the technique for the practitioner.
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Affiliation(s)
- Isabelle Kilcoyne
- Department of Surgical and Radiological Sciences, UC Davis School of Veterinary Medicine, One Shields Avenue, Davis, CA 95616, USA.
| | - Jorge E Nieto
- Department of Surgical and Radiological Sciences, UC Davis School of Veterinary Medicine, One Shields Avenue, Davis, CA 95616, USA
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Haralambus R, Florczyk A, Sigl E, Gültekin S, Vogl C, Brandt S, Schnierer M, Gamerith C, Jenner F. Detection of synovial sepsis in horses using enzymes as biomarker. Equine Vet J 2021; 54:513-522. [PMID: 33977535 PMCID: PMC9290786 DOI: 10.1111/evj.13459] [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: 11/13/2020] [Revised: 03/10/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
Background Synovial sepsis is a commonly occurring, potentially career‐ending or even life‐threatening orthopaedic emergency. Diagnosis of synovial sepsis is currently primarily based on synovial fluid analysis, which often leaves diagnostic ambiguity due to overlap of clinicopathological parameters between septic and aseptic inflammatory synovitis. Objectives To evaluate the reliability of lysozyme (LYS), myeloperoxidase (MPO) and elastase (ELT) as biomarkers for synovial sepsis in horses using a photometric assay to measure increased enzyme activity. Study design Prospective, single‐blinded, analytical, clinical study. Methods Equine synovial samples were assigned to one of three groups: (1) healthy controls (n = 10), (2) aseptic (n = 27) and (3) septic synovitis (n = 30). The enzyme activity assays (LYS, MPO and ELT) were compared with standard synovial fluid parameters and broad‐range bacterial 16S rDNA PCR. Results LYS and MPO activities were significantly different between septic synovial samples, and both aseptic and control samples (P < .001, LYS: confidence interval [CI]: 2.25‐3.41, resp., 2.21‐3.8, MPO: CI 0.752‐1.6, resp., 0.639‐1.81). LYS achieved a 100% sensitivity and 100% specificity in differentiating between septic and aseptic (cut‐off value 751.4) or control (cut‐off: 484.6) samples (P < .001). MPO reached 93.33% sensitivity, 100% specificity for distinguishing septic from control (cut‐off value: 0.1254) synovial samples and 93.33% sensitivity, 81.48% specificity for discriminating between septic and aseptic (cut‐off value: 0.1305) synovial samples (P < .001). ELT activity could not be measured in any synovial sample. Both the LYS and the MPO measurements showed a highly significant correlation with PCR (LYS r = .79, MPO r = .69), synovial leukocyte count (LYS r = .752, MPO r = .571), % neutrophils (LYS r = .751, MPO r = 0.663) and each other (r = .744, all P < .001). Main limitations Variation in horses’ signalment, affected synovial structures and synovial fluid freezing times may have affected the discriminative power of this study. Conclusions Increased MPO and LYS activities allow reliable, rapid diagnosis of synovial sepsis with high sensitivity and specificity.
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Affiliation(s)
- Rhea Haralambus
- Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Agnieszka Florczyk
- Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Eva Sigl
- Qualizyme Diagnostics GmbH & Co KG, Neue Stiftingtalstraße 2, Graz, Austria
| | - Sinan Gültekin
- Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Claus Vogl
- Department of Biomedical Sciences, Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Sabine Brandt
- Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Marlies Schnierer
- Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Clemens Gamerith
- Qualizyme Diagnostics GmbH & Co KG, Neue Stiftingtalstraße 2, Graz, Austria.,Department of Environmental Biotechnology, University of Natural Resources and Life Sciences Vienna, Tulln an der Donau, Austria
| | - Florien Jenner
- Department of Companion Animals and Horses, Equine Surgery Unit, University of Veterinary Medicine Vienna, Vienna, Austria
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Kilcoyne I, Nieto JE, Galuppo LD, Dechant JE. Time required to achieve maximum amikacin concentration in the synovial fluid of the tarsocrural joint following administration of the drug by intravenous regional limb perfusion in horses. Am J Vet Res 2021; 82:99-104. [PMID: 33480277 DOI: 10.2460/ajvr.82.2.99] [Citation(s) in RCA: 3] [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 the median time to maximum concentration (tmax) of amikacin in the synovial fluid of the tarsocrural joint following IV regional limb perfusion (IVRLP) of the drug in a saphenous vein of horses. ANIMALS 7 healthy adult horses. PROCEDURES With each horse sedated and restrained in a standing position, a 10-cm-wide Esmarch tourniquet was applied to a randomly selected hind limb 10 cm proximal to the point of the tarsus. Amikacin sulfate (2 g diluted with saline [0.9% NaCl] solution to a volume of 60 mL) was instilled in the saphenous vein over 3 minutes with a peristaltic pump. Tarsocrural synovial fluid samples were collected at 5, 10, 15, 20, 25, and 30 minutes after completion of IVRLP. The tourniquet was removed after collection of the last sample. Amikacin concentration was quantified by a fluorescence polarization immunoassay. Median maximum amikacin concentration and tmax were determined. RESULTS 1 horse was excluded from analysis because an insufficient volume of synovial fluid for evaluation was obtained at multiple times. The median maximum synovial fluid amikacin concentration was 450.5 μg/mL (range, 304.7 to 930.7 μg/mL), and median tmax was 25 minutes (range, 20 to 30 minutes). All horses had synovial fluid amikacin concentrations ≥ 160 μg/mL (therapeutic concentration for common equine pathogens) at 20 minutes after IVRLP. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that, in healthy horses, maintaining the tourniquet for 20 minutes after IVRLP of amikacin in a saphenous vein was sufficient to achieve therapeutic concentrations of amikacin in the tarsocrural joint.
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Rubio‐Martínez LM. Antimicrobial regional limb perfusion: Does it really fight infection? EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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12
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Ehrle A, Mesquita LA, Crosby-Durrani HE, Singer ER. What Is Your Diagnosis? J Am Vet Med Assoc 2020; 255:161-164. [PMID: 31260407 DOI: 10.2460/javma.255.2.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Hann MJ, Parker RA, South VEN, Underwood CE. Ethylenediaminetetraacetic acid (
EDTA
) anticoagulant affects the refractometric measurement of total protein concentration in equine synovial fluid. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.12971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M. J. Hann
- Phillip Leverhulme Equine Hospital University of Liverpool Neston UK
| | | | | | - C. E. Underwood
- Department of Clinical Studies New Bolton Center University of Pennsylvania Philadelphia Pennsylvania USA
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Jimenez Rihuete P, Villarino N, Pelisiak A, Rubio-Martinez LM. Concentration of dipotassium ethylenediaminetetraacetic acid but not lithium heparin affects total protein determination in equine synovial fluid. Vet Rec 2020; 187:e62. [PMID: 32327552 DOI: 10.1136/vr.105567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/12/2020] [Accepted: 03/27/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Refractometric determination of total protein (TP) in synovial fluid (SF) is commonly used for diagnosis and monitoring of synovial sepsis in horses. Previous studies have shown that elevated concentrations of certain anticoagulants may overestimate refractometric determination of TP concentration. OBJECTIVES The aim of the study was to evaluate the effect of different concentrations of dipotassium EDTA (K2EDTA) and lithium heparin (LH) on TP determination by using a hand-held refractometer in equine synovial fluid. STUDY DESIGN Cross-section observational study. METHODS Thirty samples of synovial fluid obtained from 22 horses with different synovial conditions were collected. Synovial fluid samples were separated into different aliquots and placed in commercially available collection tubes containing K2EDTA or LH at four different concentrations (1.76, 3.52, 7.04 and 17.6 mg/ml for K2EDTA; 16, 32, 64 and 160 IU/ml for LH) . Refractometric TP determination was performed on untreated and K2EDTA and LH aliquots with a hand-held refractometer and by spectophotometric Biuret method as the gold standard. RESULTS Refractometric TP determination was overestimated in SF samples containing 10 times the recommended K2EDTA concentrations. Lower concentrations of K2EDTA and LH concentrations did not affect refractometric TP determinations. MAIN LIMITATIONS Limited number of samples mostly obtained from large synovial structures. CONCLUSION To avoid incorrect TP determination, the use of LH containing collection tubes may be an appropriate alternative when the SF volume available is not enough to fill the K2EDTA collection tube.
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Affiliation(s)
- Pablo Jimenez Rihuete
- Department Equine Clinical Science, University of Liverpool Institute of Veterinary Science, Liverpool, Merseyside, UK
| | - Nicolas Villarino
- Program in Individualized Medicine, Washington State University, Pullman, Washington, USA
| | | | - Luis M Rubio-Martinez
- Department Equine Clinical Science, University of Liverpool Institute of Veterinary Science, Liverpool, Merseyside, UK .,Sussex Equine Hospital, Ashington, West Sussex, UK
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15
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Louro LF, Fernández‐Flores FF, Bautista OD, Senior M. Postanaesthetic brachial compartmental syndrome in a horse. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-000974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Luís Filipe Louro
- Equine Clinical ScienceUniversity of Liverpool Institute of Veterinary ScienceLiverpoolUK
| | | | | | - Mark Senior
- Equine Clinical ScienceUniversity of Liverpool Institute of Veterinary ScienceLiverpoolUK
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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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Duggan MJS, Mair TS. Comparison of outcomes following treatment of septic calcaneal bursitis by needle or bursoscopic lavage: A retrospective study of 29 horses. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. J. S. Duggan
- Bell Equine Veterinary Clinic Mereworth Maidstone Kent ME18 5GS UK
| | - T. S. Mair
- Bell Equine Veterinary Clinic Mereworth Maidstone Kent ME18 5GS UK
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18
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Crosby DE, Labens R, Hughes KJ, Nielsen S, Hilbert BJ. Factors Associated With Survival and Return to Function Following Synovial Infections in Horses. Front Vet Sci 2019; 6:367. [PMID: 31696123 PMCID: PMC6817570 DOI: 10.3389/fvets.2019.00367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022] Open
Abstract
Synovial infections (SI) are common in horses of all ages and can be associated with high rates of morbidity and mortality. Identifying factors influencing survival and return to function may be useful for management of affected individuals and determination of prognosis. The objectives of this study were to identify factors associated with survival and return to function of horses and foals with SI presented to an equine hospital. This study is a retrospective case series. Data were collected from medical records of all horses with SI that were presented to a single equine hospital between April 1st, 2008 and May 1st, 2017. Long–term follow up was obtained by a semi-structured telephone questionnaire of clinical outcomes and analysis of online race records. Univariate models were created using generalized linear and linear mixed models to assess factors associated with outcomes. Multivariable models were created using generalized linear and linear mixed models to determine factors significantly associated with outcomes. Of 186 horses presented with SI, 161/186 (86.6%) were treated and 145/161 (90.1%) survived to discharge. The majority of joints were treated with synovial lavage (93.8%). One hundred and twenty horses were included in the return to function analysis and 79 (65%) returned to function. Increasing number of days of treatment with systemic antimicrobials was associated with increased likelihood of survival for each horse (OR 1.15, 95% CI 1.04−1.27, P = 0.025) and when considering each individual synovial structure (OR 1.11, 95% CI 1.04−1.17, P = 0.004). Horses treated with doxycycline were less likely to return to function (OR 0.39, 95% CI 0.19−0.8, P = 0.031). The overall rate of survival of horses treated with SI is good. The likelihood of return to function is lower than for survival. The findings of this study, combined with relevant antimicrobial stewardship practices, can be used as a part of evidence-based decision-making when veterinarians are treating horses with SI.
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Affiliation(s)
- Danielle E Crosby
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Raphael Labens
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Kristopher J Hughes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Sharon Nielsen
- Sharon Nielsen Statistical Consulting and Training, Wagga Wagga, NSW, Australia
| | - Bryan J Hilbert
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
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Isgren CM, Salem SE, Singer ER, Wylie CE, Lipreri G, Graham RJTY, Bladon B, Boswell JC, Fiske-Jackson AR, Mair TS, Rubio-Martínez LM. A multi-centre cohort study investigating the outcome of synovial contamination or sepsis of the calcaneal bursae in horses treated by endoscopic lavage and debridement. Equine Vet J 2019; 52:404-410. [PMID: 31502700 PMCID: PMC7186813 DOI: 10.1111/evj.13180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
Abstract
Background Previous studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited. Objectives To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections. Study design Retrospective analysis of clinical records. Methods Medical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow‐up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival. Results Horses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (hazard ratio, [HR] 0.41, 95% CI 0.18–0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12–5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95% CI 1.78–8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95% CI 1.00–1.02, P = 0.04), post‐operative synoviocentesis (HR 3.18, 95% CI 1.36–7.43, P = 0.006) and post‐operative wound dehiscence (HR 2.5, 95% CI 1.08–5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95% CI 0.11–0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross‐sectional area) (HR 7.92, 95% CI 3.31–19.92, P<0.001). At follow‐up (median 30 months, range 0.25–13 years, n = 70) 87.1% horses were alive, 7.1% had been euthanised due to the calcaneal injury and 5.7% had been euthanised for unrelated reasons. From 57 horses with athletic performance follow‐up, 91.2% returned to the same/higher level of exercise, 5.3% to a lower level and 3.5% were retired due to persistent lameness of the affected limb. Main limitations Retrospective study and incomplete follow‐up. Conclusion Endoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.
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Affiliation(s)
- C M Isgren
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.,Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Wirral, UK
| | - S E Salem
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Wirral, UK.,Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt
| | - E R Singer
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - C E Wylie
- Rossdales Equine Hospital, Exning, Newmarket, Suffolk, UK
| | - G Lipreri
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - R J T Y Graham
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, The University of Edinburgh, Midlothian, UK
| | - B Bladon
- Donnington Grove Veterinary Group, Newbury, Oxfordshire, UK
| | - J C Boswell
- The Liphook Equine Hospital, Forest Mere, Liphook, Hampshire, UK
| | - A R Fiske-Jackson
- Equine Referral Hospital, Royal Veterinary College, North Mymms, Hertfordshire, UK
| | - T S Mair
- Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent, UK
| | - L M Rubio-Martínez
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK.,Sussex Equine Hospital, West Sussex, UK
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20
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Stack JD, Cousty M, Steele E, Handel I, Lechartier A, Vinardell T, David F. Comparison of Serum Amyloid A Measurements in Equine Synovial Fluid With Routine Diagnostic Methods to Detect Synovial Infection in a Clinical Environment. Front Vet Sci 2019; 6:325. [PMID: 31632987 PMCID: PMC6779708 DOI: 10.3389/fvets.2019.00325] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/11/2019] [Indexed: 11/24/2022] Open
Abstract
Synovial fluid analysis is utilized to diagnose septic synovitis. However, not all cases are clearly and rapidly discernible with the diagnostic tools available in the laboratory. Serum amyloid A (SAA), an acute phase protein, has been shown to be elevated in synovial fluid from inflamed synovial structures. The goal of this study is to describe the correlation between two diagnostic tests measuring equine SAA levels in septic and non-septic synovial structures and to understand the correlation between an elevated SAA result and synovial sepsis. Prospective estimation of sensitivity (Se) and specificity (Sp) of two tests, handheld and ELISA, measuring SAA in synovial fluid was completed in 62 horses presented with injured synovial structures. The comparison was made to a reference diagnosis based on white cell count, percentage of neutrophils, intracellular bacteria and bacterial culture on synovial fluid. Handheld test levels were classified as: 4 lines visible—SAA level negative; 3 lines visible—SAA level mild; 2 lines visible—SAA level moderate; and 1 line visible—SAA level severe and compared to the numerical value obtained with ELISA test. The ELISA SAA test had an area under the curve of 0.88 (0.78–0.98). An ELISA cut-off of 23.95 μg/mL maximized Se and Sp. This cutoff gave a Se of 0.93 (0.66–1.00) and Sp of 0.77 (0.63–0.88). The handheld test was highly correlated with the ELISA SAA test (Spearman rank correlation 0.96) and at a cutoff of moderate or higher for positive results gave identical Se and Sp. Se and Sp of synovial fluid SAA are very reliable when clinical signs of synovitis are present for >6 h. This test, in conjunction with traditional methods, can assist practitioners to rapidly diagnose and expedite appropriate intervention of synovial sepsis.
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Affiliation(s)
- John David Stack
- Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Matthieu Cousty
- Centre Hospitalier Vétérinaire Equin de Livet, Saint-Michel-de-Livet, France
| | - Emma Steele
- Clinique Vétérinaire de la Côte Fleurie, Bonneville-sur-Touques, France
| | - Ian Handel
- The Royal (Dick) School of Veterinary Studies, The Roslin Institute, The University of Edinburgh, Midlothian, United Kingdom
| | | | - Tatiana Vinardell
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Florent David
- Equine Veterinary Medical Center, Member of Qatar Foundation, Doha, Qatar.,College of Health and Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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21
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Byrne CA, Lumsden JM, Lang HM, O'Sullivan CB. Synovial sepsis of unknown origin in the adult Thoroughbred racehorse. Equine Vet J 2019; 52:91-97. [PMID: 31006125 DOI: 10.1111/evj.13127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Synovial sepsis of unknown origin is a rare cause of lameness in the adult horse, and a haematogenous pathogenesis has been proposed in previous cases. OBJECTIVES To describe the features and outcome of synovial sepsis of unknown origin in adult Thoroughbred racehorses. STUDY DESIGN Retrospective case series. METHODS Hospital records for admissions between 2005 and 2015 were reviewed to identify adult horses diagnosed with synovial sepsis of unknown origin. Presentation, clinicopathological, microbiological and diagnostic imaging findings were recorded. Treatment methods, surgical findings, complications and long-term outcome were evaluated. RESULTS Eleven cases were identified over the study period. Diagnosis was established from clinical examination and clinicopathologic findings, which were comparable to other aetiologies of synovial sepsis. Affected structures included synovial joints, tendon sheaths and bursae. Concurrent osteochondritis dissecans or articular cartilage lesions were evident during arthroscopic surgery in three cases. Significant intrasynovial haemorrhage was not identified. Microbial culture of synovial fluid or synovial biopsy was positive in 6/11 of cases, with all isolates being Gram-positive cocci. Of the 6 positive microbial cultures, all isolates demonstrated in vitro sensitivity to a cephalosporin antimicrobial agent. A concurrent remote wound was present in a single case. No other potential origins of bacteraemia were identified. Treatment methods included endoscopic surgery, standing multineedle lavage, intravenous regional limb perfusion, intrasynovial medication and/or systemic antimicrobial administration. All horses survived to hospital discharge. For the 6/11 cases that raced following synovial sepsis, the median period for return to racing was 221 days. MAIN LIMITATIONS A small study population, which was retrospectively reviewed. CONCLUSIONS Synovial sepsis of unknown origin is rare in the adult Thoroughbred racehorse and can affect a range of synovial structures. A concurrent potential source of bacteraemia is rarely identified. With appropriate management, the prognosis to return to racing is fair.
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Affiliation(s)
- C A Byrne
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - J M Lumsden
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - H M Lang
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - C B O'Sullivan
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
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22
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Affiliation(s)
- N. M. Ashton
- Oakham Veterinary Hospital - Equine Surgery; Oakham Rutland UK
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23
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Bryant HA, Dixon JJ, Weller R, Bolt DM. Use of positive contrast radiography to identify synovial involvement in horses with traumatic limb wounds. Equine Vet J 2018; 51:20-23. [PMID: 29931725 DOI: 10.1111/evj.12985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The diagnostic value of positive contrast radiography in the work-up of suspected synovial infection in horses with limb wounds near synovial structures has yet to be systematically evaluated. OBJECTIVES To determine the specificity, sensitivity and positive and negative predictive values of positive contrast radiography for identification of synovial infection in a population of horses with limb wounds. STUDY DESIGN Retrospective case study comparing the performance of positive contrast radiography to the gold standard of synovial fluid cytology in horses presenting with limb wounds in the vicinity of synovial structures. METHODS Case records of horses presenting to the Royal Veterinary College Equine Hospital between 2010 and 2015 with limb wounds that may have compromised adjacent synovial structures were analysed. Synovial fluid cytology results were used to categorise synovial structures in infected and noninfected groups. Positive contrast radiography results were compared between infected and noninfected groups and sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Fifty horses with 66 synovial structures were included in the study. Positive contrast radiography had a high specificity (86.4%), but only a moderate sensitivity (59.1%) for the identification of synovial infection. In addition, a low positive predictive value (68.4%) and high negative predictive value (80.9%) were observed in this population of horses. MAIN LIMITATIONS Sensitivity, specificity and predictive values may differ between different synovial structures and cases. Different conclusions may be drawn from the results in a single population. Sensitivity and specificity of positive contrast radiography may also be influenced by different techniques used by examiners and by inherent characteristics of individual cases. CONCLUSIONS Positive contrast radiography should be used for the investigation of potential synovial infection in horses with limb wounds, particularly if no synovial fluid sample for laboratory analysis can be obtained. However, it appears that positive contrast radiography is best used in combination with other tests to ensure that a correct and timely diagnosis is made.
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Affiliation(s)
- H A Bryant
- Department of Clinical Science & Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - J J Dixon
- Rainbow Equine Hospital, Malton, North Yorkshire, UK
| | - R Weller
- Department of Clinical Science & Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - D M Bolt
- Department of Clinical Science & Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
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24
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Kilcoyne I, Nieto JE, Knych HK, Dechant JE. Time required to achieve maximum concentration of amikacin in synovial fluid of the distal interphalangeal joint after intravenous regional limb perfusion in horses. Am J Vet Res 2018; 79:282-286. [DOI: 10.2460/ajvr.79.3.282] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Cousty M, David Stack J, Tricaud C, David F. Effect of arthroscopic lavage and repeated intra-articular administrations of antibiotic in adult horses and foals with septic arthritis. Vet Surg 2017; 46:1008-1016. [PMID: 28771839 DOI: 10.1111/vsu.12696] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effect of arthroscopic lavage and repeated intra-articular administration of antibiotic in adult horses and foals with septic arthritis. STUDY DESIGN Retrospective clinical study. ANIMALS Adult horses and foals with septic arthritis (n = 62). METHODS Age, sex, cause of septic synovitis, joint involved, hospitalization time, and outcome were recorded. Arthroscopic lavage was performed at day 0 (D 0). Synovial fluid was collected every 48 hours prior to intra-articular administration of antibiotic, and until hospital discharge. Synovial nucleated cell count, total protein, and percentage of neutrophils were compared across time and between subjects with a favorable or unfavorable outcome. RESULTS Synovial nucleated cell counts decreased progressively and were lower at all times compared to D 0. Percentages of neutrophils were lower than baseline at D 8 and 10, only. Total protein contents decreased progressively and were lower than baseline at D 2, 4, 6, 8, 10, and 14. When adult horses and foals with a favorable outcome were compared to those with an unfavorable outcome, the nucleated cell count was lower at D 10, 12, and 14 and the percentage of neutrophils was lower at D 4 only, but total protein content did not differ between groups at any time. CONCLUSION Synovial nucleated cell counts and total protein concentrations decreased after arthroscopic lavage and repeated intra-articular administration of antibiotic in horses and foals with septic arthritis. Synovial nucleated cell count is limited as a monitoring tool during treatment of septic arthritis.
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Affiliation(s)
- Matthieu Cousty
- Centre Hospitalier Vétérinaire Equin de Livet, Cour Samson, St Michel de Livet, France
| | - John David Stack
- UCD, University College Dublin Campus, Belfield, Dublin 4, Ireland
| | - Cyril Tricaud
- Centre Hospitalier Vétérinaire Equin de Livet, Cour Samson, St Michel de Livet, France
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26
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Robinson CS, Singer ER, Piviani M, Rubio-Martinez LM. Are serum amyloid A or D-lactate useful to diagnose synovial contamination or sepsis in horses? Vet Rec 2017; 181:425. [PMID: 28765498 PMCID: PMC5738594 DOI: 10.1136/vr.104386] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/16/2017] [Accepted: 06/22/2017] [Indexed: 11/04/2022]
Abstract
Synovial sepsis in horses is life threatening and accurate diagnosis allowing prompt treatment is warranted. This study assessed the diagnostic value of serum amyloid A (SAA) and D-lactate in blood and synovial fluid (SF) as diagnostic markers of synovial sepsis in horses and correlated them with total nucleated cell count (TNCC), percentage of neutrophils (%N) and total protein (TP) in SF. Blood and SF SAA and D-lactate concentrations were determined in a case–control observational study including 112 horses (38 with synovial contamination or sepsis (SCS), 66 with non-septic intra-synovial pathology (NSISP) and 8 controls). Blood and SF SAA were significantly higher in SCS than in NSISP and control horses. SAA values were similar in NSISP and control horses. SF SAA was moderately correlated with synovial TNCC, TP and blood SAA. Blood and SF SAA were 82.4 per cent and 80 per cent sensitive and 88.9 per cent and 73 per cent specific for diagnosis of SCS, with cut-off values of 60.7 and 1.14 µg/ml, respectively. Blood and SF D-lactate concentrations were not significantly different between groups. This study shows that blood and SF SAA concentrations can aid to distinguish SCS from non-septic synovial pathology; however, D-lactate was not useful.
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Affiliation(s)
- Claire S Robinson
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - Ellen R Singer
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - Martina Piviani
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
| | - Luis M Rubio-Martinez
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Wirral, UK
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27
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Orsini JA. Meta-Analysis of Clinical Factors Affecting Synovial Structure Infections and Prognosis. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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28
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Haltmayer E, Schwendenwein I, Licka TF. Course of serum amyloid A (SAA) plasma concentrations in horses undergoing surgery for injuries penetrating synovial structures, an observational clinical study. BMC Vet Res 2017; 13:137. [PMID: 28532514 PMCID: PMC5441074 DOI: 10.1186/s12917-017-1057-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injuries penetrating synovial structures are common in equine practice and often result in septic synovitis. Significantly increased plasma levels of serum amyloid A (SAA) have been found in various infectious conditions in horses including wounds and septic arthritis. Plasma SAA levels were found to decrease rapidly once the infectious stimulus was eliminated. The purpose of the current study was to investigate the usefulness of serial measurements of plasma SAA as a monitoring tool for the response to treatment of horses presented with injuries penetrating synovial structures. In the current study plasma SAA concentrations were measured every 48 hours (h) during the course of treatment. RESULTS A total of 19 horses with a wound penetrating a synovial structure were included in the current study. Horses in Group 1 (n = 12) (injuries older than 24 h) only needed one surgical intervention. Patients in this group had significantly lower median plasma SAA levels (P = 0.001) between 48 h (median 776 mg/L) and 96 h (median 202 mg/L) after surgery. A significant decrease (P = 0.004) in plasma SAA levels was also observed between 96 h after surgery (median 270 mg/L) and 6 days (d) after surgery (median 3 mg/L). Four horses (Group 2) required more than one surgical intervention. In contrast to Group 1 patients in Group 2 had either very high initial plasma concentrations (3378 mg/L), an increase or persistently high concentrations of plasma SAA after the first surgery (median 2525 mg/L). A small group of patients (n = 3) (Group 3) were admitted less than 24 h after sustaining a wound. In this group low SAA values at admission (median 23 mg/L) and peak concentrations at 48 h after surgery (median 1016 mg/L) were observed followed by a decrease in plasma SAA concentration over time. CONCLUSIONS A decrease in plasma SAA concentrations between two consecutive time points could be associated with positive response to treatment in the current study. Therefore, serial measurements of plasma SAA could potentially be used as an additional inexpensive, quick and easy tool for monitoring the treatment response in otherwise healthy horses presented with injuries penetrating synovial structures. However further studies will be necessary to ascertain its clinical utility.
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Affiliation(s)
- Eva Haltmayer
- Department of Small Animals and Horses, Clinic for Horses, Equine Surgery, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210, Vienna, Austria.
| | - Ilse Schwendenwein
- Department of Pathobiology, Clinical Pathology, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210, Vienna, Austria
| | - Theresia F Licka
- Department of Small Animals and Horses, Clinic for Horses, Equine Surgery, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210, Vienna, Austria.,Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, Scotland
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29
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Wright L, Ekstrøm CT, Kristoffersen M, Lindegaard C. Haematogenous septic arthritis in foals: Short- and long-term outcome and analysis of factors affecting prognosis. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12616] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Wright
- Evidensia Equine Specialist Hospital; Helsingborg Sweden
| | - C. T. Ekstrøm
- Section of Biostatistics; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | | | - C. Lindegaard
- Evidensia Equine Specialist Hospital; Helsingborg Sweden
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30
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Kilcoyne I, Dechant JE, Nieto JE. Evaluation of 10-minute versus 30-minute tourniquet time for intravenous regional limb perfusion with amikacin sulfate in standing sedated horses. Vet Rec 2016; 178:585. [DOI: 10.1136/vr.103609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/04/2022]
Affiliation(s)
- I. Kilcoyne
- Veterinary Medical Teaching Hospital, UC Davis School of Veterinary Medicine; Davis California USA
| | - J. E. Dechant
- Department of Surgical and Radiological Sciences; UC Davis School of Veterinary Medicine; Davis California USA
| | - J. E. Nieto
- Department of Surgical and Radiological Sciences; UC Davis School of Veterinary Medicine; Davis California USA
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31
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Isgren CM, Salem SE, Archer DC, Worsman FCF, Townsend NB. Risk factors for surgical site infection following laparotomy: Effect of season and perioperative variables and reporting of bacterial isolates in 287 horses. Equine Vet J 2016; 49:39-44. [PMID: 26713622 DOI: 10.1111/evj.12564] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/17/2015] [Indexed: 12/14/2022]
Abstract
REASONS FOR PERFORMING STUDY Surgical site infection (SSI) is an important cause of post operative morbidity following laparotomy. OBJECTIVES To investigate risk factors for SSI, including effect of season and surgery performed outside normal working hours, and to report bacterial isolates and antimicrobial resistance patterns. STUDY DESIGN Retrospective cohort study. METHODS Data were obtained from horses that had undergone exploratory laparotomy over a 3-year period (2010-2013) in a UK hospital population. SSI was defined as any purulent or serous discharge from the laparotomy incision of >24 h duration that developed during hospitalisation. Multivariable logistic regression was used to identify associations between pre-, intra- and post operative variables and altered likelihood of SSI. RESULTS Surgical site infection developed in 73/287 (25.4%) horses during hospitalisation. Horses of greater bodyweight (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.0002-1.005, P = 0.03), increased packed cell volume (≥48%) on admission (OR 3.03, 95% CI 1.32-6.94, P = 0.01), small intestinal resection (OR 2.27, 95% CI 1.15-4.46, P = 0.02) and post operative colic (OR 2.86, 95% CI 1.41-5.79, P = 0.003) were significantly associated with increased likelihood of SSI in a multivariable model. SSI was also significantly more likely to occur during winter (OR 3.84, 95% CI 1.38-10.70, P = 0.01) and summer (OR 5.63, 95% CI 2.07-15.3, P = 0.001) months in the model. Three-layer closure of the incision was protective (OR 0.31, 95% CI 0.16-0.58, P<0.001) compared to 2-layer closure. There was no effect of surgery being performed outside normal working hours (P = 0.5). The most common bacterial isolates were Escherichia coli (59.5%), Enterococcus spp. (42.4%) and Staphylococcus spp. (25.4%). Penicillin resistant isolates accounted for 92% (96/104) of isolates while 18% (21/119) of isolates were gentamicin resistant. CONCLUSIONS Laparotomy during winter and summer months was associated with increased likelihood of SSI but there was no effect of surgery performed outside normal working hours. This information assists in identifying horses at high risk of SSI and informing development of preventive strategies.
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Affiliation(s)
- C M Isgren
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
| | - S E Salem
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK.,Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zakazik, Egypt
| | - D C Archer
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
| | - F C F Worsman
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
| | - N B Townsend
- Philip Leverhulme Equine Hospital, School of Veterinary Science/Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Neston, Wirral, UK
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Sanchez-Teran AF, Bracamonte JL, Hendrick S, Burguess HJ, Duke-Novakovski T, Schott M, Hoff B, Rubio-Martínez LM. Effect of Arthroscopic Lavage on Systemic and Synovial Fluid Serum Amyloid A in Healthy Horses. Vet Surg 2016; 45:223-30. [DOI: 10.1111/vsu.12439] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - José L. Bracamonte
- Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon Canada
| | - Steven Hendrick
- Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon Canada
| | - Hilary J. Burguess
- Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon Canada
| | - Tanya Duke-Novakovski
- Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon Canada
| | - Monica Schott
- Western College of Veterinary Medicine; University of Saskatchewan; Saskatoon Canada
| | - Brent Hoff
- Animal Health Laboratory, Division of Laboratory Services; University of Guelph; Guelph Ontario Canada
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Woodford NS, Puzio J, Parker RD. Idiopathic infectious arthritis of the coxofemoral joint in a mature horse. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - J. Puzio
- Endell Equine Hospital; Salisbury Wiltshire UK
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Sanchez-Teran AF, Bracamonte JL, Hendrick S, Riddell L, Musil K, Hoff B, Rubio-Martínez LM. Effect of repeated through-and-through joint lavage on serum amyloid A in synovial fluid from healthy horses. Vet J 2016; 210:30-3. [PMID: 26831179 DOI: 10.1016/j.tvjl.2016.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 12/07/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
Abstract
The objective of this study was to evaluate the effect of through-and-through joint lavage on systemic and synovial serum amyloid A (SAA), total protein, nucleated cell count and percentage of neutrophils in the synovial fluid of six healthy horses. A prospective experimental study was performed where one healthy tarsocrural joint of each horse was randomly assigned to receive repeated through-and-through joint lavage at 0, 48 and 96 h. Synovial fluid and blood samples were collected at 0 (baseline), 24, 48, 72, 96 and 120 h. Systemic and synovial SAA, total protein, nucleated cell count and percentage of neutrophils were measured and compared to baseline. Concentrations of systemic and synovial SAA percentage of neutrophils were not increased from baseline in contrast to total protein and nucleated cell counts (except for nucleated cell count at 96 h). In conclusion, repeated through-and-through joint lavage did not affect synovial SAA concentrations in horses; however, synovial total protein and nucleated cell count values increased. Some of the total protein and nucleated cell count values observed in this study were within the range reported for septic arthritis 24 h after joint lavage. Hence, synovial SAA may be a valuable marker to evaluate the clinical progression of septic joints after through-and-through joint lavage. Clinical studies evaluating synovial fluid SAA concentrations while treating synovial sepsis with through-and-through joint lavage are warranted.
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Affiliation(s)
- A F Sanchez-Teran
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 5B4.
| | - J L Bracamonte
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 5B4
| | - S Hendrick
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 5B4
| | - L Riddell
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 5B4
| | - K Musil
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 5B4
| | - B Hoff
- Animal Health Laboratory, Laboratory Services Division, University of Guelph, Guelph, ON, Canada N1G 2W1
| | - L M Rubio-Martínez
- School of Veterinary Science, University of Liverpool, Neston CH64 7TE, UK
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Abstract
The current understanding of pathology as it relates to common diseases of the equine musculoskeletal system is reviewed. Conditions are organized under the fundamental categories of developmental, exercise-induced, infectious, and miscellaneous pathology. The overview of developmental pathology incorporates the new classification system of juvenile osteochondral conditions. Discussion of exercise-induced pathology emphasizes increased understanding of the contribution of cumulative microdamage caused by repetitive cyclic loading. Miscellaneous musculoskeletal pathology focuses on laminitis, which current knowledge indicates should be regarded as a clinical syndrome with a variety of possible distinct mechanisms of structural failure that are outlined in this overview.
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Affiliation(s)
- Frances J Peat
- Equine Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Rd, Fort Collins, CO 80523, USA
| | - Christopher E Kawcak
- Equine Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Rd, Fort Collins, CO 80523, USA.
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