Vancomycin-Impregnated Calcium Sulfate Beads as Treatment for MRSP Bone Sequestrum after TPLO Explant in a Canine

A 9-year-old male neutered German Shepherd dog was presented for left pelvic limb lameness with chronic draining tracts along the distomedial left stifle. A tibial plateau levelling osteotomy (TPLO) had been performed 9 months prior, and implant explantation 3 months prior to referral. Prior to referral, medical management of the draining tracts ensued for 3 months with multiple short courses of antibiotics including TMS, ciprofloxacin, and chloramphenicol. Previously, the patient’s chronic pyoderma had been empirically treated with antibiotics including cephalexin, doxycycline, cefpodoxime, and topical antibiotic spray. CT fistulogram revealed a sequestrum at the previous surgical site. A recent culture and sensitivity results of the draining tracts indicated a current methicillin-resistant Staphylococcus pseudintermedius (MRSP) infection and multidrug-resistant (MDR) Escherichia coli. The draining tract and bone sequestrum were surgically debrided, and vancomycin-impregnated calcium sulfate beads were packed into the resultant bony defect. At mid- and long-term follow-up, the chronic infection had resolved. The patient’s surgical site has since undergone bony remodelling and the patient recovered well. To the authors’ knowledge, this is the first reported case of chronic MDR osteomyelitis with a sequestrum after routine TPLO explantation, with antibiotic-impregnated beads used as treatment. Antimicrobial stewardship is crucial for patient management and a multi-factorial approach to prevent and manage MDR. While bone sequestra are not novel, their rare occurrences should remain a differential for unresolved deep SSIs postexplantation. Increased awareness of antibiotic-impregnated material can make it a more frequently considered treatment option by clinicians at various levels of surgical practice.

Acknowledgment

None.

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Artikel online veröffentlicht:
15. Juli 2025