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Can Honey Prevent Surgical Site Infections After Colic Surgery?
By Adam Marcus
The application of medical grade honey (MGH) into the incisions of horses undergoing colic surgery can dramatically reduce the risk of postoperative infections, a new study has found.
Researchers at Hebrew University of Jerusalem's Koret School of Veterinary Medicine, in Israel, found that horses that received standard therapy were about 4 times more likely to develop post-operative infections as those given the honey solution.
“It’s quite clear that the group receiving medical grade honey suffered significantly less from incisional infections,” said Kajsa Gustafsson, DVM, who presented her group’s findings at the 2019 annual meeting of the American Association of Equine Practitioners.
Applying medical grade honey to the surgical incision.
Courtesy of Dr. Kajsa Gustafsson
Applying medical grade honey to the surgical incision.
Courtesy of Dr. Kajsa Gustafsson
Colic surgery is one of the most commonly performed emergency procedures in horses. Roughly 3% of equids suffer colic in a given year, and up to 17% require surgery to correct the problem, Dr. Gustafsson said. Of those, between 11% and 42% will develop a post-operative infection, with the range reflecting how those infections are defined, she said. These infections carry their own morbidity and mortality, but also can lead to other complications, such as incisional hernias, that carry high costs to treat and prolong hospitalizations.
Although the use of MGH to treat established wound infections has been studied in both humans and animals, it had not previously been assessed as a prophylactic treatment to battle incisional infections in horses, according to Dr. Gustafsson. For the new study, she and her colleagues compared the use of MGH to conventional therapy in 89 horses undergoing colic surgery at their institution. All of the animals received a regimen of antibiotics, and 49 also received local application of sterile MGH, at a dose of approximately 1 mL/2 cm of incision length, intraoperatively on the abdominal wall (linea alba) prior to skin closure.
Why MGH might be effective as an antimicrobial agent is not entirely clear. The elevated osmolality created by the high sugar content creates an unfavorable medium for the growth of bacteria, Dr. Gustafsson told Modern Equine Vet. The substance also contains glucose oxidase, which converts to hydrogen peroxide, an antiseptic; has a low pH, which is helpful for healing; and is rich in a protein called bee-defensin 1, which is instrumental in the immune system of honeybees, Dr. Gustafsson reported.
The researchers followed the horses for 2 weeks, during which time 17 (19.1%) developed an incisional infection. Of those, 4 animals (8.2%) had received MGH, whereas 13 (32.5%) had received standard therapy (P=0.02; adjusted odds ratio, 0.265).
Dr. Gustafsson said the severity of infections did not differ between the two groups; 12 of the 17 incisional infections were bacterial, and of those 11 were multidrug resistant organisms—3 were methicillin resistant Staphylococcus aureus, all of which occurred in horses that received standard treatment, she added.
“Applying medical grade honey on the linia alba intraoperatively is a simple, easy and rapid procedure that does not appear to have any adverse effects,” Dr. Gustafsson concluded.
