Surgical site infections in orthopedic settings are rare, yet many equine surgeons are hesitant to withhold antibiotics for orthopedic surgeries, particularly those involving implants, said John Peroni, DVM, MS, Dipl. ACVS, from the Department of Large Animal Medicine, at the University of Georgia’s College of Veterinary Medicine, in Athens. He presented on orthopedic antimicrobial use at the 2024 American Association of Equine Practitioners Convention, held Dec. 7-11 in Orlando, Florida.

“Risk of infection is a major concern with equine orthopedics, and infections at or near the surgery site can occur anywhere from a few days to one year following surgery if implants are left in place,” he said. “Horses that develop surgical site infections (SSIs) are at risk of support-limb laminitis, which is life-threatening. Plus, treating these infections quickly becomes very expensive.”

Exceptions include arthroscopic surgery, after which SSIs are extremely rare. Peroni shared data from a study showing an infection rate of 0.5% following arthroscopy of 636 joints performed without antimicrobial prophylaxis (Borg et al. 2013).

“Based on these types of studies, the use of antibiotics should be up for discussion,” he said. “But habitual practices are hard to get away from. I’m not saying antibiotics shouldn’t be used, but the why needs to be looked at.”

Peroni said in his opinion, whether antibiotic use is appropriate boils down to a risk-benefit analysis. For example, an antibiotic might be warranted if the surgery lasts more than 90 minutes, breaks in sterile technique are likely, the horse has comorbidities, or there is risk of bone exposure.

“If an antibiotic is going to be prescribed, administer the medication 30 to 60 minutes before making the first incision for optimal effect,” Peroni said. “Prolonged antibiotic use, meaning beyond 24 hours, is not currently supported, especially in minimally invasive procedures such as arthroscopy.”

He listed ways to improve ­antimicrobial stewardship in surgical settings:

• Minimize their use for clean arthroscopic procedures.
• Use antibiotic alternatives such as the biologics—platelet- and cell-based products—that have antimicrobial properties but don’t induce resistance.
• Improve public education regarding wound care following these elective procedures and recognizing infection.

Peroni then introduced the idea of “Care Bundles,” which are practices being used in human medicine to reduce SSIs. Care Bundle components include using evidence-based data to address pre-, intra-, and postoperative risk of infection and standardizing practices to ensure consistent application between patients.