Patterns of antimicrobial drug use in veterinary primary care and specialty practice: A 6‐year multi‐institution study

Goggs, Robert; Menard, Julie; Altier, Craig; Cummings, Kevin J.; Jacob, Megan E.; LaLonde‐Paul, Denise F.; Papich, Mark G.; Norman, Keri N.; Fajt, Virginia R.; Scott, H. Morgan; Lawhon, Sara D.

doi:10.1111/jvim.16136

Cited by 22 publications

(25 citation statements)

References 36 publications

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“…Unlike penicillins and fluoroquinolones, which are the most commonly prescribed antimicrobial drug classes, tetracyclines are rarely prescribed at Cornell University Hospital for Animals emergency (6%) and critical care (0.8%) services ( Robbins et al, 2020 ). These findings are similar to those recently reported in primary care and specialty practice across three academic veterinary hospitals (Cornell University, North Carolina State University, and Texas A&M University) in the United States ( Goggs et al, 2021 ). Tetracyclines are not excreted in urine at high levels in the canine population and are therefore not recommended to treat urinary infections ( Weese et al, 2019 ).…”

Section: Discussionsupporting

confidence: 90%

Antimicrobial resistance among canine enterococci in the northeastern United States, 2007–2020

Osman

Altier²,

Cazer³

2023

Front. Microbiol.

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IntroductionAntimicrobial 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.MethodsThrough 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.ResultsEnterococcus 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.ConclusionThere 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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Section: Discussionsupporting

confidence: 90%

Antimicrobial resistance among canine enterococci in the northeastern United States, 2007–2020

Osman

Altier²,

Cazer³

2023

Front. Microbiol.

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“…These studies primarily frame antimicrobial selection in the context of highly individualized choices made by a veterinarian for individual patients under individual client pressures (eg, preferences and financial resources). 45,46 A recent international literature review reported similar findings in other parts of the world. 49 There are increasing calls for a reframing of antibiotic use in veterinary practice as a product not solely of individual choices in an individual context, but as a result of systemic and structural pressures.…”

Section: Discussionsupporting

confidence: 56%

“…Professional organizations and veterinary colleges have launched surveillance systems, research and guidelines to assist veterinarians in this pursuit. 16,[44][45][46] The US Food and Drugs Administration Center for Veterinary Medicine has made antimicrobial stewardship in veterinary medicine a priority, although initial efforts primarily target agricultural settings in terms of research, funding and regulation. 47 Supporting antimicrobial stewardship and judicious use principles remain a critical issue in both human and veterinary contexts.…”

Section: Discussionmentioning

confidence: 99%

Outbreak management of multidrug-resistant Bordetella bronchiseptica in 16 shelter-housed cats

Rodriguez¹,

Berliner

2023

Journal of Feline Medicine and Surgery

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Case series summary This case series describes an outbreak of multidrug-resistant (MDR) Bordetella bronchiseptica in 16 shelter-housed cats with infectious respiratory disease. Four cats presented with acute dyspnea on the same day, each with a history of previous upper respiratory disease that had resolved with treatment. Early diagnostic testing and culture and sensitivity allowed for targeted antimicrobial therapy and environmental interventions. A case definition based on exposure and clinical signs identified 12 additional presumptive cases, including the likely index case. Comprehensive outbreak management included diagnostic testing, risk assessment, vaccination, use of isolation and quarantine, increased surveillance and review of biosecurity practices. The outbreak resolved in 26 days. Relevance and novel information Management of an MDR B bronchiseptica outbreak in shelter-housed cats has not been previously described. Along with standard population and environmental measures, early and appropriate use of necropsy, PCR and bacterial culture allowed rapid and appropriate use of effective, second-line antibiotics. Shelters are resource-challenged population centers. Veterinarians working in animal shelters can play an important role in helping to develop cost-efficient and effective antimicrobial stewardship practices for companion animal settings. Outbreak management expertise and funding for diagnostic testing, as well as application of the principles of antimicrobial stewardship, are essential components of shelter medicine practice.

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“…Compared with human medical practice, companion animal practice in Australia uses antibiotics relatively infrequently; antimicrobial exposure per life-year in dogs and cats is less half that of Australian people, and the proportion of dog and cat prescriptions representing the highest priority critically important antimicrobials (HPCIAs) is low [ 2 ]. While companion animal practitioners in several other countries use higher proportions of HPCIAs, particularly third-generation cephalosporins and fluoroquinolones [ 3 , 4 , 5 , 6 , 7 , 8 ], there is undoubtedly scope in all countries to improve antimicrobial use in companion animal practice [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Pet Owners and Antibiotics: Knowledge, Opinions, Expectations, and Communication Preferences

et al. 2021

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Despite the important role of antimicrobial use in companion animals in the global challenge presented by antimicrobial resistance (AMR), very few studies have quantified pet owner factors that can contribute to suboptimal veterinary antimicrobial use. We conducted an online survey of pet owners, asking about their experiences with veterinarians, their opinions on antibiotic use and knowledge of antibiotics, and their communication preferences regarding judicious prescribing. Just over half (54%) of the 558 pet owners had received antibiotics for their pet at their last non-routine veterinary consultation and most owners were happy (83%) with the antibiotic prescribing decision of their veterinarian. A quarter (25%) indicated that they had been surprised, disappointed or frustrated when a veterinarian had not given their pet antibiotics; 15% had explicitly requested them. Owners placed a higher priority on their pet receiving the most effective treatment than on treatment being cheap or convenient. Most respondents recognized the limitations of antibiotic therapy and the risks associated with antibiotic use, but 50% believed the risks were confined to the treated animal; only a minority was aware of inter-species transfer of bacteria. Pet owners indicated that they would find judicious prescribing messages focused on the direct risks of antibiotics to their pet more compelling than those about public health. Our findings suggest that veterinary communications about responsible antibiotic use should focus on pet owners’ priorities and address or bypass their gaps in understanding regarding antibiotic resistance.

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Patterns of antimicrobial drug use in veterinary primary care and specialty practice: A 6‐year multi‐institution study

Cited by 22 publications

References 36 publications

Antimicrobial resistance among canine enterococci in the northeastern United States, 2007–2020

Antimicrobial resistance among canine enterococci in the northeastern United States, 2007–2020

Outbreak management of multidrug-resistant Bordetella bronchiseptica in 16 shelter-housed cats

Pet Owners and Antibiotics: Knowledge, Opinions, Expectations, and Communication Preferences

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