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Robbins SN, Goggs R, Kraus‐Malett S, Goodman L. Effect of institutional antimicrobial stewardship guidelines on prescription of critically important antimicrobials for dogs and cats. J Vet Intern Med 2024; 38:1706-1717. [PMID: 38465850 PMCID: PMC11099728 DOI: 10.1111/jvim.17043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Veterinary hospital antimicrobial stewardship (AMS) guidelines might help combat antimicrobial resistance (AMR). OBJECTIVES Determine the conditions and types of infection for which antimicrobial drugs (AMDs) deemed critically important (CIA) by the World Health Organization (WHO) were prescribed and assess the effect of hospital AMS guidelines on adherence to International Society for Companion Animal Infectious Diseases published guidelines for the treatment of superficial bacterial folliculitis, respiratory tract disease and urinary tract infection in these cases. ANIMALS Dogs and cats managed at an academic veterinary hospital from 1/21 to 6/21 and 9/21 to 6/22. METHODS Prescriptions of cephalosporins (third or fourth generation), glycopeptides, macrolides/ketolides, polymyxins, and quinolones were identified. Data on culture and susceptibility (C/S) testing and previous AMD exposure were collected. Frequencies were compared between time periods using Fisher's exact test with Bonferroni corrections. RESULTS In animals prescribed ≥1 WHO-CIA AMD, fluoroquinolones were the most frequently prescribed WHO-CIA class in dogs (567/1724, 32.9%) and cats (192/450, 42.7%). No animals were prescribed carbapenems, dihydrofolate reductase inhibitors/sulfonamides, or polymyxins. No cats were prescribed aminoglycosides or amphenicols. Institutional guidelines were followed in 57.8% (324/561) cases. The most frequent causes of nonadherence were failure to perform C/S testing 46.0% (109/237) and unnecessary use of a higher-tier AMD 43.0% (102/237). Bacterial C/S testing was more frequently performed after AMS guideline institution (59.7% vs. 46.8%, P = 0.0006). CONCLUSIONS AND CLINICAL IMPORTANCE Adherence to published guidelines remained poor despite an increase in C/S testing. There were no changes in the frequencies of confirmed infections, positive cultures or AMD resistance between time periods.
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Affiliation(s)
- Sarah N. Robbins
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Robert Goggs
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | | | - Laura Goodman
- College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
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2
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Rocholl C, Zablotski Y, Schulz B. Online-Assisted Survey on Antibiotic Use by Pet Owners in Dogs and Cats. Antibiotics (Basel) 2024; 13:382. [PMID: 38786111 PMCID: PMC11117295 DOI: 10.3390/antibiotics13050382] [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: 03/23/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
The aim of the study was two-fold: first, to collect data on the use of antibiotics in Germany for dogs and cats and, second, their owners' experiences and opinions. Using an anonymous online survey, dog and cat owners were asked about the last antibiotic administration in their pet. The inclusion criterion was any antibiotic administration within the last year. A total of 708 questionnaires from 463 dogs and 245 cats could be evaluated. Diarrhea was reported as the most common reason for antibiotic administration in dogs (18.4%). Wound infection/abscess/bite injury was the second most common reason in dogs (16.0%). In cats wound infection/abscess/bite injury was the most common reason (23.3%), followed by dental treatment (21.2%) and upper respiratory tract infections (16.7%). The most common antibiotics used systemically in both species were amoxicillin/clavulanic acid (32.5%), amoxicillin (14.8%), metronidazole (6.9%), and doxycycline (6.8%). While efficacy (99.9%) and tolerability (94.8%) were rated as most important for the choice of antibiotics, costs (51.6%) were cited as predominantly unimportant. First-line antibiotics were used significantly more often than critically important antibiotics. The majority of animal owners show awareness for avoidance of antibiotic resistance and the use of critically important antibiotics.
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Affiliation(s)
- Clara Rocholl
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig Maximilian University of Munich, 80539 Munich, Germany
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Melanie P, Niola C, Plataroti I, Mancini S, Fratini F. Use of Ozone in Veterinary Dentistry as an Alternative to Conventional Antibiotics and Antiseptics. Vet Sci 2024; 11:163. [PMID: 38668430 PMCID: PMC11053877 DOI: 10.3390/vetsci11040163] [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: 02/06/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/29/2024] Open
Abstract
This paper aims to assess the disinfecting capacity of a double-distilled ozonated water solution as an alternative to common antibiotic and antiseptic devices. Seventy-five dogs were subjected to the surgical procedures of scaling and dental extraction and included in three study groups: Group 1 subjected to antibiotic pre-treatment (association amoxicillin + clavulanic acid and ampicillin + metronidazole) and disinfection with chlorhexidine, and Group 2 and 3 devoid of preventive anti-microbial treatment in which disinfection was performed, respectively, with ozonated water and chlorhexidine. Sampling by bacteriological buffer was carried out to evaluate the bacterial count in the oral cavity. The analysis of the samples determined the total mesophilic bacterial count by seeding on the culture medium via the inclusion of PCA (Plate Count Agar). The results highlighted the anti-bacterial efficacy of intra-operative ozone as an alternative to pre-surgical antibiotic treatment.
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Affiliation(s)
- Pierre Melanie
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (P.M.); (S.M.); (F.F.)
| | - Carlotta Niola
- Veterinary Practiotioner, Ambulatorio Veterinario Associato “A.M.S”, 56127 Pisa, Italy
| | - Ilaria Plataroti
- Veterinary Practiotioner, VetPartners, Ospedale Veterinario “Leonardo da Vinci”, 50059 Spicchio-Sovigliana, Italy;
| | - Simone Mancini
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (P.M.); (S.M.); (F.F.)
- Interdepartmental Research Center “Nutraceuticals and Food for Health”, University of Pisa, 56124 Pisa, Italy
| | - Filippo Fratini
- Department of Veterinary Sciences, University of Pisa, 56124 Pisa, Italy; (P.M.); (S.M.); (F.F.)
- Interdepartmental Research Center “Nutraceuticals and Food for Health”, University of Pisa, 56124 Pisa, Italy
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4
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Beaudoin AL, Bollig ER, Burgess BA, Cohn LA, Cole SD, Dear JD, Fellman CL, Frey E, Goggs R, Johnston A, Kreuder AJ, KuKanich KS, LeCuyer TE, Menard J, Reagan KL, Sykes JE, Veir JK, Viviano K, Wayne A, Granick JL. Prevalence of antibiotic use for dogs and cats in United States veterinary teaching hospitals, August 2020. J Vet Intern Med 2023; 37:1864-1875. [PMID: 37526594 PMCID: PMC10473043 DOI: 10.1111/jvim.16814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/05/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Awareness of prescribing practices helps identify opportunities to improve antibiotic use (AU). OBJECTIVES To estimate AU prevalence in dogs and cats in U.S. veterinary teaching hospitals (VTHs) and identify antibiotic drugs commonly prescribed, indications for use, and evidence of bacterial infection. ANIMALS Medical record data were collected from dogs and cats examined at 14 VTHs. METHODS Data were collected from VTH medical records of dogs and cats examined by primary care, urgent care, emergency and critical care, internal medicine, and surgery services on a single day during August 13-September 3, 2020. Data included signalment; clinical service; inpatient or outpatient status; clinical conditions; diagnostic tests; evidence of bacterial infection; intended reason for AU; name and route of antibiotics prescribed. RESULTS Of 883 dogs and cats, 322 (36.5%) were prescribed at least 1 antibiotic. Among 285 antibiotics administered systemically intended for treatment of infection, 10.9% were prescribed without evidence of infection. The most common class of antibiotics presribed for systemic administration was potentiated penicillin for dogs (115/346, 33.3%) and cats (27/80, 33.8%). For dogs and cats, first-generation cephalosporins (93/346, 26.9% and 11/80, 13.8%, respectively) and fluoroquinolones (51/346, 14.7% and 19/80, 23.8%, respectively) was second or third most-prescribed. Common AU indications included skin, respiratory, and urinary conditions, and perioperative use. CONCLUSIONS AND CLINICAL IMPORTANCE Collaborative data collection provides a sustainable methodology to generate national AU prevalence estimates and bring attention to areas requiring additional research and detailed data collection. These efforts can also identify practice improvement opportunities in settings where future veterinarians are trained.
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Affiliation(s)
| | - Emma R. Bollig
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, University of MinnesotaSaint PaulMinnesotaUSA
| | - Brandy A. Burgess
- Department of Population HealthCollege of Veterinary Medicine, University of GeorgiaAthensGeorgiaUSA
| | - Leah A. Cohn
- Department of Veterinary Medicine and SurgeryCollege of Veterinary Medicine, University of MissouriColumbiaMissouriUSA
| | - Stephen D. Cole
- Department of PathobiologySchool of Veterinary Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jonathan D. Dear
- Department of Medicine and EpidemiologySchool of Veterinary Medicine, University of California‐DavisDavisCaliforniaUSA
| | - Claire L. Fellman
- Department of Clinical SciencesCummings School of Veterinary Medicine, Tufts UniversityGraftonMassachusettsUSA
| | - Erin Frey
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth CarolinaUSA
| | - Robert Goggs
- Department of Clinical SciencesCollege of Veterinary Medicine, Cornell UniversityIthacaNew YorkUSA
| | - Andrea Johnston
- Department of Veterinary Clinical SciencesSchool of Veterinary Medicine, Louisiana State UniversityBaton RougeLouisianaUSA
| | - Amanda J. Kreuder
- Department of Veterinary Microbiology and Preventive MedicineCollege of Veterinary Medicine, Iowa State UniversityAmesIowaUSA
| | - Kate S. KuKanich
- Department of Clinical SciencesCollege of Veterinary Medicine, Kansas State UniversityManhattanKansasUSA
| | - Tessa E. LeCuyer
- Department of Biomedical Sciences and PathobiologyVirginia‐Maryland College of Veterinary Medicine, Virginia TechBlacksburgVirginiaUSA
| | - Julie Menard
- Department of Clinical SciencesCollege of Veterinary Medicine, Cornell UniversityIthacaNew YorkUSA
- Present address:
Department of Veterinary Diagnostic and Clinical Sciences, Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Krystle L. Reagan
- Department of Medicine and EpidemiologySchool of Veterinary Medicine, University of California‐DavisDavisCaliforniaUSA
| | - Jane E. Sykes
- Department of Medicine and EpidemiologySchool of Veterinary Medicine, University of California‐DavisDavisCaliforniaUSA
| | - Julia K. Veir
- Department of Clinical SciencesCollege of Veterinary Medicine and Biomedical Sciences, Colorado State UniversityFort CollinsColoradoUSA
- Present address:
Antech DiagnosticsFountain ValleyCaliforniaUSA
| | - Katrina Viviano
- Department of Medical SciencesSchool of Veterinary Medicine, University of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Annie Wayne
- Department of Clinical SciencesCummings School of Veterinary Medicine, Tufts UniversityGraftonMassachusettsUSA
- Present address:
Ethos Veterinary HealthWoburnMassachusettsUSA
| | - Jennifer L. Granick
- Department of Veterinary Clinical SciencesCollege of Veterinary Medicine, University of MinnesotaSaint PaulMinnesotaUSA
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Ellis C, Odunayo A, Tolbert MK. The use of metronidazole in acute diarrhea in dogs: a narrative review. Top Companion Anim Med 2023; 56-57:100824. [PMID: 37884173 DOI: 10.1016/j.tcam.2023.100824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 10/28/2023]
Abstract
Acute diarrhea is a common reason for non-wellness veterinary visits in dogs. Treatment for acute diarrhea usually consists of supportive care with nutritional intervention, fluid therapy, anthelmintics, and often an antibiotic - commonly metronidazole in North America. The empirical use of metronidazole for acute diarrhea in dogs has been a common practice in veterinary medicine for many decades; however, recent studies evaluating its use suggest it may be inappropriately utilized in many cases. Herein, we review the evidence evaluating the use of metronidazole and other antibiotics in acute diarrhea in the human and veterinary literature. Recommendations on the use of metronidazole and other antibiotics as well as other therapeutic considerations in the treatment of acute diarrhea are also provided.
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Affiliation(s)
- Connor Ellis
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA
| | - Adesola Odunayo
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, USA.
| | - M Katherine Tolbert
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, USA
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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.
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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;
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Osman M, Altier C, Cazer C. Antimicrobial resistance among canine enterococci in the northeastern United States, 2007-2020. Front Microbiol 2023; 13:1025242. [PMID: 36687655 PMCID: PMC9849698 DOI: 10.3389/fmicb.2022.1025242] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/07/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Antimicrobial resistance (AMR) is a growing and complex One Health concern worldwide, threatening the practice of human and veterinary medicine. Although dogs are a potential reservoir of multidrug-resistant bacteria, there are very few surveillance studies on AMR from the canine population in the United States. Here, we assessed the antimicrobial susceptibility patterns, identified temporal resistance and minimum inhibitory concentration trends, and described associations between resistance phenotypes among canine clinical enterococci in the northeastern United States. Methods Through a large-scale retrospective study design, we collected species identification, minimum inhibitory concentration, and clinical data from 3,659 canine enterococci isolated at the Cornell University Animal Health Diagnostic Center between 2007 and 2020. We used the Mann-Kendall test, Sen's slope, multivariable logistic regression, and survival analysis models to detect the presence of a significant trend in resistance over the study period. Results Enterococcus faecalis was the most prevalent species (67.1% of isolates), followed by Enterococcus faecium (20.4%). We found high levels of AMR among enterococci to almost all the tested antimicrobials, particularly E. faecium. The lowest percentage of resistance was to vancomycin and chloramphenicol. Multidrug resistance was common (80% of E. faecium and 33% of E. faecalis) and 31 isolates were extensively drug resistant. Multidrug resistance among E. faecium increased over time, but not in E. faecalis. Resistance to penicillins, enrofloxacin, and rifampin increased during the study period, but resistance to tetracyclines is on a downward trajectory compared to AMR data from the last decade. Emerging vancomycin-resistant E. faecalis (0.3%) and E. faecium (0.8%) infections in the canine population are of great concern to both human and animal health. One E. faecium isolate with acquired vancomycin resistance was identified in 2017 and four vancomycin-resistant enterococci isolates were identified in 2020. Conclusion There is a crucial need to make rational prescribing decisions on the prudent use of antimicrobials and improve the quality of care for patients, especially when empirical antimicrobial treatment for enterococcal infection is common.
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Affiliation(s)
- Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, United States,Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States,*Correspondence: Marwan Osman,
| | - Craig Altier
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Casey Cazer
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States,Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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Kelly PA, McKay JS, Maguire D, Jones M, Roberts L, Powell F, Breathnach R. A retrospective study of cases of canine demodicosis submitted to a commercial diagnostic laboratory servicing the United Kingdom and Ireland (2017-2018) part 2; Aerobic culture and antimicrobial susceptibility results. Res Vet Sci 2022; 153:92-98. [PMID: 36334407 DOI: 10.1016/j.rvsc.2022.10.021] [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: 09/07/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Clinical diagnostic reports from 508 cases of canine demodicosis diagnosed either by histological or skin scraping analysis from a United Kingdom Accreditation Service (UKAS) accredited veterinary diagnostic laboratory servicing the United Kingdom (UK) and Ireland were evaluated. Of the 508 cases, 284 had skin swabs submitted for culture on the same day the skin biopsy and/or skin scraping were obtained. Dogs with juvenile-onset (JO) demodicosis represented 57.4% of these cases, whilst adult-onset (AO) cases comprised 42.6%. The data revealed that overgrowth of pathogenic bacteria was more common in AO demodicosis cases (75.2%) in comparison to the JO cases (57%). Adult-onset cases also had increased involvement of bacteria belonging to multiple genera and/or yeast (28.9%) in comparison to JO cases (18.4%). Pruritus was significantly associated with an overgrowth of Staphylococcus pseudintermedius (p < 0.001). Resistance to one or more antimicrobial classes was noted in S. pseudintermedius isolates from 56.3% of JO cases with 10.3% of these cases being classified as Multi-Drug Resistant (MDR). Similarly, 51.9% of S. pseudintermedius isolates from the AO cases were noted to be resistant to one or more antimicrobial class with 8.6% of these cases being considered MDR. Cephalosporins were the most frequently administered antimicrobial class noted in submission histories, followed by the penicillin and fluoroquinolone classes. Whilst our findings reveal a high prevalence of concurrent overgrowth of pathogenic bacteria warranting therapeutic intervention in canine demodicosis, the presence of resistance within isolates highlights the need for prudent selection and targeted use of antimicrobial therapy that encompass the key principles of antimicrobial stewardship.
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Affiliation(s)
- Pamela A Kelly
- University College Dublin Veterinary Hospital, School of Veterinary Medicine, Belfield, Dublin 4, Ireland.
| | - Jennifer S McKay
- IDEXX Laboratories, Grange House, Sandbeck Way, Wetherby LS22 7DN, United Kingdom.
| | - David Maguire
- IDEXX Laboratories, Grange House, Sandbeck Way, Wetherby LS22 7DN, United Kingdom.
| | - Matthew Jones
- IDEXX Laboratories, Grange House, Sandbeck Way, Wetherby LS22 7DN, United Kingdom.
| | - Larry Roberts
- IDEXX Laboratories, Grange House, Sandbeck Way, Wetherby LS22 7DN, United Kingdom.
| | - Frank Powell
- The Charles Institute of Dermatology, University College Dublin, Belfield, Dublin 4, Ireland; The Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland.
| | - Rory Breathnach
- University College Dublin Veterinary Hospital, School of Veterinary Medicine, Belfield, Dublin 4, Ireland.
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Osman M, Albarracin B, Altier C, Gröhn YT, Cazer C. Antimicrobial resistance trends among canine Escherichia coli isolated at a New York veterinary diagnostic laboratory between 2007 and 2020. Prev Vet Med 2022; 208:105767. [PMID: 36181749 PMCID: PMC9703301 DOI: 10.1016/j.prevetmed.2022.105767] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/21/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022]
Abstract
Dogs are a potential source of drug-resistant Escherichia coli, but very few large-scale antimicrobial resistance surveillance studies have been conducted in the canine population. Here, we assess the antimicrobial susceptibility patterns, identify temporal resistance and minimum inhibitory concentration (MIC) trends, and describe associations between resistance phenotypes among canine clinical E. coli isolates in the northeastern United States. Through a retrospective study design, we collected MICs from 7709 E. coli isolates from canine infections at the Cornell University Animal Health Diagnostic Center between 2007 and 2020. The available clinical data were limited to body site. Isolates were classified as resistant or susceptible to six (urinary) and 22 (non-urinary) antimicrobials based on Clinical and Laboratory Standards Institute breakpoints. We used the Mann-Kendall test (MKT) and Sen's slope to identify the presence of a significant trend in the percent of resistant isolates over the study period. Multivariable logistic regression (MLR) models were built with ceftiofur, enrofloxacin, or trimethoprim-sulfamethoxazole resistance as the outcome and either body site and isolation date, or resistance to other antimicrobials as predictors. MIC trends were characterized with survival analysis models, controlling for body site and year of isolation. Overall, 16.4% of isolates were resistant to enrofloxacin, 14.3% to ceftiofur, and 14% to trimethoprim-sulfamethoxazole. The MKT and Sen's slope revealed a significant decreasing temporal trend for gentamicin and trimethoprim-sulfamethoxazole resistance among non-urinary isolates. No significant temporal resistance trends were detected by MKT for other antimicrobials. However, controlling for body-site in MLR models identified a decrease in resistance rates to enrofloxacin and trimethoprim-sulfamethoxazole after 2010. Similarly, survival analysis data confirmed these findings and showed a decrease in MIC values after 2010 for gentamicin and trimethoprim-sulfamethoxazole, but an increase in cephalosporin MICs. MLR showed that non-urinary isolates were significantly more likely than urinary isolates to demonstrate in vitro resistance to ceftiofur, enrofloxacin, and trimethoprim-sulfamethoxazole after controlling for year of isolation. We identified a higher level of ceftiofur resistance among enrofloxacin resistant isolates from urinary and non-urinary origins. Our findings confirmed that dogs are still a non-negligeable reservoir of drug-resistant E. coli in the northeastern United States. The increase in extended-spectrum cephalosporin MIC values in 2018-2020 compared to 2007-2010 constitutes a particularly worrying issue; the relationship between ceftiofur and enrofloxacin resistance suggests that the use of fluoroquinolones could contribute to this trend. Trimethoprim-sulfamethoxazole may be a good first-line choice for empiric treatment of E. coli infections; it is already recommended for canine urinary tract infections.
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Affiliation(s)
- Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY 14853, USA; Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
| | - Belen Albarracin
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Craig Altier
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Yrjö T Gröhn
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA; Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Casey Cazer
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA; Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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Kovačević Z, Vidović J, Erdeljan M, Cincović M, Ružić Z, Galić I, Kukurić T, Stojanac N, Horvat O. Veterinary Practitioners' Standpoints and Comprehension towards Antimicrobial Use-Are There Opportunities for Antimicrobial Stewardship Improvement? Antibiotics (Basel) 2022; 11:antibiotics11070867. [PMID: 35884121 PMCID: PMC9311883 DOI: 10.3390/antibiotics11070867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/04/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022] Open
Abstract
The main subject of the research is the assessment of the knowledge, attitudes and behaviors of veterinarians regarding the use of antibiotics (AMU) and antimicrobial resistance (AMR) through a questionnaire conducted among veterinarians in the northern region of Serbia. A total of 62 respondents completed the questionnaire, which represents a response rate of 44.3%. Male veterinarians are less likely to be in the group of veterinarians with insufficient knowledge (p < 0.05). Veterinarians engaged in mixed practice (small and large animals) (p < 0.001) and veterinarians who have over 100 patients per month (p < 0.005) are also less likely to be in the group with insufficient knowledge of antimicrobial resistance. The proportion of those with insufficient knowledge is growing among veterinarians whose source is the Internet (p < 0.01), while the proportion of those with insufficient knowledge about antimicrobial resistance is declining among veterinarians whose source of information is continuous education (p < 0.05). The majority of the respondents (n = 59, 95.2%) completely agreed that AMR is a very big issue in the global health sector right now. Unfortunately, there are crucial gaps in the knowledge and attitudes of the surveyed participants. They do not appear to be aware of the importance of AMU in veterinary medicine and its influence on overall AMR, or the crucial part that non-prescribed antibiotics have in all of it. Positively, many veterinarians use good practice AMU guidelines in their everyday practice and in line with the global trend of AMU reduction, respondents have also decreased their AMU compared to the previous year.
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Affiliation(s)
- Zorana Kovačević
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Jovana Vidović
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Mihajlo Erdeljan
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Marko Cincović
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Zoran Ružić
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
- Correspondence:
| | - Ivan Galić
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Tijana Kukurić
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Nenad Stojanac
- Department for Veterinary Medicine, Faculty of Agriculture, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.K.); (J.V.); (M.E.); (M.C.); (I.G.); (T.K.); (N.S.)
| | - Olga Horvat
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
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11
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Menard J, Porter I, Lerer A, Robbins S, Johnson PJ, Goggs R. Serial evaluation of thoracic radiographs and acute phase proteins in dogs with pneumonia. J Vet Intern Med 2022; 36:1430-1443. [PMID: 35616241 PMCID: PMC9308444 DOI: 10.1111/jvim.16448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/04/2022] [Indexed: 01/03/2023] Open
Abstract
Background Acute phase proteins (APP) may guide treatment of pneumonia in dogs but correlations with radiographic abnormalities are poorly characterized. Objectives Develop a thoracic radiographic severity scoring system (TRSS), assess correlation of radiographic changes with APP concentrations, and compare time to APP and radiograph normalization with duration of antimicrobials treatment. Animals Sixteen client‐owned dogs, 12 with aspiration pneumonia, and 4 with community‐acquired pneumonia. Methods Concentrations of C‐reactive protein (CRP), serum amyloid A (SAA), and haptoglobin were measured on days 1, 3, 7, 14, 28, and 60 and orthogonal 2‐view thoracic radiographs were obtained on days 1, 7, 14, 28, and 60. Treatment was clinician‐guided and blinded to APP concentrations. Radiographic severity scores were assigned by blinded, randomized retrospective review by 2 board‐certified radiologists with arbitration by a third radiologist. Results Median (interquartile range [IQR]) time to normalization of CRP (7 days [7‐14]) and SAA concentrations (7 days [7‐14]) were shorter than antimicrobial treatment duration (17.5 days [14.5‐33.5]; P = .001 and .002, respectively) and TRSS normalization (14 days [8.8‐52], P = .02 and .02, respectively). The CRP and SAA concentrations were positively correlated with TRSS (CRP rs, 0.643; SAA rs, 0.634; both P < .0001). Both CRP and SAA identified normal thoracic radiographs area under the curve (AUC) 0.873 and 0.817, respectively, both P < .0001. Interobserver agreement for TRSS assignment was moderate (κ, .499; P < .0001). Conclusion and Clinical Importance Concentrations of CRP and SAA normalized before radiographic resolution and before clinicians discontinued antimicrobial treatment. The CRP and SAA concentrations may guide duration of antimicrobial treatment for dogs with pneumonia.
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Affiliation(s)
- Julie Menard
- Department of Veterinary Clinical and Diagnostic Science, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ian Porter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Assaf Lerer
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Sarah Robbins
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Philippa J Johnson
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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12
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Goggs R, Robbins SN, LaLonde‐Paul DM, Menard JM. Serial analysis of blood biomarker concentrations in dogs with pneumonia, septic peritonitis, and pyometra. J Vet Intern Med 2022; 36:549-564. [PMID: 35103342 PMCID: PMC8965213 DOI: 10.1111/jvim.16374] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Prolonged antimicrobial drug (AMD) treatment is associated with antimicrobial resistance development. Biomarker measurement may aid treatment decision-making. OBJECTIVES Investigate temporal changes in blood biomarker concentrations in dogs undergoing treatment for pulmonary and intra-abdominal infections; compare time to biomarker concentration normalization with duration of clinician-directed AMD treatment. ANIMALS Forty-two client-owned dogs with pneumonia (n = 22), septic peritonitis (n = 10), or pyometra (n = 10). METHODS Plasma concentrations of C-reactive protein (CRP), serum amyloid A (SAA), haptoglobin, procalcitonin, nucleosomes, cell-free DNA (cfDNA), high-mobility group box-1 (HMGB1), CC-motif chemokine ligand-2 (CCL2), CXC-motif chemokine ligand-8 (CXCL8), and keratinocyte chemoattractant-like (KC-Like) were quantitated in samples collected on days 1, 3, 7, 14, 28, and 60. Treatment was directed by clinicians blinded to biomarker concentrations. RESULTS Concentrations of CCL2, CRP, and KC-Like were maximal on D1, concentrations of SAA, cfDNA, HMGB1, and nucleosomes were maximal on D3 and haptoglobin concentrations were maximal on D7. These maximal concentrations were significantly different from those on D60. Concentrations of CRP and SAA decreased by 80% from peak and into respective reference intervals before AMDs were discontinued. For CRP, the median (interquartile range [IQR]) times to 20% peak and normal were 7 (6-9) and 7 (6-12) days, respectively, and for SAA they were 4 (4, 5) and 6 (5-8) days, respectively, compared to a median (IQR) duration of AMD prescribing of 16 (12-23) days (all P < .0001). CONCLUSIONS AND CLINICAL IMPORTANCE Biomarker concentrations normalized within 7 to 14 days. Serial measurements of CRP and SAA might aid identification of disease resolution and could help guide AMD prescription decision-making.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Sarah N. Robbins
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Denise M. LaLonde‐Paul
- Department of Clinical Sciences, College of Veterinary MedicineCornell UniversityIthacaNew YorkUSA
| | - Julie M. Menard
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
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13
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Pumphrey SA, Wayne AS. Patterns of bacterial culture and antimicrobial susceptibility test results for dogs with retrobulbar abscesses: 133 cases (2002-2019). J Am Vet Med Assoc 2022; 260:1-9. [PMID: 35175928 DOI: 10.2460/javma.21.04.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate patterns of bacterial culture and antimicrobial susceptibility test results for dogs with retrobulbar abscesses and generate recommendations for empirical antimicrobial selection. ANIMALS 133 dogs examined between 2002 and 2019. PROCEDURES Records were retrospectively reviewed to determine type of bacterial culture, number and type of bacterial isolates, antimicrobial susceptibility test results, concurrent and recent antimicrobial exposure, effect of culture results on antimicrobial regimen, and outcome. RESULTS Aerobic culture alone was performed in 37 dogs, and aerobic and anaerobic culture was performed in 96 dogs. Isolates were recovered from 96 dogs, with multiple isolates recovered from 54 (56%) of those dogs. Of the 69 dogs for which both aerobic and anaerobic culture was performed and at least 1 isolate was obtained, 34 (49%) had purely aerobic infections, 15 (22%) had mixed aerobic and anaerobic infections, and 20 (29%) had purely anaerobic infections. Pasteurella spp (n = 26), Streptococcus spp (20), and Escherichia coli (12) were the most common aerobic isolates. Bacteroides spp (n = 22), Actinomyces spp (10), and Fusobacterium (10) spp were the most common anaerobic isolates. Susceptibility test results led to changes in the antimicrobial regimen in 37 of 80 (46%) dogs. Of the 76 dogs for which outcome information was available, 78 (97%) recovered. CLINICAL RELEVANCE Multipathogen and anaerobic infections were common in dogs with retrobulbar abscesses. Susceptibility data supported the use of amoxicillin-clavulanate or a combination of clindamycin and enrofloxacin as first-line treatments. Additional study is needed to characterize anaerobic antimicrobial susceptibilities and to compare results of susceptibility testing with in vivo responses to antimicrobial administration.
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14
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Vientós-Plotts AI, Masseau I, Reinero CR. Comparison of Short- versus Long-Course Antimicrobial Therapy of Uncomplicated Bacterial Pneumonia in Dogs: A Double-Blinded, Placebo-Controlled Pilot Study. Animals (Basel) 2021; 11:ani11113096. [PMID: 34827828 PMCID: PMC8614313 DOI: 10.3390/ani11113096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Dogs diagnosed with bacterial pneumonia are often treated with long courses of antibiotics (3–6 weeks) and chest X-rays are used to help guide the duration of treatment. This is in stark contrast with humans with the same disease who are often treated for 5–10 days, and chest X-rays are not considered to be useful for monitoring response to treatment. The main goal of this study was to determine whether a shorter course of antibiotics (10 days) would be sufficient to treat dogs with bacterial pneumonia. Eight dogs with pneumonia were randomly assigned to receive 10 or 21 days of antibiotics. They were evaluated at 10, 30 and 60 days after diagnosis. At 10 days, 6/8 dogs had resolution of both clinical signs and evidence of inflammation on bloodwork and 5/8 dogs showed improvement in the chest X-rays. After 60 days, none of the dogs had clinical signs or evidence of inflammation on bloodwork regardless of antibiotic therapy duration. However, 3/8 dogs showed changes in the chest X-rays. This study suggests that a 10-day course of antibiotics may be sufficient to treat dogs with bacterial pneumonia, and chest X-rays may not be a reliable marker to monitor response to therapy. Abstract Current treatment for canine bacterial pneumonia relies on protracted courses of antimicrobials (3–6 weeks or more) with recommendations to continue for 1–2 weeks past resolution of all clinical and thoracic radiographic abnormalities. However, in humans, bacterial pneumonia is often treated with 5–10-day courses of antimicrobials, and thoracic radiographs are not considered useful to guide therapeutic duration. The primary study objective was to determine whether a short course of antimicrobials would be sufficient to treat canine bacterial pneumonia. Eight dogs with uncomplicated bacterial pneumonia were enrolled in this randomized, double-blinded, placebo-controlled study comparing clinical and radiographic resolution with differing durations of antimicrobial therapy. Dogs received a course of antimicrobials lasting 10 (A10) or 21 (A21) days. Dogs randomized to the A10 group received placebo for 11 days following antimicrobial therapy. Patients were evaluated at presentation and 10, 30 and 60 days after the initiation of antimicrobials. At 10 days, 6/8 dogs had resolution of both clinical signs and inflammatory leukogram, and 5/8 dogs had improved global radiographic scores. After 60 days, clinical and hematologic resolution of pneumonia was noted in all dogs regardless of antimicrobial therapy duration; however, 3/8 dogs had persistent radiographic lesions. Thoracic radiographs do not appear to be a reliable marker to guide antimicrobial therapy in canine bacterial pneumonia as radiographic lesions may lag or persist despite clinical cure. This pilot study suggests a 10-day course of antimicrobials may be sufficient to treat uncomplicated canine bacterial pneumonia.
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Affiliation(s)
| | - Isabelle Masseau
- Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, Montreal, QC H3T 1J4, Canada;
| | - Carol R. Reinero
- College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA;
- Correspondence: ; Tel.: +1-(573)-882-7821
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15
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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.
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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
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16
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Rule EK, Boyle AG, Redding LE. Antimicrobial prescribing patterns in equine ambulatory practice. Prev Vet Med 2021; 193:105411. [PMID: 34147960 DOI: 10.1016/j.prevetmed.2021.105411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 12/29/2022]
Abstract
Antimicrobial resistance is one of the most important public health risks facing our world today. Antimicrobials are commonly prescribed in equine veterinary medicine, but limited information exists documenting their use in practice. The goal of this study was to investigate antimicrobial prescription patterns in regards to prescription frequency, duration, drug class, clinician and affected body system in an equine ambulatory setting via retrospective analysis of billing and electronic medical records. Risk factors associated with antimicrobial prescription including the nature of the visit, submission of a culture, body system affected and clinician were assessed using multivariable regression. We found that antimicrobials were prescribed in 8.5 % of visits with a median number of 3.5 (IQR 0.8-12.2) animal-defined daily doses (ADD), defined as the number of daily doses of all antimicrobials prescribed to a patient at a single visit. Aminoglycosides were the most common class of antimicrobials prescribed and trimethoprim sulfamethoxazole was the most common drug prescribed overall. Amikacin was primarily used for patients presenting with musculoskeletal signs, and the median number of ADDs for visits where amikacin was prescribed was 1 (IQR 0.9-1.9), while the median number of antimicrobial ADDs for all other visits was 4.4 (IQR 0-14.1). Statistically significant differences in antimicrobial use patterns existed across clinicians, months, years and affected body systems. Horses presenting with ocular (OR 1199; 95 % CI 204-7,037; p < 0.001) and integumentary (OR 365; 95 % CI 87.2-1532; p < 0.001) signs were most likely to be prescribed an antimicrobial. Emergency visits (OR 5.61; 95 % CI 3.19-9.89; p < 0.001) and submission of a bacterial culture (OR 3.58; 95 % CI 2.11-6.09; p < 0.001) were associated with an increased likelihood of an antimicrobial prescription. This observational study was the first to quantitatively characterize antimicrobial use patterns in equine ambulatory practice in the United States, which is an important step needed to determine appropriateness of use and develop and evaluate antimicrobial stewardship guidelines.
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Affiliation(s)
- Emily K Rule
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA, 19348, USA.
| | - Ashley G Boyle
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA, 19348, USA
| | - Laurel E Redding
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA, 19348, USA
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17
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Nocera FP, Ambrosio M, Fiorito F, Cortese L, De Martino L. On Gram-Positive- and Gram-Negative-Bacteria-Associated Canine and Feline Skin Infections: A 4-Year Retrospective Study of the University Veterinary Microbiology Diagnostic Laboratory of Naples, Italy. Animals (Basel) 2021; 11:ani11061603. [PMID: 34072316 PMCID: PMC8227065 DOI: 10.3390/ani11061603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Pet animals’ bacterial skin infections represent the main reason for presentation in small animal practice and are generally secondary complications of other pathological conditions. Pyoderma and otitis externa are generally caused by Staphylococcus spp., and particularly Staphylococcus pseudintermedius is often isolated from dogs and cats suffering from skin disorders. However, also Gram-negative bacteria, such as Pseudomonas aeruginosa and Escherichia coli, can be responsible for both otitis externa and pyoderma. Since multi-drug-resistant bacterial strains have become a relevant threat in veterinary medicine, this study aimed to identify the bacteria most frequently associated with the most common clinical cases of skin infections in dogs and cats attending the University Veterinary Teaching Hospital of Naples in the period from January 2016 to December 2019. Moreover, their antibiotic resistance profiles were evaluated, highlighting an increasing spread of multi-drug-resistant strains. It is worth noting that this spread may also concern humans because of their close contact with pets. Thus, it not only is of veterinary significance but also has zoonotic importance, with pets acting as reservoirs for humans, especially pet owners and veterinarians. Abstract A 4-year retrospective study (2016–2019) of selected routine bacteriological examinations of the veterinary microbiology laboratory of the University Veterinary Teaching Hospital of Naples (Italy) was carried out. A total of 189 bacteriological samples were collected from 171 dogs and 18 cats suffering from skin infections. In dogs, the most common cutaneous infection was otitis externa, while pyoderma was found to be prevalent in cats. The number of recorded Gram-positive strains over the study period did not vary considerably from year to year and was always significantly higher (p-value = 0.0007) in comparison with Gram-negative bacterial isolations. In dogs, Staphylococcus pseudintermedius was the most common identified Gram-positive bacterium (65%), while Pseudomonas aeruginosa (36%) was the one among the isolated Gram-negative bacteria. In cats, coagulase-negative staphylococci were the most predominant isolated bacteria (47%). The phenotypic profiles of antibiotic resistance showed that most of the strains were resistant to amoxicillin–clavulanate, penicillin, clindamycin, and trimethoprim–sulfamethoxazole. Several multi-drug-resistant strains (35%) were detected in canine isolates. An updating of antibiotic resistance profiles of the main Gram-positive and Gram-negative bacteria principally associated with skin infections of pet animals is necessary to improve stewardship programs of veterinary hospitals and clinics.
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Affiliation(s)
| | | | | | - Laura Cortese
- Correspondence: (L.C.); (L.D.M.); Tel.: +39-081-253-6005 (L.C.); +39-081-253-6180 (L.D.M.)
| | - Luisa De Martino
- Correspondence: (L.C.); (L.D.M.); Tel.: +39-081-253-6005 (L.C.); +39-081-253-6180 (L.D.M.)
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18
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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.
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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
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19
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Werner M, Unterer S. [Use of antimicrobials in acute canine diarrhea - overview of potential risks, indications and alternatives]. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2021; 49:110-120. [PMID: 33902119 DOI: 10.1055/a-1395-2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In Germany, antibiotics are frequently used in dogs with gastrointestinal disorders such as acute diarrhea. In line with global efforts to limit antibiotic use, this literature review aims to provide a guideline for the rational and judicious use of antibiotics in acute canine diarrhea. Antibiotics can lead to gastrointestinal side effects and may exert a negative influence on the intestinal microbiota in addition to increasing the occurrence of resistant bacteria. There is also evidence that chronic immunological diseases may be triggered by the administration of antibiotics. Therefore, these should not be administered in uncomplicated acute diarrhea without signs of sepsis or systemic inflammatory reaction. In addition, enteropathogenic bacteria usually do not play a role in the etiology of acute diarrhea. For select clinical entities such as acute hemorrhagic diarrhea syndrome, antibiotic therapy should only be recommended in cases displaying signs of bacterial translocation with subsequent sepsis. In the case of parvovirosis, on the other hand, the administration of antibiotics is unavoidable due to the immunological incompetence of the dog caused by the accompanying severe neutropenia.
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Affiliation(s)
- Melanie Werner
- Medizinische Kleintierklinik, Zentrum für Klinische Tiermedizin, Ludwig-Maximilians-Universität München
| | - Stefan Unterer
- Medizinische Kleintierklinik, Zentrum für Klinische Tiermedizin, Ludwig-Maximilians-Universität München
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20
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Chirollo C, Nocera FP, Piantedosi D, Fatone G, Della Valle G, De Martino L, Cortese L. Data on before and after the Traceability System of Veterinary Antimicrobial Prescriptions in Small Animals at the University Veterinary Teaching Hospital of Naples. Animals (Basel) 2021; 11:ani11030913. [PMID: 33806745 PMCID: PMC8005210 DOI: 10.3390/ani11030913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Veterinary electronic prescription (VEP) is mandatory by law, dated 20 November 2017, No. 167 (European Law 2017) Article 3, and has been implemented in Italy since April 2019. In this study, the consumption of antimicrobials before and after the mandatory use of VEP was analyzed at the Italian University Veterinary Teaching Hospital of Naples in order to understand how the traceability of antimicrobials influences veterinary prescriptions. The applicability and utility of VEP may present an effective surveillance strategy able to limit both the improper use of antimicrobials and the spread of multidrug-resistant pathogens, which have become a worrying threat both in veterinary and human medicine. Abstract Over recent decades, antimicrobial resistance has been considered one of the most relevant issues of public health. The aim of our study was to evaluate the differences related to the prescription of antimicrobials at the University Veterinary Teaching Hospital, before and after the mandatory use of veterinary electronic prescription (VEP). In particular, the consumption of antimicrobials was examined, especially taking into consideration the recommendations of prudent use. A comparison of data collected before and after the use of electronic prescription highlighted that during the period chosen for the study, the choice of antimicrobial molecules was appropriate, favoring those of “first” and “second line.” However, prescription and the use of some molecules not registered for veterinary medicine were observed in the period before VEP. Broad-spectrum antimicrobials, including penicillins with β-lactamase inhibitors, as well as first-generation cephalosporins and fluoroquinolones, were the most frequently prescribed compounds. There are few studies conducted in Italy aimed at investigating the use of antimicrobials in companion animals under field conditions and with particular regard to prudent use recommendations. This type of study underlines the importance of electronic medical recording in veterinary practice and, above all, its usefulness in monitoring the use of certain antimicrobial agents classified as of critical importance in human medicine.
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Puvača N, de Llanos Frutos R. Antimicrobial Resistance in Escherichia coli Strains Isolated from Humans and Pet Animals. Antibiotics (Basel) 2021; 10:69. [PMID: 33450827 PMCID: PMC7828219 DOI: 10.3390/antibiotics10010069] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Throughout scientific literature, we can find evidence that antimicrobial resistance has become a big problem in the recent years on a global scale. Public healthcare systems all over the world are faced with a great challenge in this respect. Obviously, there are many bacteria that can cause infections in humans and animals alike, but somehow it seems that the greatest threat nowadays comes from the Enterobacteriaceae members, especially Escherichia coli. Namely, we are witnesses to the fact that the systems that these bacteria developed to fight off antibiotics are the strongest and most diverse in Enterobacteriaceae. Our great advantage is in understanding the systems that bacteria developed to fight off antibiotics, so these can help us understand the connection between these microorganisms and the occurrence of antibiotic-resistance both in humans and their pets. Furthermore, unfavorable conditions related to the ease of E. coli transmission via the fecal-oral route among humans, environmental sources, and animals only add to the problem. For all the above stated reasons, it is evident that the epidemiology of E. coli strains and resistance mechanisms they have developed over time are extremely significant topics and all scientific findings in this area will be of vital importance in the fight against infections caused by these bacteria.
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Affiliation(s)
- Nikola Puvača
- Faculty of Biomedical and Health Sciences, Jaume I University, Avinguda de Vicent Sos Baynat, s/n, 12071 Castelló de la Plana, Spain;
- Department of Engineering Management in Biotechnology, Faculty of Economics and Engineering Management in Novi Sad, University Business Academy in Novi Sad, Cvećarska 2, 21000 Novi Sad, Serbia
| | - Rosa de Llanos Frutos
- Faculty of Biomedical and Health Sciences, Jaume I University, Avinguda de Vicent Sos Baynat, s/n, 12071 Castelló de la Plana, Spain;
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