Retrospective evaluation of the effects of a single intraoperative dose of dexamethasone in horses undergoing exploratory laparotomy for small intestinal lesions (2008-2019): 240 cases.

OBJECTIVE: To determine the effect of a single intraoperative dose of dexamethasone on the risk of postoperative reflux (POR) in horses undergoing small intestinal surgery and to investigate its association with incisional complications and short-term survival. DESIGN: Retrospective cohort study over an 11-year period (2008-2019). SETTING: UK-based private referral center. ANIMALS: Two hundred and forty client-owned horses >6 months of age undergoing exploratory laparotomy for treatment of a small intestinal lesion. INTERVENTIONS: Ninety-seven horses received a single intraoperative dose of dexamethasone (0.1 mg/kg, IV). MEASUREMENTS AND MAIN RESULTS: Of 97 horses that received dexamethasone, 52 (53.6%) required small intestinal resection. Of 143 horses that did not receive dexamethasone, small intestinal resection was performed in 78 (54.5%). A total of 70 horses (29%) developed POR. There was no difference in the risk of POR between horses that received dexamethasone (25/97; 26%) and those that did not (45/143; 31%, P = 0.34). Risk factors associated with the development of POR included small intestinal resection (odds ratio [OR]: 4.55, 95% confidence interval [CI]: 2.27-9.11, P < 0.001), a PCV >40% 24 hours postoperatively (OR: 4.11, 95% CI: 2-8.45, P < 0.001), and a WBC count >10 × 109/L on admission (OR: 3.29, 95% CI: 1.47-7.41, P = 0.004). Dexamethasone was not associated with the odds of POR. Horses undergoing repeat laparotomy had a higher risk of incisional infection (OR: 8.07, 95% CI: 1.98-32.81, P = 0.004). Dexamethasone administration was not associated with incisional infection. The development of POR was negatively associated with short-term survival (OR: 0.07, 95% CI: 0.03-0.17, P ≤ 0.001). Dexamethasone administration was not retained in the final multivariable model for survival. CONCLUSIONS: Intraoperative dexamethasone was not associated with the development of POR in this study population, nor did it have an effect on postoperative survival or incisional infection in horses undergoing surgical management of small intestinal disease.

Antibiotic usage in 14 equine practices over a 10-year period (2012-2021).

BACKGROUND: Monitoring antibiotic usage is an important part of tackling antimicrobial resistance. The use of computerised records for monitoring has been previously described in the equine sector but there is currently no consensus on metrics used to report usage. OBJECTIVES: To document antibiotic use in equine practices in the United Kingdom over a 10-year period using commercially available practice management software. STUDY DESIGN: Retrospective survey. METHODS: A custom antibiotic usage report was created using Eclipse® practice management software. Participating practices were given instructions on how to generate the usage report. Annual reports were requested for a 10-year period (2012-2021 inclusive). Each report provided sales of each class of antibiotic in total mg and in mg/kg, based on the number of equids treated (for any transaction) and their average weight. The defined daily dose for animals (DDDvet) and the DDD/1000 (used in people) were also calculated to correct for variation in dosage rates between antibiotics. RESULTS: Fourteen practices submitted data for an annual maximum of 107 977 horses. Overall, median annual antibiotic usage was 54.25 mg/kg (range 45.34-60.27 mg/kg), 1.52 defined daily doses/animal/year (range 1.39-1.70) and 4.17 defined daily dose/1000 animals (range 3.82-4.66). Overall median highest priority critically important antimicrobial usage was 0.67 mg/kg (range 0.56-1.71), 0.12 defined daily doses/animal/year (range 0.10-0.14) and 0.33 defined daily dose/1000 animals (range 0.29-0.39). MAIN LIMITATIONS: The software relied on the accurate identification of antibiotic preparations. The calculation of DDDvet was complicated by the varying dose rates of antimicrobials used in equine practice. CONCLUSIONS: A reliable technique to measure antibiotic usage is presented. Defined daily dosage calculations may be more helpful in equine practice due to the preponderance of potentiated sulphonamides usage. These data and methods may provide the basis for future clinical audits aiming to enhance antimicrobial stewardship.

Use of an equine compression suit to manage a deep axillary wound in a horse.

PURPOSE: To describe the use of an equine compression suit to manage a deep axillary wound in a Thoroughbred filly with bilateral pneumothorax. CASE SUMMARY: A 2-year-old Thoroughbred filly was referred for management of a deep wound to the left axilla. Packing and bandaging of the area were initially attempted, but this became repeatedly dislodged, and bandaging was discontinued. The filly subsequently developed widespread subcutaneous emphysema, and the wound was slow to granulate. Acute onset respiratory distress occurred 11 days after admission, secondary to bilateral worsening pneumothorax, and required placement of a chest drain. A commercially available equine compression suit was then successfully used to hold a primary dressing in place. This resulted in a marked improvement in the subcutaneous emphysema and pneumothorax. Wound granulation subsequently progressed well, and the filly was discharged from the clinic on day 36. UNIQUE INFORMATION PROVIDED: This case report highlights the potential applicability of a compression suit as an alternative to a stent to effectively prevent entry of air and successfully manage axillary wounds in the horse. It was also noted how delayed the progression of a pneumothorax can be after inadequate bandaging of a deep wound in the axillary region. The compression suit provided an alternative means of securing a dressing onto an awkwardly placed wound and may be useful in locations other than the axilla.