Javma-journal of The American Veterinary Medical Association最新文献

Objective: To measure the prevalence of antibiotic use in dogs and cats, identify the most common antibiotic drugs prescribed, and determine the most common indications for use.

Methods: Point-prevalence survey methodology was used to collect antibiotic prescribing data for cats and dogs from 1 practice day in 2021 at nonacademic primary care and referral practices in the US.

Results: 52 practices participated, comprising records for 2,599 dogs and cats. Antibiotics were prescribed to 29.2% of animals, including 24.6% prescribed antibiotics for systemic and 6.3% for topical administration. The most common systemically administered antibiotics prescribed were aminopenicillins with beta-lactamase inhibitors (29.7%), imidazoles (16.4%), first-generation cephalosporins (15.9%), and third-generation cephalosporins (12.5%). Of the 810 clinical conditions associated with antibiotic prescriptions, the majority were skin (17.0%), gastrointestinal (15.9%), surgical (12.5%), otic (8.6%), ocular (8.5%), urinary (7.8%), and respiratory (7.3%). Dogs, inpatients, and animals presenting to referral practices were more likely to receive an antibiotic prescription. For the 478 dogs and cats prescribed an antibiotic intended to treat infection, 13.4% had bacterial culture and susceptibility testing.

Conclusions: This study highlights areas for targeted antimicrobial stewardship efforts, including the limited use of bacterial culture and susceptibility testing, the frequent prescribing of third-generation cephalosporins and imidazoles, and the common use of prophylactic antibiotics for clean surgical procedures.

Clinical relevance: Measurement of antibiotic use in companion animals is critical to focus antibiotic use guideline development, highlight the need for outcomes-based research, and identify barriers to engage in antimicrobial stewardship efforts.

Objective: The aim of this study was to report the outcome and prognosis of canine patients treated medically or surgically for rectal plasmacytomas and to identify factors associated with recurrence, mortality, or progression to multiple myeloma.

Methods: The databases of 7 referral hospitals were reviewed. The Kaplan-Meier method and Cox proportional hazards analysis were used to determine the association of a range of variables with recurrence and progression-free interval for the surgically treated patients.

Results: 20 dogs were included. Nineteen cases were treated surgically, and 1 case was treated conservatively (analgesia and monitoring). Metastatic lesions were detected in 2 of 20 dogs (10%). Four of 19 dogs (21%) treated surgically developed postoperative complications, 1 major (1 of 19 [5.2%]) and 3 minor (3 of 19 [15.8%]). Tumor recurrence was identified in 6 of 19 dogs (31.5%). The 1-, 2-, and 3-year survival rates were 95%, 72%, and 66%, respectively. None of the variables tested were associated with occurrence of complications. Increased distance from the anus, incomplete surgical margins, and decreasing surgeon experience were associated with an increased risk of recurrence. No progression to multiple myeloma was seen in any of the cases.

Conclusions: Surgical treatment of rectal plasmacytomas is associated with a low major complication rate and long survival. Metastasis and recurrence rates are significantly higher than previously reported.

Clinical relevance: Conservative surgery leads to long-term survival, but recurrence is common. Future studies should focus on the benefits of adjuvant treatments.

Objective: The goal of this study was to evaluate the difference in weight bearing in a toes-in splint versus a toes-out forelimb splint and to determine the difference in sub-bandage pressures between the groups. We hypothesized that (1) weight bearing would not be different between the 2 splints and that (2) sub-bandage pressures would be distributed higher on the distal digits in the toes-out splint and pressures would be more evenly distributed across the paw in the toes-in splint.

Methods: In this controlled crossover trial, a random forelimb of 10 healthy dogs was bandaged with a splint that left the digits exposed and again with a splint that encompassed the digits. The ground reaction forces and the difference in sub-bandage pressures between 2 sensor sections were compared between the toes-in and toes-out bandages.

Results: The mean (SD) of peak vertical force was 26.76% (11.86%) for the toes-in bandage and 49.85% (9.21%) for the toes-out bandage. The mean (SD) sub-bandage pressure differences between sections were -121.28 (138.28) mm Hg and 130.32 (116.40) for toes-in and toes-out bandages, respectively (P = .001). This remained significant even after weight bearing was removed as a factor (P < .001).

Conclusions: Leaving the distal aspect of digits 3 and 4 exposed by a splint results in better weight bearing, but also creates a sub-bandage pressure increase on the toes relative to the rest of the paw.

Clinical relevance: These results suggest that splint placement should be adjusted based on the needs of each patient.

Objective: To evaluate the impact of peri-incisional liposomal bupivacaine (LB) on postoperative pain scores, opioid use after soft tissue surgeries, and incidence of incision site complications in dogs.

Methods: Client-owned dogs (n = 83) were enrolled in a randomized, blinded, placebo-controlled clinical study for dogs undergoing a variety of soft tissue surgical procedures between March 31, 2021, and August 18, 2022. After incision closure, an injection of a placebo (0.9% NaCl) or LB was administered into the peri-incisional subcutaneous tissues. Pain was assessed via the Glasgow Composite Measure Pain Scale (CMPS-SF) preoperatively, at extubation, and at 2, 4, 8, 12, 24, 30, 36, 48, 54, 60, and 72 hours postoperatively or until time of discharge. The need for rescue analgesia was assessed based on CMPS-SF guidelines. The effect of LB on pain scores was analyzed with mixed-model linear regression, and the χ2 test was used to examine effects on incision complications and need for rescue analgesia.

Results: 83 dogs were enrolled. There was no significant difference in CMPS-SF scores between LB and placebo groups at any time period. Rescue analgesia was administered to 21 dogs in each group and was not significantly different. There was no significant difference in incision site complications. The incidence of surgical site infections was 6.0% for all procedures.

Conclusions: Peri-incisional LB did not significantly decrease the use of rescue analgesia for postoperative soft tissue surgeries in a clinical setting with the use of multimodal analgesia. This is consistent with findings in human literature.

Clinical relevance: Clinicians should not rely on LB used in the peri-incisional subcutaneous tissue to improve analgesia in patients undergoing soft tissue surgery.

Objective: Identify rate and associated risk factors for dehiscence following gastrotomy for foreign material removal.

Methods: Medical records from 2 private practice emergency and referral hospitals were reviewed, and history, laboratory values, intraoperative findings, and outcomes were collected on 271 dogs and 31 cats (n = 302).

Results: Hospital A performed 222 procedures and Hospital B performed 80 procedures. Three cats (3 of 31 [10%]) and 20 dogs (20 of 271 [7%]) had intraoperative intestinal perforations. Two cats (2 of 31 [6.5%]) and 7 dogs (7 of 271 [2.6%]) were diagnosed with preoperative septic peritonitis. Concurrent surgical procedures in felines included enterotomy (3 of 31 [10%]), multiple enterotomies (3 of 31 [10%]), intestinal resection and anastomosis (IR&A; 2 of 31 [6%]), and other (1 of 31 [3%]). Concurrent surgical procedures in canines included enterotomy (55 of 271 [20%]), multiple enterotomies (11 of 271 [4%]), IR&A (24 of 271 [9%]), IR&A and enterotomy (1 of 271 [0.4%]), splenectomy (11 of 271 [4%]), and other (50 of 271 [18%]). There was no proven gastrotomy dehiscence. Two patients that did not have follow-up surgery or necropsy before euthanasia developed postoperative septic peritonitis, and gastrotomy dehiscence could not be ruled out as a differential diagnosis. Assuming neither patient, 1 patient, or both patients had gastrotomy dehiscence, the gastrotomy dehiscence rate was 0% to 0.66%. However, these patients also had an IR&A.

Conclusions: Two cases were presumed to have gastrotomy dehiscence, as the authors would rather overestimate the dehiscence rate. However, it is more likely that the IR&A was the dehiscence site rather than the gastrotomy.

Clinical relevance: Gastrotomy dehiscence rate is low in cats and dogs, and the dehiscence rate reported in this study may be an overestimation.

Objective: To determine whether folded-flap palatoplasty (FFP) results in improved respiratory outcomes compared to standard staphylectomy (SS).

Methods: English Bulldogs were randomized to receive FFP or SS in a parallel, equal-allocation, prospective study design at a single institution. Exercise-tolerance testing (ETT), arterial blood gas, head CT, and an owner survey were completed preoperatively and at recheck (approx 30 days postoperatively). Soft palate (SP) length and thickness and pharyngeal air volume were measured on blinded CT images. Linear mixed models and Mann-Whitney U tests were performed.

Results: 16 dogs completed the study (FFP group, 8; SS group, 8) and 3 did not (excluded due to FFP dehiscence [2] and lack of recheck [1]). Median preoperative ETT grade was not different between groups (SS group, 1 [0 to 3]; FFP group, 1.5 [1 to 3]). Standard staphylectomy resulted in a greater reduction in SP length compared to FFP (P = .020; FFP, 5.79 ± 0.50 cm preoperatively, 4.86 ± 0.52 cm at recheck; SS, 6.13 ± 0.53 cm preoperatively, 4.57 ± 0.47 cm at recheck). No other variables differed between groups. At recheck, owners subjectively rated their dogs as improved (FFP group, 5; SS group, 8), unchanged (FFP group, 2), and not rated (FFP group, 1).

Conclusions: Folded-flap palatoplasty did not improve SP thickness, pharyngeal air volume, ETT, arterial blood gas values, or owner survey variables more than SS in these English Bulldogs. Standard staphylectomy resulted in a greater reduction in SP length than FFP.

Clinical relevance: Standard staphylectomy or FFP can be performed in English Bulldogs. Standard staphylectomy may be preferable due to dehiscence potential with FFP.