1
|
Otero Balda I, Fuertes-Recuero M, Penelo Hidalgo S, Espinel Rupérez J, Lapostolle B, Ayllón-Santiago T, Ortiz-Díez G. A Spanish Survey on the Perioperative Use of Antimicrobials in Small Animals. Animals (Basel) 2023; 13:2475. [PMID: 37570284 PMCID: PMC10417378 DOI: 10.3390/ani13152475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Appropriate use of perioperative antimicrobials can significantly reduce the risk of post-operative infections. However, inappropriate antimicrobial use can result in the creation of multidrug-resistant bacteria, increased costs, host flora disruption, side effects and increased risk of hospital-acquired infections. This survey evaluated the current perioperative use of antimicrobials in small animals by Spanish veterinarians using a web-based questionnaire. Responses were represented using descriptive statistics and a statistical analysis of the association between demographic data and perioperative antimicrobial use was performed. Pre-operative antimicrobials were administered in clean surgery by up to 68.3% of participants, 81.0% in clean-contaminated surgery and 71.3% in dirty surgery, while in the post-operative period, antimicrobials were administered by up to 86.3% of participants in clean surgery, 93.2% in clean-contaminated surgery and 87.5% in dirty surgery. Factors considered "very important" for antimicrobial selection were the degree of wound contamination, patient immunosuppression and use of prosthesis. The most frequently used antimicrobial was beta-lactamase-resistant (or potentiated) penicillin. Post-operative antimicrobial use was associated with participants without specific surgical postgraduate training. This study highlights an overuse of antimicrobials in perioperative procedures in small animal surgery in Spain. Therefore, evidence-based guidelines and further education regarding the correct use of antimicrobial prophylaxis are recommended.
Collapse
Affiliation(s)
- Ignacio Otero Balda
- Department of Small Animal Surgery, Section of Small Animal Clinical Studies, University College Dublin, D04 W6F6 Dublin, Ireland;
| | - Manuel Fuertes-Recuero
- Department of Physiology, College of Veterinary Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Silvia Penelo Hidalgo
- Hospitalization, Emergencies and Critical Care Service, Veterinary Teaching Hospital, Complutense University of Madrid, 28040 Madrid, Spain;
| | | | - Benoit Lapostolle
- Veterinary Teaching Hospital, College of Veterinary Medicine, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - Tania Ayllón-Santiago
- Veterinary Teaching Hospital, College of Veterinary Medicine, Alfonso X el Sabio University, 28691 Madrid, Spain;
- Department of Genetics, Physiology and Microbiology, Faculty of Biological Sciences, Complutense University of Madrid, 28040 Madrid, Spain
| | - Gustavo Ortiz-Díez
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| |
Collapse
|
2
|
Walker B, Sánchez-Vizcaíno F, Barker EN. Effect of an antimicrobial stewardship intervention on the prescribing behaviours of companion animal veterinarians: A pre-post study. Vet Rec 2022; 190:e1485. [PMID: 35202485 DOI: 10.1002/vetr.1485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/06/2022] [Accepted: 02/02/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Antimicrobial stewardship is a cornerstone of efforts to combat antimicrobial resistance. We evaluated the impact of a formal discussion of antimicrobial stewardship for dogs and cats on systemic antimicrobial prescribing behaviours among companion animal veterinarians. METHODS Electronic health records including information about the prescription of antimicrobials were collected from a multisite UK veterinary practice between 2017 and 2020. We undertook interrupted time series analysis using a quasi-Poisson model to compare the pre- and postintervention change in level and slope for multiple outcomes. RESULTS After the intervention, there were sustained reductions in the prescription rate of cefovecin to cats and metronidazole to dogs and increases in amoxicillin-clavulanic acid prescribing. There was no evidence for an immediate change in overall prescribing rates in either species, although rates increased over the 12 months after the intervention. There was a transient increase in the proportion of dogs who had their weight recorded at the time of prescription. Results suggest decreases in the prescription of off-licence antimicrobials in both species and the likelihood of underdosing in dogs. CONCLUSIONS Discussion of antimicrobial stewardship is more likely to influence the antimicrobial choice than whether to prescribe or not. Interventions may benefit by focusing on appropriate antimicrobial selection rather than overall prescription frequency.
Collapse
Affiliation(s)
- Ben Walker
- Population Health Sciences, University of Bristol, Canynge Hall, Bristol, UK
| | | | - Emi N Barker
- Bristol Veterinary School, University of Bristol, Langford, Bristol, UK.,Langford Vets, University of Bristol, Langford, Bristol, UK
| |
Collapse
|
3
|
Taylor DD, Martin JN, Scallan Walter EJ. Survey of companion animal veterinarians' antimicrobial drug prescription practices and awareness of antimicrobial drug use guidelines in the United States. Zoonoses Public Health 2022; 69:277-285. [DOI: 10.1111/zph.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/13/2021] [Accepted: 11/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel D. Taylor
- Colorado School of Public Health Colorado Integrated Food Safety Center of Excellence Aurora Colorado USA
| | - Jennifer N. Martin
- College of Agricultural Sciences Department of Animal Sciences Colorado State University Fort Collins Colorado USA
| | - Elaine J. Scallan Walter
- Colorado School of Public Health Colorado Integrated Food Safety Center of Excellence Aurora Colorado USA
| |
Collapse
|
4
|
Tompson AC, Mateus ALP, Brodbelt DC, Chandler CIR. Understanding Antibiotic Use in Companion Animals: A Literature Review Identifying Avenues for Future Efforts. Front Vet Sci 2021; 8:719547. [PMID: 34692805 PMCID: PMC8531418 DOI: 10.3389/fvets.2021.719547] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022] Open
Abstract
Addressing antibiotic use is essential to tackle antimicrobial resistance, a major human and animal health challenge. This review seeks to inform stewardship efforts in companion animals by collating research insights regarding antibiotic use in this group and identifying overlooked avenues for future research and stewardship efforts. The development of population-based methods has established that antibiotics are frequently used in companion animal care. Research insights are also contributing toward an in-depth comprehension of the contexts to antibiotic use. Qualitative approaches, for example, have enabled a nuanced understanding in four key areas: interactions with owners, clinical and financial risk management, time pressures, and clinic dynamics. This review identifies that much of the existing research frames antibiotic use as the result of choices made by the individuals at the interface of their use. Future research and policy endeavours could look beyond the moment of prescribing to consider the societal structures and networks in which companion animal antibiotic use is entangled. A diversification in research approaches and frameworks through which antibiotic use is understood will facilitate the identification of additional targets for stewardship initiatives beyond providing information and awareness campaigns.
Collapse
Affiliation(s)
- Alice C Tompson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ana L P Mateus
- VEEPH Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, United Kingdom
| | - Dave C Brodbelt
- VEEPH Group, Department of Pathobiology and Population Sciences, Royal Veterinary College, London, United Kingdom
| | | |
Collapse
|
5
|
Liu CP, Chen ZD, Ye ZY, He DY, Dang Y, Li ZW, Wang L, Ren M, Fan ZJ, Liu HX. Therapeutic Applications of Functional Nanomaterials for Prostatitis. Front Pharmacol 2021; 12:685465. [PMID: 34140892 PMCID: PMC8205439 DOI: 10.3389/fphar.2021.685465] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/10/2021] [Indexed: 01/02/2023] Open
Abstract
Prostatitis is a common disease in adult males, with characteristics of a poor treatment response and easy recurrence, which seriously affects the patient's quality of life. The prostate is located deep in the pelvic cavity, and thus a traditional infusion or other treatment methods are unable to easily act directly on the prostate, leading to poor therapeutic effects. Therefore, the development of new diagnostic and treatment strategies has become a research hotspot in the field of prostatitis treatment. In recent years, nanomaterials have been widely used in the diagnosis and treatment of various infectious diseases. Nanotechnology is a promising tool for 1) the accurate diagnosis of diseases; 2) improving the targeting of drug delivery systems; 3) intelligent, controlled drug release; and 4) multimode collaborative treatment, which is expected to be applied in the diagnosis and treatment of prostatitis. Nanotechnology is attracting attention in the diagnosis, prevention and treatment of prostatitis. However, as a new research area, systematic reviews on the application of nanomaterials in the diagnosis and treatment of prostatitis are still lacking. In this mini-review, we will highlight the treatment approaches for and challenges associated with prostatitis and describe the advantages of functional nanoparticles in improving treatment effectiveness and overcoming side effects.
Collapse
Affiliation(s)
- Chun-Ping Liu
- Department of Urology, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zi-De Chen
- Department of Interventional Radiology, Cancer Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
| | - Zi-Yan Ye
- Department of Interventional Radiology, Cancer Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
| | - Dong-Yue He
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Dang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhe-Wei Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau, China
| | - Lei Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Miao Ren
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Jin Fan
- Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hong-Xing Liu
- Department of Urology, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
6
|
Liu CP, Chen ZD, Ye ZY, He DY, Dang Y, Li ZW, Wang L, Ren M, Fan ZJ, Liu HX. Therapeutic Applications of Functional Nanomaterials for Prostatitis. Front Pharmacol 2021. [DOI: 10.3389/fphar.2021.685465
expr 881861845 + 830625731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Prostatitis is a common disease in adult males, with characteristics of a poor treatment response and easy recurrence, which seriously affects the patient’s quality of life. The prostate is located deep in the pelvic cavity, and thus a traditional infusion or other treatment methods are unable to easily act directly on the prostate, leading to poor therapeutic effects. Therefore, the development of new diagnostic and treatment strategies has become a research hotspot in the field of prostatitis treatment. In recent years, nanomaterials have been widely used in the diagnosis and treatment of various infectious diseases. Nanotechnology is a promising tool for 1) the accurate diagnosis of diseases; 2) improving the targeting of drug delivery systems; 3) intelligent, controlled drug release; and 4) multimode collaborative treatment, which is expected to be applied in the diagnosis and treatment of prostatitis. Nanotechnology is attracting attention in the diagnosis, prevention and treatment of prostatitis. However, as a new research area, systematic reviews on the application of nanomaterials in the diagnosis and treatment of prostatitis are still lacking. In this mini-review, we will highlight the treatment approaches for and challenges associated with prostatitis and describe the advantages of functional nanoparticles in improving treatment effectiveness and overcoming side effects.
Collapse
|
7
|
Goggs R, Menard JM, Altier C, Cummings KJ, Jacob ME, Lalonde-Paul DF, Papich MG, Norman KN, Fajt VR, Scott HM, Lawhon SD. Patterns of antimicrobial drug use in veterinary primary care and specialty practice: A 6-year multi-institution study. J Vet Intern Med 2021; 35:1496-1508. [PMID: 33942943 PMCID: PMC8163138 DOI: 10.1111/jvim.16136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Combatting antimicrobial resistance requires a One Health approach to antimicrobial stewardship including antimicrobial drug (AMD) use evaluation. Current veterinary AMD prescribing data are limited. OBJECTIVES To quantify companion animal AMD prescribing in primary care and specialty practice across 3 academic veterinary hospitals with particular focus on third-generation cephalosporins, fluoroquinolones, and carbapenems. ANIMALS Dogs and cats presented to 3 academic veterinary hospitals from 2012 to 2017. METHODS In this retrospective study, AMD prescribing data from 2012 to 2017 were extracted from electronic medical records at each hospital and prescriptions classified by service type: primary care, specialty practice or Emergency/Critical Care (ECC). Hospital-level AMD prescribing data were summarized by species, service type, AMD class, and drug. Multivariable logistic full-factorial regression models were used to estimate hospital, year, species, and service-type effects on AMD prescribing. Estimated marginal means and confidence intervals were plotted over time. RESULTS The probability of systemic AMD prescribing for any indication ranged between 0.15 and 0.28 and was higher for dogs than cats (P < .05) apart from 2017 at hospital 1. Animals presented to primary care were least likely to receive AMDs (dogs 0.03-0.15, cats 0.03-0.18). The most commonly prescribed AMD classes were aminopenicillins/β-lactamase inhibitors (0.02-0.15), first-generation cephalosporins (0.00-0.09), fluoroquinolones (0.00-0.04), nitroimidazoles (0.01-0.06), and tetracyclines (0.00-0.03). Among the highest priority classes, fluoroquinolones (dogs 0.00-0.09, cats 0.00-0.08) and third-generation cephalosporins (dogs 0.00-0.04, cats 0.00-0.05) were most frequently prescribed. CONCLUSIONS AND CLINICAL IMPORTANCE Antimicrobial drug prescribing frequencies were comparable to previous studies. Additional stewardship efforts might focus on fluoroquinolones and third-generation cephalosporins.
Collapse
Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Julie M Menard
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Craig Altier
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Kevin J Cummings
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Megan E Jacob
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Denise F Lalonde-Paul
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Mark G Papich
- Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Keri N Norman
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| | - Virginia R Fajt
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| | - H Morgan Scott
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| | - Sara D Lawhon
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
8
|
Antimicrobial Prescribing Practices in Dogs and Cats by Colombian Veterinarians in the City of Medellin. Vet Sci 2021; 8:vetsci8050073. [PMID: 33925855 PMCID: PMC8145059 DOI: 10.3390/vetsci8050073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022] Open
Abstract
This study surveyed the prescribing behavior of Colombian companion animal veterinarians and compared the responses to the current guidelines of the International Society for Companion Animals on Infectious Diseases (ISCAID). A convenience sample of 100 primary-care veterinary practitioners was selected from the city of Medellin. A questionnaire was designed to present hypothetical clinical scenarios regarding prescription choices for systemic antimicrobials. The numbers of veterinarians empirically prescribing a course of systemic antimicrobials for each scenario were-perioperative elective surgeries (86%), superficial pyoderma (90%), lower urinary tract disease (52%), acute hemorrhagic diarrhea (50%), and kennel cough (46%). For urinary tract disease, cultures and susceptibility testing were only performed by half of the respondents, suggesting lower diagnostic standards. In superficial pyoderma cases, cytology was performed in the following percent of cases-0% (24), 20% (30), 40% (17), 60% (11), 80% (8), and 100% (10). Antimicrobials were over-prescribed relative to emerging standard for elective surgeries (86%), kennel cough (46%), and acute hemorrhagic diarrhea (50%). Critically important antimicrobials, such as fluoroquinolones, were applied commonly for superficial pyoderma (18%), kennel cough (12%), and lower urinary tract disease in dogs (20%) and cats (26%). In conclusion, antimicrobial prescribing behavior was inconsistent with current guidelines, and antimicrobial use could be improved by appropriate diagnostic steps allowing choice of an optimal antimicrobial drug. Overall, we documented the widespread use of antimicrobials for the treatment of these four common disease conditions.
Collapse
|
9
|
Lehner C, Hubbuch A, Schmitt K, Schuepbach-Regula G, Willi B, Mevissen M, Peter R, Muentener CR, Naegeli H, Schuller S. Effect of antimicrobial stewardship on antimicrobial prescriptions for selected diseases of dogs in Switzerland. J Vet Intern Med 2020; 34:2418-2431. [PMID: 33112451 PMCID: PMC7694852 DOI: 10.1111/jvim.15906] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 09/01/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) are important tools to foster prudent antimicrobial use. OBJECTIVE To evaluate antimicrobial prescriptions by Swiss veterinarians before and after introduction of the online ASP AntibioticScout.ch in December 2016. ANIMALS Dogs presented to 2 university hospitals and 14 private practices in 2016 or 2018 for acute diarrhea (AD; n = 779), urinary tract infection (UTI; n = 505), respiratory tract infection (RTI; n = 580), or wound infection (WI; n = 341). METHODS Retrospective study. Prescriptions of antimicrobials in 2016 and 2018 were compared and their appropriateness assessed by a justification score. RESULTS The proportion of dogs prescribed antimicrobials decreased significantly between 2016 and 2018 (74% vs 59%; P < .001). The proportion of prescriptions in complete agreement with guidelines increased significantly (48% vs 60%; P < .001) and those in complete disagreement significantly decreased (38% vs 24%; P < .001) during this time. Antimicrobial prescriptions for dogs with AD were significantly correlated with the presence of hemorrhagic diarrhea in both years, but a significantly lower proportion of dogs with hemorrhagic diarrhea were unnecessarily prescribed antimicrobials in 2018 (65% vs 36%; P < .001). In private practices, in 2018 a bacterial etiology of UTI was confirmed in 16% of dogs. Prescriptions for fluoroquinolones significantly decreased (29% vs 14%; P = .002). Prescriptions for antimicrobials decreased significantly in private practices for RTI (54% vs 31%; P < .001). CONCLUSION Antimicrobials were used more prudently for the examined indications in 2018 compared to 2016. The study highlights the continued need for ASPs in veterinary medicine.
Collapse
Affiliation(s)
- Claudia Lehner
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland.,Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Alina Hubbuch
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Kira Schmitt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Barbara Willi
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Meike Mevissen
- Division of Pharmacology and Toxicology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Ruth Peter
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Cedric R Muentener
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Hanspeter Naegeli
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Simone Schuller
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| |
Collapse
|
10
|
Tompson AC, Chandler CIR, Mateus ALP, O'Neill DG, Chang YM, Brodbelt DC. What drives antimicrobial prescribing for companion animals? A mixed-methods study of UK veterinary clinics. Prev Vet Med 2020; 183:105117. [PMID: 32890918 DOI: 10.1016/j.prevetmed.2020.105117] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/07/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Abstract
Antimicrobial use in companion animals is a largely overlooked contributor to the complex problem of antimicrobial resistance. Humans and companion animals share living spaces and some classes of antimicrobials, including those categorised as Highest Priority Critically Important Antimicrobials (HPCIAs). Veterinary guidelines recommend that these agents are not used as routine first line treatment and their frequent deployment could offer a surrogate measure of 'inappropriate' antimicrobial use. Anthropological methods provide a complementary means to understand how medicines use makes sense 'on-the-ground' and situated in the broader social context. This mixed-methods study sought to investigate antimicrobial use in companion animals whilst considering the organisational context in which increasing numbers of veterinarians work. Its aims were to i) to epidemiologically analyse the variation in the percentage of antimicrobial events comprising of HPCIAs in companion animal dogs attending UK clinics belonging to large veterinary groups and, ii) to analyse how the organisational structure of companion animal practice influences antimicrobial use, based on insight gained from anthropological fieldwork. A VetCompassTM dataset composed of 468,665 antimicrobial dispensing events in 240,998 dogs from June 2012 to June 2014 was analysed. A hierarchical model for HPCIA usage was built using a backwards elimination approach with clinic and dog identity numbers included as random effects, whilst veterinary group, age quartile, breed and clinic region were included as fixed effects. The largest odds ratio of an antimicrobial event comprising of a HPCIA by veterinary group was 7.34 (95% confidence interval 5.14 - 10.49), compared to the lowest group (p < 0.001). Intraclass correlation was more strongly clustered at dog (0.710, 95% confidence interval 0.701 - 0.719) than clinic level (0.089, 95% confidence interval 0.076 -0.104). This suggests that veterinarians working in the same clinic do not automatically share ways of working with antimicrobials. Fieldwork revealed how the structure of the companion animal veterinary sector was more fluid than that depicted in the statistical model, and identified opportunities and challenges regarding altering antimicrobial use. These findings were organised into the following themes: "Highest priority what?"; "He's just not himself"; "Oh no - here comes the antibiotics police"; "We're like ships that pass in the night"; and "There's not enough hours in the day". This rigorous mixed-methods study demonstrates the importance of working across disciplinary silos when tackling the complex problem of antimicrobial resistance. The findings can help inform the design of sustainable stewardship schemes for the companion animal veterinary sector.
Collapse
Affiliation(s)
- Alice C Tompson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH, United Kingdom; Veterinary Epidemiology, Economics and Public Health, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom.
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, Kings Cross, London, WC1H 9SH, United Kingdom.
| | - Ana L P Mateus
- Veterinary Epidemiology, Economics and Public Health, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom.
| | - Dan G O'Neill
- Veterinary Epidemiology, Economics and Public Health, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom.
| | - Yui-Mei Chang
- Research Support Office, The Royal Veterinary College, Royal College Street, London, NW1 0TU, United Kingdom.
| | - Dave C Brodbelt
- Veterinary Epidemiology, Economics and Public Health, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom.
| |
Collapse
|
11
|
Norris JM, Zhuo A, Govendir M, Rowbotham SJ, Labbate M, Degeling C, Gilbert GL, Dominey-Howes D, Ward MP. Factors influencing the behaviour and perceptions of Australian veterinarians towards antibiotic use and antimicrobial resistance. PLoS One 2019; 14:e0223534. [PMID: 31600264 PMCID: PMC6786536 DOI: 10.1371/journal.pone.0223534] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global crisis with impacts on the future health and welfare of humans and animals. Determining key factors that influence veterinarians' antimicrobial prescribing behaviours can bridge the gap between prescribing guidelines and clinical usage. Veterinarians practicing in Australia were surveyed on their frequency in prescribing different antibiotics; factors influencing their antibiotic prescribing behaviours; and their perceptions of current drivers of AMR. Antibiotics were prescribed in a third of consultations with key differences in the frequency of use of specific antibiotics by small companion animal (SCA), equine and livestock veterinarians, which broadly aligned with antibiotic registration restrictions in Australia. SCA veterinarians reported prescribing broad-spectrum antibiotics of higher importance to human health more frequently than livestock veterinarians. Factors that were reported as 'strong' or 'moderate' barriers to appropriate antibiotic prescribing were the 1) cost of culture and susceptibility testing and 2) lack of access to rapid and affordable diagnostic tests. Fear of losing clients, colleague pressure, and lack of their own understanding about antibiotics were considered to be 'no' or 'somewhat' of a barrier to appropriate prescribing by respondents. SCA veterinarians placed greater importance on the contribution of antibiotic use in livestock to AMR, than antibiotic use in companion animals. Despite reporting use of fewer, mostly narrow spectrum antibiotics of lower importance to human and animal health, livestock veterinarians were generally more aware of their potential contribution to AMR. This study provides insights into the similarities and differences in SCA, equine and livestock veterinarians practicing in Australia and informs sector-specific strategies to improve antimicrobial stewardship.
Collapse
Affiliation(s)
- Jacqueline M. Norris
- Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- * E-mail:
| | - Annie Zhuo
- School of Geosciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Merran Govendir
- Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Samantha J. Rowbotham
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Maurizio Labbate
- School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Degeling
- Australian Centre for Health Engagement, Evidence & Values, School of Health and Society - Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Wollongong Antimicrobial Resistance Research Alliance (WARRA), University of Wollongong, Wollongong, New South Wales, Australia
| | - Gwendolyn L. Gilbert
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - Dale Dominey-Howes
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- School of Geosciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael P. Ward
- Sydney School of Veterinary Science, The University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Roberts M, White J, Lam A. Prevalence of bacteria and changes in trends in antimicrobial resistance of Escherichia coli isolated from positive canine urinary samples from an Australian referral hospital over a 5-year period (2013-2017). Vet Rec Open 2019; 6:e000345. [PMID: 31565230 PMCID: PMC6746538 DOI: 10.1136/vetreco-2019-000345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 11/04/2022] Open
Abstract
Lower urinary tract disease is common in dogs with approximately 14% developing a bacterial lower urinary tract infection (UTI) during their lifetime. Empirical antimicrobials are often prescribed while waiting urine culture and susceptibility results. Regional knowledge of bacterial prevalence and antimicrobial resistance patterns aids veterinarians in antimicrobial choice. This study aimed to identify the prevalence of uropathogens in canine urine tract isolates and to assess for changes in antimicrobial resistance of Escherichia coli (E. coli) over a 5-year study period at a large multidisciplinary private referral hospital in Australia (January 2013-December 2017). The proportion of resistant isolates was compared across 5 years (Fisher's exact test and Cochran Armitage test for trend) for select antimicrobials towards E. coli. A total of 246 positive urine cultures were included. E. coli was the most prevalent uropathogen at 64%, followed by Proteus sp., Staphylococcus sp. and Enterococcus sp., respectively (9%, 8% and 7%). E. coli was most commonly resistant to amoxicillin at 41%. There was no statistically significant difference, nor trend, in resistance of E. coli isolates towards the selected antimicrobials over the 5 years. Resistance towards trimethoprim-sulfonamide was lower at 15%. This information will aid local veterinarians in selecting empirical antimicrobials pending culture results for the treatment of UTIs in dogs.
Collapse
Affiliation(s)
- Madeleine Roberts
- Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| | - Joanna White
- Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| | - Amy Lam
- Small Animal Specialist Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Ortega-Paredes D, Haro M, Leoro-Garzón P, Barba P, Loaiza K, Mora F, Fors M, Vinueza-Burgos C, Fernández-Moreira E. Multidrug-resistant Escherichia coli isolated from canine faeces in a public park in Quito, Ecuador. J Glob Antimicrob Resist 2019; 18:263-268. [PMID: 30980959 DOI: 10.1016/j.jgar.2019.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study focused on estimating the prevalence of extended-spectrum β-lactamases (ESBLs), plasmid-mediated AmpC β-lactamases, carbapenemases and MCR-1-producing Escherichia coli in canine faeces from a public park in Quito, Ecuador. METHODS Phenotypic and genotypic characterisation of E. coli isolated from 50 canine faecal samples recovered from a city park in Quito was performed. In addition, a multiple choice survey was conducted among 50 dog owners. RESULTS Of the 50 faecal samples, 20 (40.0%) presented E. coli resistant to ceftriaxone. Moreover, 23 E. coli isolates were recovered for further analysis. All of the isolates showed as multidrug-resistant (MDR) phenotype (resistant to three or more antibiotic families). Resistance to carbapenems, tigecycline and amikacin was not observed. No major clonal relatedness was observed among the resistant isolates. The ESBL genes blaCTX-M-15, blaCTX-M-55 and blaCTX-M-65 were the most common. Two isolates harboured the blaCMY-2 gene and one isolate harboured both mcr-1 and blaCTX-M-65. Statistical analysis showed that older people were more conscious of collecting and disposing of dog faeces than subjects aged <35 years (P < 0.05). CONCLUSION The finding of MDR E. coli in dog faeces in a city park in Ecuador illustrates the importance of analysing canine faeces in public settings (e.g. parks, playgrounds) as part of surveillance programmes for MDR E. coli. In addition, this research might be a sentinel sampling method to gain a better understanding of community sources of antibiotic-resistant Enterobacteriaceae at human-animal-environment interfaces.
Collapse
Affiliation(s)
- David Ortega-Paredes
- Carrera de Medicina, Facultad de Ciencias de la Salud, Universidad de las Américas, Quito, Ecuador; Unidad de Investigación de Enfermedades Transmitidas por Alimentos y Resistencias a los Antibióticos, Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito, Ecuador; Life Science Initiative, lsi-ec.com, Quito, Ecuador.
| | - Marco Haro
- Life Science Initiative, lsi-ec.com, Quito, Ecuador; Laboratorio Clínico e Inmunológico INMUNOLAB, Quito, Ecuador
| | - Paula Leoro-Garzón
- Life Science Initiative, lsi-ec.com, Quito, Ecuador; Laboratorio Clínico e Inmunológico INMUNOLAB, Quito, Ecuador
| | - Pedro Barba
- Carrera de Ingeniería en Biotecnología, Facultad de Ingeniería en Ciencias Agropecuarias y Ambientales, Universidad Técnica del Norte, Ibarra, Ecuador
| | - Karen Loaiza
- Life Science Initiative, lsi-ec.com, Quito, Ecuador
| | - Francisco Mora
- Carrera de Medicina, Facultad de Ciencias de la Salud, Universidad de las Américas, Quito, Ecuador; Hospital General del Sur de Quito (IESS), Quito, Ecuador
| | - Martha Fors
- Carrera de Medicina, Facultad de Ciencias de la Salud, Universidad de las Américas, Quito, Ecuador
| | - Christian Vinueza-Burgos
- Unidad de Investigación de Enfermedades Transmitidas por Alimentos y Resistencias a los Antibióticos, Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del Ecuador, Quito, Ecuador
| | | |
Collapse
|
14
|
Jackson AE. In this issue - October 2017. Aust Vet J 2017. [DOI: 10.1111/avj.12641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|