# Comparison of Surgical Site Infection (SSI) Rates in Dogs Undergoing Tibial Plateau Leveling Osteotomy (TPLO) Using Perioperative Versus Peri- and Postoperative Antimicrobial Prophylaxis

## TL;DR

The study found that giving antibiotics only during surgery is enough to prevent infections in dogs undergoing TPLO, without needing extra post-surgery doses.

## Contribution

This study provides evidence that postoperative antibiotics are unnecessary for preventing surgical site infections in TPLO procedures.

## Key findings

- No significant difference in surgical site infection rates between dogs receiving perioperative and those receiving only perioperative antibiotics.
- Extending antibiotic use post-surgery does not reduce infection rates in TPLO procedures.
- Reducing postoperative antibiotics helps combat antibiotic resistance in clean orthopedic surgeries.

## Abstract

Tibial plateau leveling osteotomy (TPLO) is a common surgical procedure to treat stifle joints affected by cranial cruciate ligament disease in dogs. To avoid surgical site infection, peri- and postoperative antimicrobial administration is often routinely used. The effectiveness of such prophylactic protocol remains controversial. Tibial plateau leveling osteotomy is a clean orthopedic procedure usually performed in dogs free from other conditions. For these reasons, we hypothesized that perioperative antibiotic treatment alone may be sufficient to maintain surgical site infections within acceptable limits. Dogs undergoing TPLO were divided into two groups with respect to the antibiotic protocol used: in the first group, peri- and postoperative antimicrobial management was used, while in the second group, only perioperative antibiosis was administered. Results showed no difference in surgical site infection rates between the two groups, suggesting that extending antibiotic use in the postoperative period is unnecessary. Eliminating postoperative antibiotic medication in a clean orthopedic procedure such as TPLO helps to reduce antibiotic resistance and is in line with the generally accepted standards of antimicrobial stewardship.

(1) Background: Postoperative antibiotic prophylaxis in dogs undergoing tibial plateau leveling osteotomy (TPLO) is controversial. We evaluated the effect of perioperative antibiotic administration on the incidence of surgical site infection (SSI) and bone healing in dogs that underwent TPLO procedures and compared this protocol with cases that received prolonged postoperative antibiotic treatment. (2) Methods: Two different antibiotic treatment protocols were used. In group A, cefazolin (22 mg/kg IV) was administered preoperatively 30–60 min before skin incision and repeated every 90–120 min intraoperatively. Antimicrobial prophylaxis was extended in the postoperative period with oral cefazolin (22 mg/kg BID) for 10 days after surgery. In group B, dogs only received perioperative treatment, at the same dose used in group A. Dogs were considered to have SSI in cases of incisional drainage, wound dehiscence, positive bacterial culture, or evidence of radiographic signs of infection. (3) Results: In group A, SSI was observed in 3/61 TPLOs (4.9%). In group B, SSI was present in 3/51 TPLOs (5.9%). There was no difference between the two groups. (4) Conclusions: Our results indicate that perioperative antibiotic prophylaxis in TPLO procedures is sufficient to maintain overall low rates of SSI. The incidence of SSI was similarly low compared to the rate observed in dogs that also received postoperative antibiotic treatment.