Knowledge, Attitudes, and Perceptions Associated With Antimicrobial Stewardship Among Veterinary Students: A Multi-Country Survey From Nigeria, South Africa, and Sudan

In African countries, antimicrobial resistance (AMR) issue remains pertinent. Despite this, little efforts have been made to assess the future veterinary prescribers on their knowledge, attitudes and practices (KAP) related to antimicrobial usage. This multi-country survey attempts to explore the KAP of future veterinarians on stewardship of antimicrobial and identify knowledge gaps. Eight veterinary schools participated from Nigeria, Sudan and South Africa. Data regarding perceptions and knowledge were analyzed using Chi-square χ² test, Spearman's (Rho) Rank order correlation and factor analysis using principal component factoring extraction method. Fifty-two percent of the study participants were final year veterinary students, respectively, and majority (77.2%) had no previous knowledge of biomedical sciences. Majority age were 22-27 years (24.7 ± 2.8) 79% and multiple career fields post-graduation were preferred. Overall, poor perceptions and knowledge of antimicrobial stewardship were observed with variations among countries and only 36.3% (n = 123) of the students were confident in their ability to choose the ideal antimicrobial agents for a specific patient/group of animals. The majority of the final year students were confident of their knowledge regarding AMR (68%), making of Gram staining (69.2%) and in choosing the most ideal route for administering a specific antimicrobial (74.7%). The final year students had significantly (p < 0.05) higher confidence level for knowledge compared with the pre-final year students. Tetracyclines, penicillins, and sulphonamides represent the three most abused veterinary antimicrobials with similar ranking across countries. South African (69.7 ± 20.5) and Sudanese (68.1 ± 15.4) had significantly (p < 0.0001) higher mean scores compared to the Nigerian students (44.3 ± 6.8) in the student's ability to correctly match some specific antimicrobials against their classes but Nigerian students performed better in ranking antimicrobials. This survey revealed poor to average knowledge of antimicrobial stewardship among veterinary students with significant knowledge gaps across the countries. It is recommended that the relevant regulatory and standardization authorities should make concerted efforts and interventions to regularly review curricula to ensure the delivery of targeted formative and normative training, and improved lectures on antimicrobial usage and stewardship in order to improve the awareness and behaviors of future prescribers. The identified knowledge gaps of veterinary medical students on antimicrobial stewardship must be bridge to safeguard the future.

Complex posttransplantation abnormalities of renal allografts: evaluation with MR imaging

PURPOSE

To assess the efficacy of magnetic resonance (MR) imaging in the evaluation of complex abnormalities of renal allografts.

MATERIALS AND METHODS

Clinical and radiologic findings were retrospectively reviewed in 24 patients who underwent MR imaging of a renal allograft because ultrasonographic (US) findings were inconclusive or discordant with clinical findings. The final diagnoses were established with histopathologic analysis (n = 16) or clinical and imaging follow-up (n = 8).

RESULTS

MR imaging diagnoses were correct in 16 patients (67%), whereas US diagnoses were correct in six patients (25%) (P < .05). Five cases of allograft involvement by posttransplantation lymphoproliferative disorder (PTLD) were found at histopathologic analysis; at MR imaging, PTLD appeared as hypointense masses on T1-and T2-weighted images with minimal enhancement. In four of the five cases of PTLD, the masses occurred at the renal hilum and encased hilar vessels. Normal morphology was correctly diagnosed with MR imaging in five patients in whom a mass was suspected at US.

CONCLUSION

MR imaging results are often diagnostic in cases of complex abnormalities of renal allografts. Renal allograft involvement by PTLD appears to have a relatively characteristic MR imaging appearance. Normal MR imaging findings in cases of suspected masses at US may obviate biopsy.