Change starts at home: summary of the 2023 inaugural Small Animal Antimicrobial Stewardship Workshop for US Veterinary Schools.

Small animal antimicrobial stewardship (AS) is emerging as a priority area in the global battle against antimicrobial resistance. Veterinary practices have limited support for implementation of AS programs, and even within veterinary schools, efforts are largely siloed and often limited in scope. Increased collaboration is needed to support and unify AS and infection prevention and control efforts, and to identify priorities for continued research. To address this, a 2-day in-person small animal AS workshop was held in August 2023. Delegates representing 23 US veterinary schools and 4 corporations/government agencies gathered for a series of lightning talks and focused group discussions in 3 domains: implementation of clinical AS programs, research opportunities and needs, and education. The workshop's goal was to identify and propose solutions for AS challenges. Meeting discussion identified a lack of resources and training as the greatest barriers to hospital AS program advancement and suggested creating standards for AS programs and a road map to support program development. Assessing antimicrobial treatment effects and performing studies to establish necessary treatment durations were considered the highest research priorities. Integrated educational practices were recommended to support unified messaging of AS concepts between preclinical and clinical training. The development of strategies to implement these suggestions was delegated to working groups with a goal to continue meeting biennially as a large group. Sharing news of these efforts is considered integral to heightening awareness and promoting implementation of AS practices moving forward in academic, specialty, and primary care settings.

A survey of US and Caribbean veterinary schools reveals strengths and opportunities in antimicrobial stewardship and infection prevention and control activities.

OBJECTIVE: To understand antimicrobial stewardship (AS) and infection prevention and control (IPC) activities in veterinary schools. METHODS: An online survey was completed by representatives from American Association of Veterinary Medical Colleges-accredited veterinary schools in the US and Caribbean prior to attending the Inaugural Small Animal Antimicrobial Stewardship Workshop for US Veterinary Schools. Responses were examined to identify patterns among AS and IPC activities and adherence to the AVMA core principles. RESULTS: Half (12 of 24) of the surveyed schools had an AS committee and most (79% [19 of 24]) had an IPC committee. Lack of dedicated staff time was a common barrier to AS (88% [21 of 24]) and IPC (75% [18 of 24]) reported by schools both with and without AS and IPC committees. Eleven of 24 schools (46%) reported performing at least 1 activity focused on each of the AVMA's 5 core principles of AS. Although 79% (19 of 24) of schools incorporate AS into preclinical curricula, training of clinical faculty (17% [4 of 24]), veterinary technicians and support staff (21% [5 of 24]), and house officers (42% [10 of 24]) is less common, despite these individuals engaging in teaching clinical-year veterinary students. CONCLUSIONS: Veterinary schools varied in established AS education and AS and IPC practices, though financial and human resources were a common barrier. CLINICAL RELEVANCE: A collaborative and cohesive approach to AS and IPC among schools to create sustainable frameworks for practice improvement will help combat the global threat of antimicrobial resistance. This is a critical action for settings where future veterinarians are trained.

Variation in knowledge, attitude, and practices toward antibiotic use among diplomates of the American Veterinary Dental College: a survey-based study.

OBJECTIVE: To evaluate the knowledge, attitudes, and practices toward antibiotic use among board-certified veterinary dentists. SAMPLE: 104 veterinarians board certified by the American Veterinary Dental College. METHODS: A 30-question survey was generated from an online platform and sent via email listserv to board-certified veterinary dentists. Responses were examined to identify patterns or correlations among the variables of interest. RESULTS: There were 104 board-certified veterinary dentists who responded. The majority reported using prophylactic intraoperative antibiotics sparingly for dental procedures and predominately for patients with historic endocarditis or on immunosuppressive doses of steroids. For healthy patients, they reported that antibiotics are often prescribed during jaw fracture repair, maxillectomy/mandibulectomy, and treatment of stage 4 periodontal disease or periapical lucencies. Knowledge of antibiotic resistance and evidence-based antibiotic use were not significantly different between different practice sectors (academia vs private practice) or dependent on the duration of board certification. Dentists who did not believe antibiotics used postoperatively reduce local postoperative infection rates were less likely to prescribe injectable intraoperative antibiotics for the prevention of postoperative infection. No other variables were associated with the likelihood of prescribing intraoperative antibiotics. More than 95% of veterinary dentists surveyed agreed that specific antibiotic use guidelines for veterinary dentistry would help reduce inappropriate use of antibiotics. CLINICAL RELEVANCE: There are differences among veterinary dentists regarding which procedures and patient-specific comorbidities they believe necessitate the use of prophylactic antibiotics. The development of a consensus statement and prospective studies of current antibiotic use are important next steps to improving antibiotic stewardship in veterinary dentistry.

Prevalence of antibiotic use for dogs and cats in United States veterinary teaching hospitals, August 2020.

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.

A quarterly Survey of antibiotic prescribing in small animal and equine practices-Minnesota and North Dakota, 2020.

Antimicrobials are critical for medicine, but the problem of antimicrobial resistance (AMR) threatens the effectiveness of these valuable drugs. In USA, there are no national- or state-level programs or policies in place to track antibiotic use (AU) in dogs, cats, and horses, despite acknowledgement of this sector's importance to both the AMR problem and its solution. AU measurement is a key part of antibiotic stewardship and AMR prevention. This study aimed to fill existing gaps in the veterinary professions' knowledge of antibiotic prescribing in small animals and horses. To address this aim, medical record data were collected on a single day per quarter for 1 year from 19 Minnesota and North Dakota small animal and equine practices, totaling 1,899 veterinarian consults of dogs, cats, and horses. Overall, 25.8% of all canine, feline, and equine consults involved an antibiotic prescription. Third-generation cephalosporins were the most commonly prescribed systemic antibiotic drug class, and the long-acting injectable drug, cefovecin, was the most commonly prescribed antibiotic for cats (34.5%). Topical antibiotic preparations were prescribed frequently, especially in dogs (42.5% of canine prescriptions), though systemic antibiotics were often prescribed concurrently. Common general indications, based on problem or diagnosis recorded in the medical record, for antibiotics in all species combined were skin conditions (24.4%), otitis (22.1%), ophthalmic (9.4%), gastrointestinal (8.3%), respiratory (8.3%), and urinary tract (7.6%) diseases. While 44.2% of patients for which antibiotics were prescribed had cytology performed, only 3.9% had bacterial culture and susceptibility performed. In a pre-study survey, veterinarians' recommendations for AU differed from actual prescribing, suggesting collection of AU data provides more accurate assessments of veterinary prescribing behaviour than surveys. This study shows feasibility of AU measurement in small animals and horses. The data collection tool and standard operating procedures described prove suitable for national AU data collection.

Serial point-prevalence surveys to estimate antibiotic use in a small animal veterinary teaching hospital, November 2018 to October 2019.

BACKGROUND: There is no standardized methodology to measure antibiotic drug use (AU) in small animal veterinary hospitals. OBJECTIVES: To estimate AU prevalence in a small animal veterinary teaching hospital and characterize usage by indication and evidence of infection. To establish an AU measurement methodology for veterinary settings. ANIMALS: Electronic medical records of cats and dogs seen by primary care, urgent care, emergency and critical care, internal medicine, and surgery services during November 2018 to October 2019. METHODS: On 1 day each month, data (signalment, visit reason, diagnostics, and antibiotic details, including indication) were collected for all animals seen on study services. RESULTS: Of 168 inpatient dogs and 452 outpatient dogs, 98 (58.3%) and 107 (23.7%,) were receiving at least 1 antibiotic on the day of data collection, respectively. For cats 15/49 (30.6%) inpatients and 29/187 (15.5%) outpatients were receiving at least 1 antibiotic. Common drug classes prescribed for dogs were potentiated penicillins (28.7%), first-generation cephalosporins (22.1%), and nitroimidazoles (14.7%), and for cats, common drug classes administered were potentiated penicillins (26.9%), fluoroquinolones (13.5%), and penicillins (11.5%). Common indications for antibiotics included skin, respiratory, gastrointestinal, perioperative, aural, and urinary conditions. CONCLUSIONS AND CLINICAL IMPORTANCE: Serial point-prevalence surveys (PPS) can estimate AU in a large specialty hospital setting and identify targets for antimicrobial stewardship. The methodology developed during this study can be adapted for use in private practice, including large animal practice. Mirroring methods used in human healthcare, the data collection tool can also be used to describe AU nationally through completion of national PPS.

Minnesota One Health Antibiotic Stewardship Collaborative: A Reproducible Approach to Facilitate Antimicrobial Stewardship Progress.

The Minnesota One Health Antibiotic Stewardship Collaborative (MOHASC) was launched in 2016 with the mission of providing a collaborative environment to promote judicious antibiotic use and antibiotic stewardship (AS) and to reduce the impact of antibiotic-resistant pathogens of human, animal, and environmental health importance. MOHASC goals include improving AS programs in healthcare and veterinary medicine, advancing understanding of environmental impacts of antibiotic use, and promoting a One Health (OH) approach to AS. These goals are accomplished through quarterly meetings of 4 work groups, field trips, collaborative research, an annual member meeting, and public education events. This novel OH approach has strengthened multidisciplinary relationships within Minnesota and led to procurement of funding to enhance AS initiatives beyond the Collaborative. This perspective serves as a blueprint for other jurisdictions, and we advocate for use of this reproducible OH strategy to facilitate broad AS goals.