Examen EBM 1ère session 2014

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Abstract 1 :

Vet Rec. 2012 Jun 23;170(25):646. doi: 10.1136/vr.100292. Epub 2012 May 4.

Current British veterinary attitudes to the use of perioperative antimicrobials in

small animal surgery.
Knights CB1, Mateus A, Baines SJ.

A questionnaire was sent to 2951 mixed and small animal veterinary practices to examine the use of
perioperative antimicrobials in cats and dogs in the UK. The percentage of respondents who always
used antimicrobials in two surgical procedures classified according to NRC criteria as 'clean' was 25.3
per cent for removal of a 1 cm cutaneous mass and 32.1 per cent for routine prescrotal
castration. Factors considered important in decision-making about when to use antimicrobial agents
included immunosuppression, presence of a drain, degree of wound contamination, potential for
spillage of visceral contents and implantation of prosthesis. The most common antimicrobial agents
mentioned were potentiated amoxicillin (98.0 per cent), amoxicillin (60.5 per cent), clindamycin (21.8
per cent), enrofloxacin (21.7 per cent), cephalexin (18.6 per cent) and metronidazole (12.7 per cent).
Forty-three per cent of all responding veterinarians listed a long-acting preparation for perioperative
use. The routes used were subcutaneous (76.1 per cent), intravenous (25.8 per cent), intramuscular
(19.8 per cent), oral (13.5 per cent) and topical (7.7 per cent). Antimicrobials were given before
surgery (66.6 per cent), during surgery (30.2 per cent), immediately after surgery (12.0 per cent) and
after surgery (6.3 per cent). This survey has identified the suboptimal use of perioperative
antimicrobials in small animal surgery with improvements needed with respect to timing, duration,
choice of antimicrobial and a more prudent selection of surgical cases requiring prophylaxis.

Abstract 2 (Editorial)

Vet Rec. 2012 Jun 23;170(25):644-5. doi: 10.1136/vr.e4277.

Attitudes to antimicrobial use: making a difference.

Radford A, Comerford E.

Comment on

 Current British veterinary attitudes to the use of perioperative antimicrobials in small animal
surgery. [Vet Rec. 2012]

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Abstract 3 :

J Am Vet Med Assoc. 2006 Jul 1;229(1):92-5.

Perioperative administration of antimicrobials associated with elective surgery

for cranial cruciate ligament rupture in dogs: 83 cases (2003-2005).
Weese JS1, Halling KB.

OBJECTIVE: To evaluate perioperative antimicrobial use associated with elective surgery for cranial
cruciate ligament rupture in dogs.

DESIGN: Retrospective case series.

ANIMALS: 83 dogs.

Abstracts Page 1
 Examen EBM 1ère session 2014
PROCEDURES: Medical records were reviewed and antimicrobial use practices were evaluated for
dogs with no other problems that would affect antimicrobial use decisions.

RESULTS: Antimicrobials were administered before or during surgery to 75 of 83 (90%) dogs. Timing
of administration with respect to first incision, intraoperative administration, and duration of
administration were variable. Antimicrobial administration began after surgery in 3 (3.6%) dogs. Fifty-
five of 65 (85%) dogs treated before surgery received the first dose within 60 minutes of the first
incision. Time from first antimicrobial administration to closure of the incision ranged from 15 to 285
minutes (mean +/- SD, 141 +/- 53 minutes). If a guideline of repeated administration every 2 hours
after first administration until closure of the surgical site was used, 22 of 43 (51%) dogs received the
required intraoperative dose, whereas 6 of 32 (19%) dogs that did not require intraoperative treatment
were treated. Twenty-four (29%) dogs received antimicrobials after surgery.

CONCLUSIONS AND CLINICAL RELEVANCE: Certain discrepancies between antimicrobial use

practices in this study and standard guidelines used in human medicine were evident.

Abstract 4 :

J Am Vet Med Assoc. 2009 Jan 1;234(1):100-7. doi: 10.2460/javma.234.1.100.

Association of periodontal disease, oral procedures, and other clinical findings

with bacterial endocarditis in dogs.
Peddle GD1, Drobatz KJ, Harvey CE, Adams A, Sleeper MM.

OBJECTIVE: To identify risk factors potentially associated with the development of bacterial
endocarditis in dogs and determine whether periodontal disease and surgical procedures (oral and
nonoral) were associated with bacterial endocarditis.

DESIGN: Retrospective case-control study.

ANIMALS: 76 dogs with (cases) and 80 dogs without (controls) bacterial endocarditis.

PROCEDURES: Medical records were reviewed for information on signalment, physical examination
findings, recent medical history, and results of echocardiography, clinicopathologic testing, and
necropsy.

RESULTS: None of the dogs with endocarditis had a history of undergoing any dental or oral
procedure in the 3 months prior to the diagnosis of endocarditis, and no significant difference was
found between groups with regard to the prevalence of oral infection. Dogs with endocarditis were
significantly more likely to have undergone a nonoral surgical procedure that required general
anesthesia in the preceding 3 months or to have developed a new heart murmur or a change in
intensity of an existing heart murmur. Preexisting cardiac dis-ease (congenital or acquired) was not
found to be a risk factor.

CONCLUSIONS AND CLINICAL RELEVANCE: Results did not provide any evidence of an
association between bacterial endocarditis in dogs and either dental or oral surgical procedures or oral
infection. Findings suggested that the routine use of prophylactic antimicrobial administration in dogs
undergoing oral procedures needs to be reevaluated.

Abstracts Page 2
 Examen EBM 1ère session 2014

Abstract 5 :

Cochrane Database Syst Rev. 2001;(2):CD001738.

Antibiotic prophylaxis for mammalian bites.

Medeiros I1, Saconato H.

BACKGROUND: Bites by mammals are a common problem and they account for up to 1% of all visits
to hospital emergency rooms. Dog and cat bites are the most common and people are usually bitten
by their own pets or by an animal known to them. School-age children make up almost a half of those
bitten. Prevention of tetanus, rabies and wound infection are the priorities for staff in emergency
rooms. The use of antibiotics may be useful to reduce the risk of developing a wound infection.

OBJECTIVES: To determine if the use of prophylactic antibiotics in mammalian bites is effective in

preventing bite wound infection.

SEARCH STRATEGY: Relevant RCTs were identified by electronic searches of MEDLINE, EMBASE,
LILACS and the Cochrane Controlled Trials Register databases in November 2000.

SELECTION CRITERIA: We included randomised controlled trials which studied patients with bites
from all mammals. Comparisons were made between antibiotics and placebo or no intervention. The
outcome of interest was the number of infections at the site of bite.

DATA COLLECTION AND ANALYSIS: Two reviewers extracted the data independently. All analyses
were performed according to the intention-to-treat method.

MAIN RESULTS: Eight studies were included. The use of prophylactic antibiotics was associated with
a statistically significant reduction in the rate of infection after bites by humans. Prophylactic antibiotics
did not appear to reduce the rate of infection after bites by cats or dogs. Wound type, e.g. laceration or
puncture, did not appear to influence the effectiveness of the prophylactic antibiotic. Prophylactic
antibiotics were associated with a statistically significant reduction in the rate of infection in hand bites
(OR 0.10, 95% CI 0.01 to 0.86; NNT = 4, 95% CI 2 to 50).

REVIEWER'S CONCLUSIONS: There is evidence from one trial that prophylactic antibiotics reduces
the risk of infection after human bites but confirmatory research is required. There is no evidence that
the use of prophylactic antibiotics is effective for cat or dog bites. There is evidence that the use of
antibiotic prophylactic after bites of the hand reduces infection but confirmatory research is required.

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