Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Malcolm Ness — Tue, 04 Nov 2025 19:14:25 GMT

[quote userid="12150" url="~/f/clinical-questions/31252/perioperative-antibiotics-for-enterotomy-enterectomy---what-do-you-make-of-wsava-poster/247920#247920"]as has already been said, technique (Halstead's principles etc) is far more important than choice of antibacterial.[/quote]

Succinctly summarised by my teacher and mentor Gary Clayton-Jones: "Germs don't like good surgeons."

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Sean Henney — Mon, 03 Nov 2025 18:47:05 GMT

Sorry, getting back to the GIT prophylactic antibiotic thread, really boring I know, Joe Bojrab (of much gold and huge experience) used to use one dose pre-operatively of procaine penicillin @ 30,000 iu/kg.

Back in the day when he said this, pre-Synulox, I changed and never had a SSI issue; as has already been said, technique (Halstead's principles etc) is far more important than choice of antibacterial.

Perhaps we simply need to remember how to do surgeries - after all, no antibiotics when Edward VII operated on... just saying

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Ben Walker — Mon, 27 Oct 2025 21:33:05 GMT

[quote userid="3169" url="~/f/clinical-questions/31252/perioperative-antibiotics-for-enterotomy-enterectomy---what-do-you-make-of-wsava-poster/247877#247877"]I'll pay for dog faeces to be incinerated as clinical waste when the council does.[/quote]

It’s only clinical waste if it’s contaminated with a dangerous substance.

Dog faeces is (non-hazardous) offensive waste (tiger bags). Fine to go to landfill. It just needs to be transported as its own waste stream from general waste to make sure it’s handled safely.

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Sarah Keir — Mon, 27 Oct 2025 18:44:19 GMT

You know perfectly well that the rules that happen in a medical business such as a veterinary practice are completely different to what people are allowed to do in their own homes. And the council, well...

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Michael Woodhouse — Thu, 16 Oct 2025 21:27:07 GMT

[quote userid="9515" url="~/f/clinical-questions/31252/perioperative-antibiotics-for-enterotomy-enterectomy---what-do-you-make-of-wsava-poster/247867#247867"]You now can't flush down the sink - H&S.[/quote]

Have you ever seen the council empty a dog waste bin? It goes in the same truck to landfill.

I'll pay for dog faeces to be incinerated as clinical waste when the council does. What happens with babies nappies? Human "female" sanitary waste? The bloody wrapping from your beef/pork/lamb Sunday roast?

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

David Mills — Thu, 16 Oct 2025 21:05:20 GMT

Normally use IM amoxicillin for most things requiring perioperative and

Some evidence here

www.bsavalibrary.com/.../9781910443774.ch66sec11

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

David Mills — Thu, 16 Oct 2025 21:01:30 GMT

I learnt this week that you only need to use the blue stain for this leave it in for 10 seconds and rinse off - bacteria and yeast stick to the slide so don't need to fix it!

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Sarah Keir — Thu, 16 Oct 2025 19:48:37 GMT

Soaked into tissue or old cat litter and put in with the rest of clinical waste was the last I heard. Its carcinogenic apparently!

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Clive Ansell — Thu, 16 Oct 2025 17:01:38 GMT

So, what do you do with it?

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Sarah Keir — Thu, 16 Oct 2025 15:40:45 GMT

[quote userid="29221" url="~/f/clinical-questions/31252/perioperative-antibiotics-for-enterotomy-enterectomy---what-do-you-make-of-wsava-poster/247853#247853"]Restricting the slide stain pots to haematology only and running stain over the sink[/quote]

The most common use of cytology in GP practice is ear swabs. I encourage practices to have separate sets of stain for ears and anything else manky.

You now can't flush down the sink - H&S.

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Michael Woodhouse — Wed, 15 Oct 2025 22:37:05 GMT

[quote userid="9515" url="~/f/clinical-questions/31252/perioperative-antibiotics-for-enterotomy-enterectomy---what-do-you-make-of-wsava-poster/247851#247851"]I've yet to come across a small animal GP level practice that has Gram staining available![/quote]

Have Gram stain and a protocol but very rarely use it.

[quote userid="12930" url="~/f/clinical-questions/31252/perioperative-antibiotics-for-enterotomy-enterectomy---what-do-you-make-of-wsava-poster"]

What do you do?

What do you think?

[/quote]

I don't have any specific IV antibiotics in the practice for anything, other than metronidazole, and if that was available in another parenteral form I'd happily use it. I don't believe they are needed and I don't believe its a reason to spend the money, increase the risk, or jump to cascade use.

With GI surgery or orthopaedics where there will be an implant, then pre-op amoxycillin, given Subcut, followed by tablets for 5 days if contamination or a need (usually by the time I'm holding intestine in my hands - it is compromised. Would use IV metronidazole alongside if septic, perforated, worried about G-ve.

I don't even like the potentiated amoxicillin, as an injectable.

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Roger Powell — Wed, 15 Oct 2025 09:03:44 GMT

Thanks Davina - makes sense and appreciate your time answering - agreed so will try to track down another clinical pathologist who wants to conduct that study in comparison! ((-:

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Davina Anderson — Tue, 14 Oct 2025 20:39:07 GMT

I think back in the day when laboratory cultures were not easily possible, Gram staining was much more widely used in general practice. This shows my age I think.

Honestly, I do not know what the impact of routine in practice cytology would be without a G stain. I think that you could at least see if you had rods or cocci, but I think you would need to ask a clinical pathologist of the details of this or references. Our turnaround on cytology was so fast (the samples were couriered every night) that we could wait for the results. I think in a normal situation, you would have to use some conjecture and assumptions to help with your decision making and assessing the morphology of the inflammatory response to direct your diagnosis of infection would be very relevant. For example, if you take an aspirate of an abscess and then dip those slides into your stain pots, the next cytology you put through there will potentially have the bacteria on them from the abscess - but no signs of inflammation and you do not have infection, you just have contaminated slide stain pots (I have seen this more than once!). Restricting the slide stain pots to haematology only and running stain over the sink for everything else is also important! Anyway, in the real world, I think the BSAVA PROTECTME poster is more useful in that respect and enables rational decisions to be made with just the white cell morphology and whether you had rods or cocci and what location you are looking at.

Does that make sense?

Davina

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Sarah Keir — Tue, 14 Oct 2025 15:22:01 GMT

I've yet to come across a small animal GP level practice that has Gram staining available!

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Roger Powell — Tue, 14 Oct 2025 13:53:34 GMT

Hi Davina,

Adding a query if I may to your comprehensive reply but completely agree with the above and hope all's well with you!
Do you know of a study, or your thoughts and experience, of gram staining 'in practice/clinically in the field (vs. from a pure colony on a plate) relative to simpler/easier/ (sufficient?) guidance via a Romanowsky stain for morph within the cyto context, in conjunction with the site and bacterial likelihood maybe too?
I always wondered whether 'routine cytology' like this gives enough information to guide that empirical choice initially if used well etc, but haven't seen a specific study on this, vs known pitfalls with gram staining in the clinical setting mis-classifying, say, gram positives as gram negatives?
A little similar to use of special stains general in cyto (vs histo) for organisms - does it actually answer the question of 'is this infectious?' more than routine cyto does!? (-:
Thanks, Roger.

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Davina Anderson — Mon, 13 Oct 2025 16:30:14 GMT

Cefazolin. if there is a septic abdomen or large bowel involvement, then you need to have a broader spectrum and/or more activity vs the anaerobes (so I might add metronidazole for large bowel). If septic, then I am trying to see what we have from the cytology and basing my choices on that.

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Beats — Mon, 13 Oct 2025 16:08:14 GMT

Thanks Davina - that makes me feel a whole lot better!

Can I ask what broad spectrum IV antibiotic you would choose for an enterotomy/enterectomy if you are using one?

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

Davina Anderson — Mon, 13 Oct 2025 14:38:36 GMT

Hi all

I think the WSAVA poster has simplified this too much. The first question is whether antibiotics are indicated at all (Clean, clean contaminated surgeries, no antibiotics) and second whether it is a contaminated (perioperative antibiotics only) or an infected surgery (antibiotics should be chosen based on culture, or cytology and Gram stain and continued for a therapeutic course only while there remains evidence of infection)

So.. on that basis, uncomplicated upper GI (stomach, duodenum, jejunum) enterotomy, with no evidence of leakage, necrosis, inflammation etc, with a thorough abdominal lavage/suction, change instruments, gloves and redrape; I would not use antibiotics at all.

Where there is no leakage and no spill of GI contents, but the bowel wall looks compromised, oedematous or inflamed, then I would use peri operative broad spectrum antibiotics as it recommends (with a single dose initially then repeat doses as indicated but this means maybe just one more dose, and no post operative antibiotics). I agree that the current formulation of IV amoxyclav does cause reactions and we no longer use it for this purpose. If it is essential, then try pre treatment anti-histamine (although that does not always work) 20 years ago, this was not a problem, so I do not know what has changed in the formulation, but it is consistently a problem now.

if there is infection (ie perforation or peritonitis), then use a broad spectrum IV dose preoperatively, and continued into the post operative period, but take samples for culture and cytology/gram stain before you give the antibiotics and then adjust treatment during the post op period based on clinical response to treatment and laboratory results.

Peri operative antibiotics are not what prevent intestinal dehiscence. Surgical technique, intra operative decontamination procedures and post operative prevention of ileus will prevent intestinal dehiscence. Anything that promotes rapid healing will improve outcomes and this means early enteral nutrition to encourage peristalsis (ie same day oral nutrition), correction of fluid deficits, maintenance of perfusion pressure, correction of electrolyte abnormalities and adequate analgesia and reduction of stress will have a much greater impact.

This is what they should be saying on that poster. If sterile techniqueand decontamination procedures are not good enough, no amount of antibiotics are going to fix the problem.

RE: Perioperative antibiotics for enterotomy/enterectomy - What do you make of WSAVA poster?

janine redman — Sun, 12 Oct 2025 09:06:23 GMT

We had a few similar reactions to amoxyclav so would use zinacef or equivalent perioperatively . If no Contamination would cover with a further 48 hours as the benefit to the individual animal is greater than the risk to humanity overall