February 01, 2017

 

 Practices encouraged to be proactive about antimicrobials

​Posted Jan. 19, 2017

A report now available from the AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice provides a framework for instituting a clinic-level approach for judicious antimicrobial use, along with educational materials. The task force said this is an initial step to raise awareness and encourage broad action by companion animal veterinarians to help the profession combat the threat of antimicrobial resistance. 

“Within the past decade, many companion animal practitioners have been confronted with multidrug resistant infections for which there are limited effective antimicrobials. Practitioners are not uncommonly presented with pets infected with multidrug-resistant Escherichia coli, Klebsiella spp, and Staphylococcus spp, including methicillin-resistant Staphylococcus pseudintermedius. Fortunately, methicillin-resistant Staphylococcus aureus infections are less common in pets than in humans, but they have become a concern in companion animal practice,” the authors wrote in the report, part of which also appeared as a commentary (PDF) in JAVMA in 2015. “Multidrug-resistant infections are often associated with poor treatment outcomes and longer hospital stays. The antimicrobials most effective for these infections are often more expensive than the most commonly used veterinary antimicrobials and can cause more adverse reactions. Additionally, many of these organisms are found in both humans and companion animals, highlighting the possibility of zoonotic transmission.”

A key focus of the task force was to assemble these core elements of a companion animal stewardship program:

  • Each veterinary practice should commit to the reduction in antimicrobial resistance by creating and adopting a clinic-specific plan in which everyone contributes to effective antimicrobial stewardship.
  • Antimicrobial stewardship in a practice begins with the appointment of a principal person to lead the program and to support the practice stewardship goals with all available resources.
  • Practices should address issues of antimicrobial resistance by taking a proactive approach to antimicrobial use and infection control, using accepted guidelines, recommendations, and expertise.           
  • Understanding what is working and what is not requires self-assessment and monitoring, with a goal of continual improvement.

The AVMA Board of Directors approved the release of the task force’s final report this past November as information to the public and allied organizations. However, the document has not been approved as policy by the Board or House of Delegates.

The task force was established by the Board in 2013 and had been chaired by Dr. Jeff B. Bender, professor of veterinary public health at the University of Minnesota College of Veterinary Medicine, until it was sunset in spring 2015. Its goal had been to consider the emerging impact of multidrug-resistant organisms in companion animal practice and design approaches to address this challenge. Some of the activities the task force developed to help the profession combat antimicrobial resistance were devising assessments to better understand laboratory practices and practitioner prescribing behaviors, developing general do’s and don’ts of antimicrobial prescribing, and creating educational programs and materials for practitioners and clients. These are available here.

Additionally, the task force conducted a survey (PDF) of AVMA members in 2015 about their attitudes toward antimicrobial stewardship. Forty-five percent of respondents expressed strong concern about antimicrobial-resistant infections in dogs and cats, and an additional 37 percent indicated that they were somewhat concerned. Most veterinarians surveyed (62 percent) thought that the way antimicrobials are used in small animal practice has an impact on the overall antimicrobial resistance issue.

The task force was also interested in exploring barriers to appropriate antimicrobial use in companion animal practice. Eighty-four percent of respondents strongly agreed or somewhat agreed that the cost of culture and susceptibility testing was a barrier to recommending these tests.

The AVMA Committee on Antimicrobials, which was created last June, has taken on the work in this area. The committee is developing an entity vision statement and strategies for antimicrobial stewardship and is reviewing the Association’s antimicrobial use policies. Once the committee has had an opportunity to review the task force report in light of the committee’s vision and strategies, it plans to introduce recommendations.  

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