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Bone infection in dogs

Bone infection in dogs


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Bone infection in dogs usually presents with a localized swelling over a bone, and clinical diagnosis is usually easy. The more common complications of osteomyelitis are septic arthritis and subperiosteal abscess formation ([@bib1]). Bone biopsies to confirm the diagnosis are warranted if the physical examination reveals a pnful localized swelling ([@bib2]). In addition, the histopathological findings in the bone, including neutrophilic infiltration and destruction of bone matrix, are useful for identifying the nature of the lesion ([@bib2]). Furthermore, microbiological analysis is usually performed to identify the causative organisms ([@bib2]). In order to provide effective treatment, it is important to know the species of organisms isolated ([@bib3]).

Treatment of infected long bones in dogs involves surgical debridement of the infected bone and stabilization of the bone to allow healing to take place ([@bib1]). Antibiotic therapy usually follows a combination of systemic and local treatment ([@bib1]). Surgical therapy is considered the treatment of choice in long bones in dogs ([@bib1]). However, the optimal time of treatment of infection and the appropriate antimicrobial drug to use have not been clearly defined ([@bib1]). In humans, the duration of antimicrobial therapy varies from three weeks to 12 weeks ([@bib4]). In contrast, the duration of antimicrobial therapy in dogs remns unclear. Long-term intravenous (IV) and oral antimicrobial therapy is often recommended to treat long bone infections in dogs, and the duration of therapy is typically 12 to 16 weeks ([@bib2]). Additionally, the most appropriate antimicrobial drug to use is still not well established in dogs ([@bib1]).

Despite the fact that this is the standard of care, there is a paucity of research and a dearth of clinical guidelines on the subject of treating dogs with bone infection. The purpose of this study was to assess the outcomes in cases of canine long bone osteomyelitis treated with antibiotic therapy alone. We hypothesized that antibiotic therapy alone can be successful in cases of canine long bone osteomyelitis and that dogs will recover well from their osteomyelitis.

METHODS

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Medical records of dogs diagnosed with long bone osteomyelitis treated at the Veterinary Teaching Hospital at Colorado State University from January 2009 to April 2017 were reviewed. The clinical records were retrospectively reviewed and the medical records of all dogs that received antibiotics without surgical intervention were included. Exclusion criteria included antibiotic treatment without surgery. Information extracted from the medical records included signalment, history, physical examination findings, diagnostic tests and imaging, and treatment. Medical records were also reviewed to determine the number of days between the diagnosis of osteomyelitis and the date that the dog began receiving treatment.

The treatment protocol for osteomyelitis consisted of a combination of systemic and local antibiotic treatment ([Table 1](#tbl1){ref-type="table"}). At the time of the initial visit, the dog was administered subcutaneous buprenorphine 0.01 ,mg/kg. The dogs were treated every 8--12 ,h, and buprenorphine was continued on a per os basis as needed. During the first 48 ,h after diagnosis, cefazolin was administered at 20--30 ,mg/kg IV every 8--12 ,h. Cefazolin was continued in this manner for up to 10 ,days. On the 10th day, if the patient was febrile or clinically deteriorated, the patient was started on a third-generation cephalosporin for an additional 10 ,days. If, at this time, the patient was still febrile or showing clinical deterioration, the third-generation cephalosporin was continued. An attempt to switch to another antibiotic was not made. Antibiotic treatment was considered to have fled when it was decided that the patient did not respond to initial therapy, had a recurrence of clinical signs or radiographs, or had to be euthanized.

C-reactive protein, hematology, and serum chemistry {#sec2.4}

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Blood samples were obtned before the administration of antibiotic therapy and then at 12, 24, 48, 72, and 120 ,h post treatment. Blood samples were analyzed with an IDEXX Vetlab 800 analyzer (Westbrook, ME) and the results were used to calculate the rate of change of serum C-reactive protein (CRP) concentration. Serum chemistry panel analysis (IDEXX Vetlab 800 analyzer, Westbrook, ME) was performed for alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, blood urea nitrogen, and creatinine.

Radiographs and bone densitometry {#sec2.5}

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A radiograph of the spine and any other affected bones were performed using a lateral radiograph of the dog. In some cases, a lateral and ventrodorsal radiograph of the thoracic and lumbar spine were taken. The radiographs were taken at the time of presentation (day 0), at 30, 60, 90, and 120 ,days post treatment. The radiographs were graded independently by the following criteria: bone score, osteolytic lesions, and sclerosis. Each criterion was rated on a scale of 1 to 5, with 5 being the most severe. For example, bone score of 5 indicated that all visible bone was destroyed and osteolytic lesions were present in every bone. The grades for the radiographs were calculated and recorded as bone score, osteolytic lesions, and sclerosis, respectively. If there were multiple ribs affected, the grade was calculated based on the most severely affected rib. The same methods were used to score the radiographs of affected paws and ankles. All the radiographs were scored using a 5-point scale: 0, normal bone, 1, soft-tissue opacity, 2, partial opacity, 3, significant opacity, and 4, complete opacity. The highest score was 25 for the radiographs of the hind limbs, and the highest score was 33 for the radiographs of the forelimbs. A separate radiographic score was calculated for the hips. These are the total numbers of the hind limbs and the forelimbs, respectively, needed to get a total number of 10 or more to define bone loss.

Bone mineral density was performed using a DXA scan at the initial and 120-day time points. BMD was measured at the lumbar spine, hip, tibial plateau, and radius. The same method was used for each of the measurements.

Tissue biopsy {#sec2.6}

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Hematoxylin and eosin (H&,E) stning was used to assess bone morphology and the number of osteoclasts. Tissue samples were fixed in 10% formalin and then dehydrated in a series of graded alcohols. The tissue was then cleared in xylene, mounted in paraffin, and sectioned. The sections were stned with H&,E, and a microscope was used to obtn images. Tartrate-resistant acid phosphatase (TRAP) stning was also performed using a commercial kit (Sigma-Aldrich), according to the manufacturer's instructions. The bone marrow and trabecular areas of the knee joint were used to count osteoclasts. The sections were visualized under a light microscope to determine the number of osteoclasts. All the samples were stned at the same time.

Statistical analysis {#sec2.7}

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The data were entered into the Ep



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