Antimicrobial Delivery by Intrasynovial Catheterisation

Intra-articular catheters for intrasynovial sepsis

Intra-articular catheters are invaluable for treating sepsis of the joints. This lecture (and below notes) are a summary of Stewart, Goodrich, et al; Journal of the Australian Veterinary Association, 2010, Volume 88, pages 115-123. The lecture will cover a “how to” in use of IA catheters and summarize the results of this journal article. Also, personal experiences with these catheters will be shared.

Objective

To present the technique for intra-articular catheter placement and report the clinical outcomes of 38 cases of equine synovial trauma and/or infection treated with broad-spectrum antimicrobials administered via an intrasynovial catheter (ISC).

Procedure

Medical records of 38 horses treated for synovial trauma and sepsis with frequent antimicrobial administration through an ISC from 1995 to 2008 were reviewed. Follow-up information was obtained via clinical re-evaluation or telephone contact with the owners.

Results

The majority of horses (84%) received amikacin and Timentin®four times daily. In addition, synovial lavage through the ISC was carried out in 27 horses (71%). Only radiological evidence of osteolysis had a significant negative impact on both lameness at the time of hospital discharge and the long-term outcome. In total, 92% of horses treated with frequent antimicrobial administration through an ISC had clinical resolution of infection. Catheter obstruction occurred in three cases, necessitating replacement or removal, and two synovial fistulae developed at sites of open drainage. The majority of horses treated had a favorable outcome, with 86% being at least pasture sound and 43% returned to riding.

Notes

• Septic arthritis and tenosynovitis are secondary to trauma, surgery, intra-articular injections, or haematogenous infections. Early and aggressive therarpy warranted.
• Focus on improving antimicrobials to site of infection: direct intraarticular injections, continuous intraarticular infusions, antimicrobial impregnated beads inserted intraarticularly, collagen sponges, intraosseous/intravenous region limb perfusion
• Standard minimum concentration amikacin is ≤16µg/mL^23.
• ISC delivers intrasynovial broad spectrum antimicrobials several times daily- need close management
• Mila catheters also allow for daily lavage of joint or tendon sheath

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