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Hur B, Hardefeldt LY, Verspoor K, Baldwin T, Gilkerson JR. Overcoming challenges in extracting prescribing habits from veterinary clinics using big data and deep learning. Aust Vet J 2022; 100:220-222. [DOI: 10.1111/avj.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/02/2022] [Indexed: 11/27/2022]
Affiliation(s)
- B Hur
- Asia‐Pacific Centre for Animal Health, Melbourne Veterinary School University of Melbourne Melbourne Victoria Australia
- School of Computing and Information Systems University of Melbourne Melbourne Victoria Australia
| | - LY Hardefeldt
- Asia‐Pacific Centre for Animal Health, Melbourne Veterinary School University of Melbourne Melbourne Victoria Australia
| | - K Verspoor
- School of Computing and Information Systems University of Melbourne Melbourne Victoria Australia
- School of Computing Technologies RMIT University Melbourne Victoria Australia
| | - T Baldwin
- School of Computing and Information Systems University of Melbourne Melbourne Victoria Australia
| | - JR Gilkerson
- Asia‐Pacific Centre for Animal Health, Melbourne Veterinary School University of Melbourne Melbourne Victoria Australia
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2
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Crabb HK, Hardefeldt LY, Bailey KE, Billman-Jacobe H, Gilkerson JR, Browning GF. Survey of veterinary prescribing for poultry disease. Aust Vet J 2019; 97:288. [PMID: 31359424 DOI: 10.1111/avj.12812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/20/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND To enable better antimicrobial stewardship, it is important to know what the patterns of prescribing behaviour are and what diseases or reasons antibiotics are being prescribed. A prescribing guideline (i.e. recommended best practice for writing prescriptions) developed by the Australian poultry veterinarians exists. However, it is not a prescribing guideline detailing treatments for the commonly observed bacterial diseases in commercial poultry. METHODS An online survey was deployed to all registered veterinarians and members of the Australian Veterinary Poultry Association to identify prescribing behaviours for the most frequently observed bacterial diseases of poultry. RESULTS A total of 39 survey responses were received. Most surveys were started but not completed; 13 (33%) were completed with 18 (46%) containing some information on prescribing. The most frequent treatment responses were for Escherichia coli in both layers and broilers, chronic respiratory disease (CRD), fowl cholera and spotty liver in layers and necrotic enteritis in broilers. Treatments described were for products registered for poultry use, within the recommended label dose and duration of treatment (Tables 1, 2). Unsurprisingly, tetracyclines and amoxycillin, followed by lincomycin and trimethoprim sulfonamide products were the most frequently reported treatment options. Inappropriate treatments were reported for salmonellosis and one veterinarian recommended the use of enrofloxacin for the treatment of fowl cholera. CONCLUSION Information provided by respondents will enable the initial development of prescribing guidelines for both commercial and small poultry flocks. Importantly, it identified less than optimal prescribing behaviour for some diseases, a reliance on one class of antibiotic more than others and a failure to utilise all antimicrobial classes potentially available for treatment. Critically, the survey identified a lack of treatment options for bacterial disease in poultry. The most important bacterial diseases of poultry remain the same; effective alternatives for antibiotic treatment are required and old diseases, thought once gone, are reinventing themselves as problems for the future. Surveys of prescribing behaviours are essential for identifying diseases of high priority, changes in treatments and response to treatment and to identify areas for targeted antimicrobial stewardship, and research needs.
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Affiliation(s)
- H K Crabb
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - L Y Hardefeldt
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - K E Bailey
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - H Billman-Jacobe
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - J R Gilkerson
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - G F Browning
- National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
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Norris JM, Heller J, Gibson JS, Hardefeldt LY, Hyndman TH, Nielsen TD, Ward MP, Govendir M, Chambers JP, Browning GF, Wingett K, Britton S. Development of a veterinary antimicrobial stewardship online training program for Australian veterinarians: a national collaborative effort. Aust Vet J 2019; 97:290-291. [PMID: 31286468 DOI: 10.1111/avj.12821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- J M Norris
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - J Heller
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - J S Gibson
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
| | - L Y Hardefeldt
- Melbourne Veterinary School, University of Melbourne, Parkville, and National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - T H Hyndman
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - T D Nielsen
- University of Adelaide School of Animal and Veterinary Science, Adelaide, South Australia, Australia
| | - M P Ward
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - M Govendir
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - J P Chambers
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - G F Browning
- Melbourne Veterinary School, University of Melbourne, Parkville, and National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - K Wingett
- NSW Department of Primary Industries Biosecurity and Food Safety, Orange, New South Wales, Australia
| | - S Britton
- Department of Industry Skills and Regional Development, NSW Department of Primary Industries, Orange, New South Wales, Australia
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Hardefeldt LY, Crabb HK, Bailey KE, Johnstone T, Gilkerson JR, Billman-Jacobe H, Browning GF. Appraisal of the Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery in dogs and cats. Aust Vet J 2019; 97:316-322. [PMID: 31286484 DOI: 10.1111/avj.12848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 01/03/2023]
Abstract
The Australian Veterinary Prescribing Guidelines for antimicrobial prophylaxis for surgery on dogs and cats are evidence-based guidelines for veterinary practitioners. Validation of these guidelines is necessary to ensure quality and implementability. Two validated tools, used for medical guideline appraisal, were chosen to assess the guidelines. The terminology from the GuideLine Implementability Appraisal (GLIA) and the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) were adapted for use by veterinarians. A two-phase evaluation approach was conducted. In the first phase of the evaluation, the GLIA tool was used by two specialist veterinary surgeons in clinical practice. The results of this phase were then used to modify the guidelines. In the second phase, the AGREE II tool was used by 6 general practitioners and 6 specialists to appraise the guidelines. In phase 1, the specialist surgeons either agreed or strongly agreed that the guidelines were executable, decidable, valid and novel, and that the guidelines would fit within the process of care. The surgeons were neutral on flexibility and measurability. Additional clarity around one common surgical procedure was added to the guidelines, after which the surgeons agreed that the guidelines were sufficiently flexible. In phase 2, 12 veterinarians completed the assessment using the AGREE II tool. In all sections the scaled domain score was greater than 70%. The overall quality of the guidelines was given a global scaled score of 76%. This assessment has demonstrated that the guidelines for antimicrobial prophylaxis for companion animal surgery are valid and appear implementable.
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Affiliation(s)
- L Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - H K Crabb
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - K E Bailey
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - T Johnstone
- Translational Research and Animal Clinical Trial Study Group (TRACTS), U-Vet Animal Hospital Werribee, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, 250 Princes Hwy, Werribee, 3030, Victoria, Australia
| | - J R Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - H Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
| | - G F Browning
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne and the National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Grattan St, Carlton, 3050, Victoria, Australia
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Hur B, Hardefeldt LY, Verspoor K, Baldwin T, Gilkerson JR. Using natural language processing and VetCompass to understand antimicrobial usage patterns in Australia. Aust Vet J 2019; 97:298-300. [PMID: 31209869 DOI: 10.1111/avj.12836] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently there is an incomplete understanding of antimicrobial usage patterns in veterinary clinics in Australia, but such knowledge is critical for the successful implementation and monitoring of antimicrobial stewardship programs. METHODS VetCompass Australia collects medical records from 181 clinics in Australia (as of May 2018). These records contain detailed information from individual consultations regarding the medications dispensed. One unique aspect of VetCompass Australia is its focus on applying natural language processing (NLP) and machine learning techniques to analyse the records, similar to efforts conducted in other medical studies. RESULTS The free text fields of 4,394,493 veterinary consultation records of dogs and cats between 2013 and 2018 were collated by VetCompass Australia and NLP techniques applied to enable the querying of the antimicrobial usage within these consultations. CONCLUSION The NLP algorithms developed matched antimicrobial in clinical records with 96.7% accuracy and an F1 Score of 0.85, as evaluated relative to expert annotations. This dataset can be readily queried to demonstrate the antimicrobial usage patterns of companion animal practices throughout Australia.
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Affiliation(s)
- B Hur
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia.,School of Computing and Information Systems, University of Melbourne Parkville, VIC, Australia
| | - L Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
| | - K Verspoor
- School of Computing and Information Systems, University of Melbourne Parkville, VIC, Australia.,Health and Biomedical Informatics Centre, University of Melbourne, Parkville, VIC, Australia
| | - T Baldwin
- School of Computing and Information Systems, University of Melbourne Parkville, VIC, Australia
| | - J R Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
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Hardefeldt LY, Crabb HK, Bailey KE, Gilkerson JR, Billman-Jacobe H, Browning GF. Antimicrobial dosing for common equine drugs: a content review and practical advice for veterinarians in Australia. Aust Vet J 2019; 97:103-107. [PMID: 30919436 DOI: 10.1111/avj.12791] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Appropriate dosing with antimicrobial agents is critical for effective treatment and to prevent the development of antimicrobial resistance. METHODS A review was undertaken of equine journal articles (Equine Veterinary Journal, Equine Veterinary Education, Australian Veterinary Journal, Australian Equine Veterinarian, Journal of Veterinary Internal Medicine and Journal of Equine Veterinary Science) between January 2015 and August 2018. Those with dosing regimens for procaine penicillin G, gentamicin or trimethoprim-sulfonamide in adult horses were examined and evaluated. Pharmacokinetics and -dynamics of these drugs were also reviewed. RESULTS & CONCLUSION The most frequently reported doses for penicillin, gentamicin and trimethoprim-sulfonamide were 20-25,000 IU/kg, 6.6 mg/kg and 30 mg/kg, respectively. Veterinarians treating equine patients in Australia should be aware of the current recommended doses and inter-dosing intervals to ensure efficacy in therapy and to preserve the usefulness of these antimicrobials for the future.
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Affiliation(s)
- L Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Science, University of Melbourne & National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - H K Crabb
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Science, University of Melbourne & National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - K E Bailey
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Science, University of Melbourne & National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - J R Gilkerson
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Science, University of Melbourne & National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - H Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Science, University of Melbourne & National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
| | - G F Browning
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Science, University of Melbourne & National Centre for Antimicrobial Stewardship, Carlton, Victoria, Australia
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Hardefeldt LY, Gilkerson JR, Billman-Jacobe H, Stevenson MA, Thursky K, Browning GF, Bailey KE. Antimicrobial labelling in Australia: a threat to antimicrobial stewardship? Aust Vet J 2018; 96:151-154. [PMID: 29691852 DOI: 10.1111/avj.12677] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/09/2017] [Accepted: 11/22/2017] [Indexed: 11/27/2022]
Abstract
Antimicrobial resistance is a public health emergency, placing veterinary antimicrobial use under growing scrutiny. Antimicrobial stewardship, through appropriate use of antimicrobials, is a response to this threat. The need for antimicrobial stewardship in Australian veterinary practices has had limited investigation. A 2016 survey undertaken to investigate antimicrobial usage patterns by Australian veterinarians found that antimicrobial dose rates were varied and often inappropriate. Doses of procaine penicillin in horses and cattle were often low, with 68% and 90% of respondents, respectively, reporting doses that were unlikely to result in plasma concentrations above minimum inhibitory concentrations for common equine and bovine pathogens. Frequency of penicillin administration was also often inappropriate. Gentamicin doses in horses were largely appropriate (89% of dose rates appropriate), but 9% of respondents reported twice daily dosing. Amoxycillin and amoxycillin-clavulanate were administered at the appropriate doses, or above, to dogs and cats by 54% and 70% of respondents, respectively. Here, we explore the potential reasons for inappropriate antimicrobial dose regimens and report that antimicrobial labels often recommend incorrect dose rates and thus may be contributing to poor prescribing practices. Changes to legislation are needed to ensure that antimicrobial drug labels are regularly updated to reflect the dose needed to effectively and safely treat common veterinary pathogens. This will be especially true if changes in legislation restrict antimicrobial use by veterinarians to the uses and doses specified on the label, thus hampering the current momentum towards improved antimicrobial stewardship.
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Affiliation(s)
- L Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
| | - J R Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
| | - H Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
| | - M A Stevenson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
| | - K Thursky
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, VIC, Australia
| | - G F Browning
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
| | - K E Bailey
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, VIC, Australia
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Hardefeldt LY, Marenda M, Crabb H, Stevenson MA, Gilkerson JR, Billman-Jacobe H, Browning GF. Antimicrobial susceptibility testing by Australian veterinary diagnostic laboratories. Aust Vet J 2018; 96:142-146. [DOI: 10.1111/avj.12685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/15/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- LY Hardefeldt
- Asia-Pacific Centre for Animal Health, Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
- National Centre for Antimicrobial Stewardship; Peter Doherty Institute; Parkville Victoria Australia
| | - M Marenda
- Asia-Pacific Centre for Animal Health, Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
| | - H Crabb
- Asia-Pacific Centre for Animal Health, Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
- National Centre for Antimicrobial Stewardship; Peter Doherty Institute; Parkville Victoria Australia
| | - MA Stevenson
- Asia-Pacific Centre for Animal Health, Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
| | - JR Gilkerson
- Asia-Pacific Centre for Animal Health, Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
| | - H Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
- National Centre for Antimicrobial Stewardship; Peter Doherty Institute; Parkville Victoria Australia
| | - GF Browning
- Asia-Pacific Centre for Animal Health, Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Parkville Victoria 3010 Australia
- National Centre for Antimicrobial Stewardship; Peter Doherty Institute; Parkville Victoria Australia
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Hardefeldt LY, Browning GF, Thursky K, Gilkerson JR, Billman-Jacobe H, Stevenson MA, Bailey KE. Antimicrobials used for surgical prophylaxis by equine veterinary practitioners in Australia. Equine Vet J 2017; 50:65-72. [PMID: 28608525 DOI: 10.1111/evj.12709] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/02/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antimicrobials are widely used in Australian veterinary practices, but no investigation into the classes of antimicrobials used, or the appropriateness of use in horses, has been conducted. OBJECTIVES The aim of the study was to describe antimicrobial use for surgical prophylaxis in equine practice in Australia. STUDY DESIGN Cross-sectional questionnaire survey. METHODS An online questionnaire was used to document antimicrobial usage patterns. Information solicited in the questionnaire included demographic details of the respondents, the frequency with which antimicrobials were used for specific surgical conditions (including the dose, timing and duration of therapy) and practice antimicrobial use policies and sources of information about antimicrobials and their uses. RESULTS A total of 337 members of the Australian veterinary profession completed the survey. Generally, the choice of antimicrobial was appropriate for the specified equine surgical condition, but the dose and duration of therapy varied greatly. While there was poor optimal compliance with British Equine Veterinary Association guidelines in all scenarios (range 1-15%), except removal of a nonulcerated dermal mass (42%), suboptimal compliance (compliant antimicrobial drug selection but inappropriate timing, dose or duration of therapy) was moderate for all scenarios (range 48-68%), except for an uninfected contaminated wound over the thorax, where both optimal and suboptimal compliance was very poor (1%). Veterinarians practicing at a university hospital had higher odds of compliance than general practice veterinarians (Odds ratio 3.2, 95% CI, 1.1-8.9, P = 0.03). MAIN LIMITATIONS Many survey responses were collected at conferences which may introduce selection bias, as veterinarians attending conferences may be more likely to have been exposed to contemporary antimicrobial prescribing recommendations. CONCLUSIONS Antimicrobial use guidelines need to be developed and promoted to improve the responsible use of antimicrobials in equine practice in Australia. An emphasis should be placed on antimicrobial therapy for wounds and appropriate dosing for procaine penicillin.
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Affiliation(s)
- L Y Hardefeldt
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - G F Browning
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - K Thursky
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - J R Gilkerson
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - H Billman-Jacobe
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
| | - M A Stevenson
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - K E Bailey
- Asia-Pacific Centre for Animal Health, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Victoria, Australia.,National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Carlton, Victoria, Australia
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Hardefeldt LY, Holloway S, Trott DJ, Shipstone M, Barrs VR, Malik R, Burrows M, Armstrong S, Browning GF, Stevenson M. Antimicrobial Prescribing in Dogs and Cats in Australia: Results of the Australasian Infectious Disease Advisory Panel Survey. J Vet Intern Med 2017; 31:1100-1107. [PMID: 28514013 PMCID: PMC5508328 DOI: 10.1111/jvim.14733] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/15/2017] [Accepted: 04/11/2017] [Indexed: 11/29/2022] Open
Abstract
Background Investigations of antimicrobial use in companion animals are limited. With the growing recognition of the need for improved antimicrobial stewardship, there is urgent need for more detailed understanding of the patterns of antimicrobial use in this sector. Objectives To investigate antimicrobial use for medical and surgical conditions in dogs and cats by Australian veterinarians. Methods A cross‐sectional study was performed over 4 months in 2011. Respondents were asked about their choices of antimicrobials for empirical therapy of diseases in dogs and cats, duration of therapy, and selection based on culture and susceptibility testing, for common conditions framed as case scenarios: 11 medical, 2 surgical, and 8 dermatological. Results A total of 892 of the 1,029 members of the Australian veterinary profession that completed the survey satisfied the selection criteria. Empirical antimicrobial therapy was more common for acute conditions (76%) than chronic conditions (24%). Overall, the most common antimicrobial classes were potentiated aminopenicillins (36%), fluoroquinolones (15%), first‐ and second‐generation cephalosporins (14%), and tetracyclines (11%). Third‐generation cephalosporins were more frequently used in cats (16%) compared to dogs (2%). Agreement with Australasian Infectious Disease Advisory Panel (AIDAP) guidelines (generated subsequently) was variable ranging from 0 to 69% between conditions. Conclusions and Clinical Importance Choice of antimicrobials by Australian veterinary practitioners was generally appropriate, with relatively low use of drugs of high importance, except for the empirical use of fluoroquinolones in dogs, particularly for otitis externa and 3rd‐generation cephalosporins in cats. Future surveys will determine whether introduction of the 2013 AIDAP therapeutic guidelines has influenced prescribing habits.
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Affiliation(s)
- L Y Hardefeldt
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
| | - S Holloway
- Advanced Vetcare, Kensington, Vic., Australia
| | - D J Trott
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, SA, Australia
| | - M Shipstone
- School of Veterinary Sciences, University of Queensland, Gatton, Qld, Australia
| | - V R Barrs
- Faculty of Veterinary Science, University of Sydney, Sydney, NSW, Australia
| | - R Malik
- Faculty of Veterinary Science, University of Sydney, Sydney, NSW, Australia
| | - M Burrows
- Animal Dermatology, Perth, WA, Australia
| | - S Armstrong
- Zoetis Animal Health, Rhodes, NSW, Australia
| | - G F Browning
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
| | - M Stevenson
- Faculty of Veterinary and Agricultural Sciences, Asia-Pacific Centre for Animal Health, University of Melbourne, Melbourne, Vic., Australia
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11
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Affiliation(s)
- LY Hardefeldt
- Goulburn Valley Equine Hospital; Congupna Victoria Australia
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12
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Tyner GA, Nolen-Walston RD, Hall T, Palmero JP, Couëtil L, Javsicas L, Stack A, Schott H, Johnson A, Hardefeldt L, Gruntman A, Sommardahl C, Menzies-Gow N, dePedro P, Norman T, Fennell LC, Axon JE, Lindborg S, Aceto H, Boston R, Engiles J. A multicenter retrospective study of 151 renal biopsies in horses. J Vet Intern Med 2011; 25:532-9. [PMID: 21382083 DOI: 10.1111/j.1939-1676.2011.0700.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Renal biopsies are uncommonly performed in horses and little is known about their diagnostic utility and associated complication rate. OBJECTIVE To describe the techniques, the complication rate, risk factors, and histopathology results; as well as evaluate the safety and diagnostic utility of renal biopsy in the horse. ANIMALS One hundred and forty-six horses from which 151 renal biopsies were obtained. Animals ranged in age from 48 hours to 30 years. METHODS Multicenter retrospective study, with participation of 14 institutions (1983-2009). RESULTS Renal biopsy in horses was associated with a similar rate of complications (11.3%) to that occurring in humans and companion animals. Complications were generally associated with hemorrhage or signs of colic, and required treatment in 3% of cases. Fatality rate was low (1/151; 0.7%). Biopsy specimens yielded sufficient tissue for a histopathologic diagnosis in most cases (94%) but diagnoses had only fair (72%) agreement with postmortem findings. Risk factors for complications included biopsy specimens of the left kidney (P = .030), a diagnosis of neoplasia (P = .004), and low urine specific gravity (P = .030). No association with complications was found for age, sex, breed, institution, presenting complaint, other initial clinicopathologic data, biopsy instrument, needle size, or use of ultrasonographic guidance. CONCLUSIONS AND CLINICAL IMPORTANCE Renal biopsy in horses has low morbidity and results in a morphological histopathologic diagnosis in 94% of cases. However, this procedure might result in serious complications and should only be used when information obtained would be likely to impact decisions regarding patient management and prognosis.
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Affiliation(s)
- G A Tyner
- Large Animal Internal Medicine Center, New Bolton Center, University of Pennsylvania, Kennett Square, PA 19348, USA
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Abstract
A 4-day-old alpaca cria presented for inappetence that responded to symptomatic treatment. The cria re-presented with acute signs of inappetence and azotaemia. The azotaemia persisted despite intravenous fluid therapy. There was no right kidney on ultrasound and there appeared to be perirenal oedema around the left kidney. A diagnosis of right renal agenesis and acute renal failure of the left kidney was made. The cria failed to improve and was euthanased. Necropsy examination confirmed right renal agenesis and agenesis of the right ureter and right renal artery. A section of left kidney submitted for histological examination revealed diffuse, acute, marked tubular degeneration and nephrosis. The cause of the renal failure in the left kidney was not determined.
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Affiliation(s)
- L Y Hardefeldt
- University Veterinary Centre Camden, Faculty of Veterinary Science, The University of Sydney, Camden, NSW, Australia
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