Abstract
Distal limb bacterial infections can be life-threatening to captive non-domestic mammalian species. As frequent and long-term topical or systemic options may not be feasible for those individuals that require chemical immobilization for handling and treatment, intravenous regional perfusion may be useful. This route has the ability to attain higher concentrations of antimicrobial drugs at the site of infection3, thus maximizing the effects of each immobilization and treatment. It is a successful technique in human1 and equine medicine,3,4 and limited use has been reported in other non-domestic species2,5. This technique is easily performed, well-tolerated, does not require specialized equipment, and can be adjusted to suit different management limitations. It has been observed to resolve infections even where surgical debridement and systemic antibiotic treatment has failed.
A 10-year-old male swamp wallaby (Wallabia bicolor) presented for progressive lameness and a swollen right pes of 3-week duration. Radiographs confirmed chronic osteomyelitis of the fourth pedal digit, and surgical amputation was performed. An aerobic culture revealed a mixed population of bacteria, including Streptococcus spp., Staphylococcus spp., Escherichia coli, and Corynebacterium spp. Despite systemic antibiotics (metronidazole 420 mg IV, BIS for 2 days then azithromycin 125 mg PO, SID for 2 days), swelling was increased and purulent material present at the site of amputation two days after surgery. Five events of intravenous regional perfusion were performed. The affected limb was wrapped tightly with gauze proximally to the stifle and a tourniquet was placed at the stifle. The bandage was then removed and imipenem (500 mg) was infused into a catheter in the lateral saphenous vein. The tourniquet was removed after 10 min. Three weeks following IV regional perfusion the wallaby was fully weight-bearing on the affected limb. It remained free of clinical signs for the subsequent 2 years.
A 12-year-old male lesser kudu (Tragelaphus imberbis) presented for swelling over the left rear pastern. He was immobilized and physical exam confirmed a severe fluctuant swelling over the left rear pastern, extending to the fetlock. A large volume of purulent material was drained from the swelling which cultured Morganella morganii, Clostridium bifermentams, and Fusobacterium necrophorum. The joint was lavaged with diluted povidone-iodine. Despite systemic treatment with penicillin G benzathine/procaine (1,620,000 IU SC), amikacin sulfate (700 mg IV), long-acting ceftiofur (600 mg SC), and oral sulfamethoxazole/trimethoprim (960 mg BID for 14 days), initial improvement was followed by progression to sloughed skin over and extensive involvement of the pastern joint. Intravenous regional perfusion therapy was initiated 10 days after presentation. A tourniquet was applied at the hock, and ampicillin/sublactam (1800 mg) was infused into a catheter in the lateral saphenous vein. After 10 minutes, the tourniquet was removed for 5 minutes. The procedure was then repeated using enrofloxacin (600 mg). The treatment was repeated 14, 16, 18, 32, 38 days after initial presentation, with enrofloxacin being excluded from the protocol at the 32- and 38-day treatments due to phlebitis. Marked improvement of swelling and lameness was noted by day 16. Examinations at 59 days and 8 months following initial presentation revealed no visible evidence of infection.
Acknowledgments
The authors thank Dr. J. Farese, Dr. J. Siegal-Willott, D. Peck, C. Teare, A. Whitaker, and the staff of the UF-VMTH Zoological Medicine Service, White Oak Conservation Center, and St. Augustine Alligator Farm.
Reprinted with permission from the Journal of Zoo and Wildlife Medicine.
Literature Cited
1. Finsterbusch, A., and H. Weinberg. 1972. Venous perfusion of the limb with antibiotics for osteomyelitis and other chronic infections. J. Bone Joint Surg. 54-A: 1227–1234.
2. Ollivet-Courtois, F., A. Lecu, R. Yates, and L. H. Spelman. 2003. Treatment of a sole abscess in an Asian elephant (Elephas maximus) using regional digital intravenous perfusion. J. Zoo Wildl. Med. 34: 292–295.
3. Pille, F., S. De Baere, L. Ceelen, J. Dewulf, S. Croubels, F. Gasthuys, P. De Backer, A. Martens. 2005. Synovial fluid and plasma concentrations of ceftiofur after regional intravenous perfusion in the horse. Vet. Surg. 34: 610–617.
4. Rubio-Martinez, L.M. 2006. Antimicrobial regional limb perfusion in horses. J. Am. Vet. Med. Assoc. 228: 706–712.
5. Spelman, L. H., R. Yates, P. Anikic, and L. Galuppo. 2000. Regional digital intravenous perfusion in an African elephant (Loxodonta africana). Proc. Am. Assoc. Zoo. Vet. Annu. Meet. Pp. 388–390.