Advances in the Canine Cranial Cruciate Ligament, 2nd edition

324 Surgical Treatment

Table 40.1 Criteria for the definition of different categories of surgical site infection.

Category

Superficial SSI Within 30 days of the operation. Involves only the skin and/or subcutaneous tissues.

Involvesone or moreof the following:

Purulent discharge (with or without laboratory confirmation)

Organism isolated from aseptically collected sample of fluid or tissue

At least one of the following signs of infection: Pain or tenderness, localized swelling,

redness or heatandsuperficial incision is deliberately opened by the surgeonunless

incision is culture-negative

Diagnosis of superficial incisional SSI made by a surgeon or attending clinician

Deep SSI Within 30 days of the operation if no implants or within 1 year if an implant is left in

place. Involves deep soft tissues (fascial or muscle layers).

Involvesone or moreof the following:

Purulent discharge from deep incision but not from the organ/space component of the

surgical site

A deep incision spontaneously dehisces or is deliberately opened by a surgeon when

the patient has at least one of the following clinical signs: Fever, localized pain or

tenderness, unless site is culture-negative

Organism isolated from aseptically collected sample of fluid or tissue.

An abscess or other evidence of infection involving the deep incision that is found on

direct examination, during reoperation, or by histopathologic or radiologic examination

Diagnosis of deep incisional SSI made by a surgeon or attending clinician

Organ/Space SSI Within 30 days of the operation if no implants or within 1 year if an implant is left in

place. Involves any organ/space, other than the incision, that was opened or manipulated

during surgery.

Involvesone or moreof the following:

Purulent drainage from a drain placed into the organ/space

Organisms isolated from an aseptically obtained culture or fluid or tissue in the

organ/space

An abscess or other evidence of infection involving the organ/space that is found on

direct examination, during reoperation, or by histopathologic or radiologic examination

Diagnosis of organ/space SSI made by a surgeon or attending clinician

Note: Adapted from: CDC definitions for surgical site infections (Mangramet al. 1999).

incisional dehiscence has always been a diag-
nostic challenge. Whether the animal caused
the infection by opening the incision, or the
infection caused the animal to open the incision,
will always be a matter of debate and personal
interpretation.

Incidence of infection in stifle surgery

Because of the high prevalence of cruciate lig-
ament rupture, and the popularity of tibial
plateau leveling osteotomy (TPLO), more stud-
ies have focused on this procedure than on
any other stifle procedure. Infection rates after

TPLO surgery vary greatly, and range between

2.5% and 15.8% (Pacchianaet al. 2003; Priddy

et al. 2003; Corr & Brown 2007; Fitzpatrick &

Solano 2010; Freyet al. 2010; Gatineauet al.

2011; Thompsonet al. 2011; Gallagher & Mertens

2012; Dal-bo ́et al. 2013; Etteret al. 2013; Sav-

ickyet al. 2013; Nazaraliet al. 2014). The actual

incidence is difficult to determine because few

studies use the standardized definition of infec-

tion, and even fewer are the result of active

surveillance. Most studies are retrospective in

nature and have not been designed to assess

infection rates. One prospective, multicenter

study with active surveillance for up to a year

reports an overall infection rate of 6.7% over 549