• 1. Baker SA, Van-Balen J, Lu B, et al. Antimicrobial drug use in dogs prior to admission to a veterinary teaching hospital. J Am Vet Med Assoc 2012; 241: 210217.

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  • 2. Weese JS. Investigation of antimicrobial use and the impact of antimicrobial use guidelines in a small animal veterinary teaching hospital: 1995–2004. J Am Vet Med Assoc 2006; 228: 553558.

    • Search Google Scholar
    • Export Citation
  • 3. Murphy CP, Reid-Smith RJ, Boerlin P, et al Out-patient antimicrobial drug use in dogs and cats for new disease events from community companion animal practices in Ontario. Can Vet J 2012; 53: 291298.

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    • Export Citation
  • 4. Jacob ME, Hoppin JA, Steers N, et al. Opinions of clinical veterinarians at a US veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections. J Am Vet Med Assoc 2015; 247: 938944.

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    • Export Citation
  • 5. Weese JS, Blondeau JM, Boothe D, et al. Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: Antimicrobial Guidelines Working Group of the International Society For Companion Animal Infectious Disease. Vet Med Int [serial online] 2011; 2011: 263768. Available at: www.hindawi.com/journals/vmi/2011/263768/. Accessed Nov 24, 2014.

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  • 6. Hillier A, Lloyd DH, Weese JS, et al. Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Vet Dermatol 2014; 25: 163175.

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Understanding companion animal practitioners’ attitudes toward antimicrobial stewardship

AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice
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The AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice was established by the AVMA Board of Directors in 2013 and charged with developing resources and programs to enhance antimicrobial stewardship in companion animal practice. While task force members have been working on developing these resources and programs, we have also been working to learn more about companion animal practitioners’ current knowledge of and opinions about antimicrobial resistance, both in their patients and as a public health issue. We have done this in the belief that antimicrobial stewardship resources will be useful to companion animal practitioners only if those resources address the interests and concerns of practitioners and if practitioners view antimicrobial stewardship as an important part of their practice and contribution to their communities.

To date, only a few studies1–3 have examined antimicrobial prescribing behaviors of and attitudes toward antimicrobial resistance among companion animal practitioners in North America. In this issue of the JAVMA, results of a survey4 of clinical veterinarians (faculty members, residents, and interns) at the North Carolina State University (NCSU) veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections are described. In an effort to further understand issues and priorities related to antimicrobial resistance and antimicrobial stewardship in companion animal practice, the task force conducted an informal survey of AVMA members earlier this year. The survey was distributed to 1,930 AVMA members who identified themselves as companion animal practitioners, of which 262 (13.6%) responded. Although results of this informal survey cannot be considered definitive, responses were generally consistent with previously published findings and therefore may be useful in identifying areas of further inquiry and attention.

In the NCSU survey,4 when respondents were asked to indicate (on a scale from 1 to 5, where 1 = very concerned and 5 = less concerned) how concerned they were about antimicrobial-resistant infections, 42 of 71 (59%) indicated that they were very concerned (ie, a score of 1). Similarly, in the task force's informal survey of AVMA members, 45% (118/260) indicated they were strongly concerned and 37% (96/260) indicated they were somewhat concerned about antimicrobial-resistant infections in dogs and cats. A majority (162/261 [62%]) of respondents felt that the way antimicrobials are used in small animal practice has an impact on overall antimicrobial resistance.

Although these results clearly show that veterinarians are concerned about antimicrobial-resistant infections in companion animals, other findings suggest that there are barriers to appropriate antimicrobial use. For instance, in the NCSU survey, when respondents were presented with a list of 12 factors and asked to score each (on a scale from 1 to 5, where 1 = most important and 5 = less important) in regard to importance when choosing an antimicrobial, results of bacteriologic culture and antimicrobial susceptibility testing were the most important factor. In our informal survey, however, 84% (218/259) of respondents strongly agreed or somewhat agreed that the cost of bacteriologic culture and antimicrobial susceptibility testing was a barrier to recommending these tests. In a study3 of companion animal practitioners in Canada, bacteriologic culture and antimicrobial susceptibility testing were performed in just 4% of the cases for which antimicrobials were prescribed.

Veterinarians responding to the task force's informal survey indicated that they would welcome more guidance regarding the choice of antimicrobials for various infections (196/254 [77%] strongly agreed or somewhat agreed) and the duration of antimicrobial treatment (218/262 [83%] strongly agreed or somewhat agreed). Gaps in knowledge and comfort level for appropriate prescribing among companion animal practitioners were illustrated in a study1 that examined the antimicrobial prescribing behaviors of referring veterinarians for the year prior to patient referral to The Ohio State University veterinary teaching hospital. That study1 found that for 197 of 549 (35.9%) cases examined, the duration of administration for antimicrobials that had been prescribed was not noted in the record. In addition, dose and route of administration were frequently not included.1

In another study,2 the use of guidelines was linked to a decrease in antimicrobial use overall and specifically in the use of third-line antimicrobials at the University of Guelph veterinary teaching hospital. However, most (218/247 [88%]) respondents to the task force's informal survey of AVMA members were unaware of the existence of antimicrobial use guidelines developed by veterinary professional organizations. Recent examples of prescribing guidelines include the Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease in Dogs and Cats5 and the Guidelines for the Diagnosis and Antimicrobial Therapy of Canine Superficial Bacterial Folliculitis6 issued by the International Society for Companion Animal Infectious Diseases.

Results of our informal survey of AVMA members were consistent with findings from previous studies about issues facing companion animal veterinarians with regard to selecting and prescribing antimicrobials. Infrequent antimicrobial susceptibility testing, incomplete record-keeping, and a lack of awareness of prescribing guidelines point to opportunities to enhance antimicrobial stewardship efforts. Providing support and resources for addressing these shortcomings could have an impact on antimicrobial prescribing behavior, which could in turn reduce antimicrobial resistance.

Gathering information about the use of antimicrobials by companion animal practitioners and the perceptions of these practitioners regarding antimicrobial resistance and antimicrobial stewardship will help the AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice tailor its efforts to the needs and interests of practicing small animal veterinarians. Antimicrobial stewardship can encompass a wide array of behaviors, programs, and interventions; not all of these are necessary or feasible in some clinical settings, but even small changes can have a positive impact. An antimicrobial stewardship program in a small clinic may look quite different from the program for a referral hospital, but every veterinary practice can contribute to the reduction of antimicrobial resistance by developing, instituting, and following an antimicrobial stewardship program that works for its particular setting. By adopting practices based on the best evidence available for reducing the development of antimicrobial resistance and adhering to those recommendations, companion animal veterinarians can improve the health of their patients while decreasing the public health burden.

References

  • 1. Baker SA, Van-Balen J, Lu B, et al. Antimicrobial drug use in dogs prior to admission to a veterinary teaching hospital. J Am Vet Med Assoc 2012; 241: 210217.

    • Search Google Scholar
    • Export Citation
  • 2. Weese JS. Investigation of antimicrobial use and the impact of antimicrobial use guidelines in a small animal veterinary teaching hospital: 1995–2004. J Am Vet Med Assoc 2006; 228: 553558.

    • Search Google Scholar
    • Export Citation
  • 3. Murphy CP, Reid-Smith RJ, Boerlin P, et al Out-patient antimicrobial drug use in dogs and cats for new disease events from community companion animal practices in Ontario. Can Vet J 2012; 53: 291298.

    • Search Google Scholar
    • Export Citation
  • 4. Jacob ME, Hoppin JA, Steers N, et al. Opinions of clinical veterinarians at a US veterinary teaching hospital regarding antimicrobial use and antimicrobial-resistant infections. J Am Vet Med Assoc 2015; 247: 938944.

    • Search Google Scholar
    • Export Citation
  • 5. Weese JS, Blondeau JM, Boothe D, et al. Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: Antimicrobial Guidelines Working Group of the International Society For Companion Animal Infectious Disease. Vet Med Int [serial online] 2011; 2011: 263768. Available at: www.hindawi.com/journals/vmi/2011/263768/. Accessed Nov 24, 2014.

    • Search Google Scholar
    • Export Citation
  • 6. Hillier A, Lloyd DH, Weese JS, et al. Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases). Vet Dermatol 2014; 25: 163175.

    • Search Google Scholar
    • Export Citation

Contributor Notes

Members of the Task Force for Antimicrobial Stewardship in Companion Animal Practice: Sharon E. Grayzel, DVM, MPH, Columbia Veterinary Center, 5106 NE 78th St, Vancouver, WA 98665; Jeff B. Bender, DVM, MS, Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108; Reilly P. Glore, DVM, Brady Veterinary Hospital, 450 Monte Brady Rd, Montesano, WA 98563 (representing the American Animal Hospital Association); Nigel Gumley, DVM, Canadian Veterinary Medical Association, 339 Booth St, Ottawa, ON K1R 7K1, Canada; Jane E. Sykes, BVSc, PhD, Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616; Jean M. Whichard, DVM, PhD, CDC, Mailstop G29, 1600 Clifton Rd, Atlanta, GA 30329; Mark G. Papich, DVM, MS, Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607; Jeffrey L. Watts, PhD, Anti-Infectives Research VMRD, Zoetis, 333 Portage St, Kalamazoo, MI 49009 (representing the Animal Health Institute); Tamar F. Barlam, MD, MSc, Infectious Disease Section, Boston Medical Center, 1 Boston Medical Center Place, Boston, MA 02118 (representing the Infectious Disease Society of America); Michael J. Murphy, DVM, PhD, Center for Veterinary Medicine, US FDA, 7519 Standish Place, Rockville, MD 20855; and Christine Hoang, DVM, MPH, AVMA, 1931 N Meacham Rd, Schaumburg, IL 60173.

Address correspondence to Dr. Grayzel (sgrayzel@comcast.net).