Understanding the relationship between pet owners and their companion animals as a key context for antimicrobial resistance-related behaviours: an interpretative phenomenological analysis

Efficacy of continuous education and determinants of antimicrobials prescription behavior in companion animal veterinarians from Quebec, Canada

Highly important antimicrobial use in veterinary companion animal medicine is frequent and in some cases unjustified. Establishing cautious and evidence-based prescription practices in veterinary companion animal medicine should be one of the key objectives of One Health antimicrobial stewardship initiatives. We aimed to (1) develop a training program on antimicrobial use in veterinary companion animal medicine in Quebec, Canada, (2) quantify the impact of this training on the use of highly important antimicrobials, and (3) identify the factors that could limit such an impact. A total of 54 veterinarians from 35 veterinary facilities participated in the study. Antimicrobials were identified from electronic medical records, prescription rates were calculated and a difference-in-differences estimation was used to compare prescription rates pre- and post-training in 2023, controlling for seasonal trends during the same period in 2022. Participating veterinarians prescribed on average 11.7 antimicrobial treatments per 100 consultations. Two thirds of the systemic antimicrobials prescribed by participants were antimicrobials of very high medical importance, according to Health Canada. Amoxicillin-clavulanic acid was the most often prescribed antimicrobial and accounted for approximately 22 % of all prescriptions. The training had a limited impact on overall prescription rates. However, a reduction of 55 % in prescription rate was observed for metronidazole, which is most often prescribed in canine patients with acute diarrhea. Interviews were conducted with 11 participating veterinarians to identify obstacles to the implementation of recommended prescription practices. The main obstacles identified were pet owner expectations, fear of therapeutic failure, lack of confidence in the recommendations and unavailability of therapeutic alternatives.

Antimicrobial Use and Antimicrobial Resistance in Food-Producing Animals: Cross-Sectional Study on Knowledge, Attitudes, and Practices Among Veterinarians and Operators of Establishments in the Republic of Cyprus

Background: Current evidence suggests that more than half of all antimicrobials are used in the sector of food-producing animals, thus constituting a major risk factor for development and spread of antimicrobial resistance (AMR). Methods: This cross-sectional study assessed the knowledge, attitudes, and practices regarding antimicrobial resistance (AMR) and antimicrobial use (AMU) among veterinarians (n = 26) working with food-producing animals and operators (n = 165) of establishments that keep food-producing animals, across all districts of Cyprus between October and December 2024. Results: Most veterinarians demonstrated sufficient knowledge regarding AMR and AMU; however, certain knowledge gaps were identified. There was a general trend toward desired responses aimed at reducing AMU. Despite this, the level of responses advocating for restrictions on the use of specific priority antimicrobials and broad-spectrum antibacterials was unsatisfactory. Over half of veterinarians prescribed Category B substances. Furthermore, there was no significant association between the use of "restricted" antibiotics and veterinarians' level of knowledge nor between antibiotic use and the practice of microbiological culture and susceptibility testing. Among operators, positive attitudes were significant predictors of implementing of good practices. Additionally, operators who had contracts with a veterinarians were more likely to follow good practices. Conclusions: There is a need for further education on AMR in the veterinary sector in the Republic of Cyprus. Raising awareness among animal producers, is also crucial, along with enforcing a policy on antimicrobial use. Comprehensive governance involving all stakeholders must be implemented to address AMR more effectively.

Pet Owners' Knowledge of Antibiotic Use and Antimicrobial Resistance and Their Antibiotic Practices: Comparison Between Contexts of Self and Pet

Objective: This study aimed to compare pet owners' knowledge of antibiotic use, understanding of antimicrobial resistance (AMR) and antibiotic practices for themselves and their pets to guide behavioral interventions to reduce AMR. Methods: A cross-sectional study conducted between March 2023 and December 2023 involved 1080 pet owners recruited from 16 veterinary clinics in Singapore. An anonymous self-administered survey assessed the participants' knowledge of antibiotic use and AMR as well as their adherence to recommended antibiotic practices for themselves and their pets. McNemar's Chi-square test was used to identify significant differences in the outcome variables between self and pets. The differences between the type of pet owned (dog owner/non-dog owner) were assessed using Pearson's Chi-square test. Results: Among the 1080 pet owners surveyed, poorer knowledge of antibiotic use (46.3% vs. 33.2%; p < 0.001) and inappropriate antibiotic use (33.9% vs. 23.5%; p < 0.001) was more common for participants' pets than for themselves. Compared to dog owners, non-dog owners had poorer knowledge of antibiotic use for their pets (poor knowledge, 55.2%; 42.4%; p < 0.001), but the knowledge of AMR occurrence and antibiotic practices did not differ between the dog owners and the non-dog owners. Conclusions: Pet owners have significantly poorer antibiotic use knowledge and antibiotic practices for their pets than for themselves. Compared to dog owners, non-dog owners have poorer knowledge of antibiotic use. Educational initiatives addressing pet owners' knowledge deficits may improve their antibiotic practices for their pets and themselves, emphasizing the importance of cross-sectoral One Health planning.

Exploring pet owners' attitudes toward compounded and human approved medicines: a questionnaire based pilot study

With the growing global pet population and increased spending on veterinary care, compounded medications offer customized, often more suitable and affordable treatment options compared to the limited available veterinary medications. This research aims to understand pet owners' attitudes towards compounded medications, focusing on their challenges and needs. A total of 300 respondents from the territory of Novi Sad, province of Vojvodina, Republic of Serbia completed the questionnaire, through face-to-face interviews at veterinary clinics. Pet owners stated that the majority of companion animals were dogs (66.7%), followed by cats (22.8%). A significant portion of them received medication in the past five years (70.7%), while nearly half of them were human-approved (47.9%) out of which more than half (55%) of the pets received antimicrobials for systemic use. Although the majority of pets did not receive compounded medication (79.8%), respondents believed that both they and their pets would benefit from it. Only small fraction of respondents knew that local pharmacies had the ability to compound medications for pets (14.5%). In the era of personalized medicine, compounded medication for specialized needs play an important role providing optimum therapy for veterinary patients. However, limitations persist, including variability in formulation quality, limited regulatory oversight, and challenges in ensuring consistency in potency and stability, as well as decreased efficacy for certain drugs and the challenges related to the lack of pharmacokinetic data for some administration routes. By customizing treatments for individual veterinary patients, we can optimize antimicrobial use, reduce the selective pressure that drives resistance, and enhance patient outcomes, while acknowledging the need for careful oversight and quality control in compounding practices to ensure safety and efficacy.

Self-reported frequency of handwashing among pet and non-pet owners in different situations: results of four surveys of the general adult population in Germany

BACKGROUND

Zoonotic diseases are partly associated with pets. However, data is sparse on pet owners' compliance with preventive recommendations. Also, research focuses on self-reports, which are subject to overestimation biases, i.e., assessing one's actual performance to be better than it is. One reason is task difficulty: people tend to overestimate their performance on hard tasks. Regarding handwashing, compliance after touching animals should be harder for pet vs. non-pet owners due to the number of opportunities. This study tests for differences in self-reported handwashing between pet and non-pet owners, and explores reasons for non-compliance. Thus, it aims to provide insights on how to improve self-report behavioral assessment methods in public health and One Health research.

METHODS

Data from cross-sectional computer-assisted telephone surveys of the general population in Germany aged 16-85 years in 2012, 2014, 2017 and 2019 were analyzed (N = 15,559; response rate: 45.9%). Handwashing frequency was operationalized for nine indications using the item "How often do you wash your hands in each of the following situations: 'never/almost never', 'seldom', 'mostly', 'always/almost always'?", with the latter defining compliance. In 2017 and 2019, those reporting to 'never/almost never' or 'rarely' wash hands were questioned regarding possible reasons. Chi²-tests, Cohen's d's and multiple logistic regressions were used.

RESULTS

Pet and non-pet owners differed in self-reported handwashing compliance primarily in the indication "After touching animals" (35.5% vs. 55.7%, effect size: d = 0.45). For other indications (e.g., "After using the toilet"), differences were insignificant (≤|3.6%|, d ≤ 0.11). Additionally, 79% of pet owners who rarely or almost never washed their hands after touching animals felt it is not necessary (non-pet owners: 67.1%; d = 0.34). Reporting to not have an appropriate washing facility available was rarer among pet owners (44.5% vs. 63%, d = 0.41). Differences regarding other reasons were trivial (d ≤ 0.16), including "It takes too long" (16.9 vs. 13.3%; p = .138 in multiple regression).

CONCLUSIONS

Study limitations include that due to unknown true compliance, over- and underestimations have to be inferred. Yet, that the only substantial difference between pet and non-pet owners pertained to "After touching animals" suggests such effects. While pet owners obviously adjust for task difficulty, the likely residual overestimation should be reduced by measures using script-based covert recall or survey items with response categories constructed to better resemble subjective compliance ratios.

Raw meat diets are a major risk factor for carriage of third-generation cephalosporin-resistant and multidrug-resistant E. coli by dogs in the UK

Introduction

Raw-meat diets (RMD) for dogs, comprising unprocessed or non-heat-treated animal material, are increasingly popular. However, RMDs have been demonstrated to be contaminated with antimicrobial resistant (AMR) bacteria, and there is concern that such diets may pose a zoonotic disease risk. Additionally, dogs fed RMD may shed more AMR- fecal bacteria compared to those fed conventional cooked diets. Data from the UK remain limited; the present study investigated the presence of AMR-Escherichia coli in the feces of RMD and non-RMD (NRMD)-fed dogs in the UK, the E. coli AMR gene complement, and the lifestyle risk factors associated with AMR- E. coli carriage.

Methods

Fecal samples from UK-owned dogs (N = 193 RMD, N = 239 NRMD) and questionnaires discussing lifestyle factors, were obtained between October 2020-August 2021. Samples underwent culture and antimicrobial susceptibility testing to determine the presence of AMR-E. coli. Whole genome sequencing determined AMR gene carriage. Risk factors for the presence of AMR-E. coli were determined by multivariable modeling.

Results

RMD dogs carried significantly more fecal AMR E. coli (p < 0.001), including third-generation cephalosporin resistant, extended-spectrum beta-lactamase (ESBL) producing, and multidrug resistant isolates and multivariable modeling confirmed raw-meat diets to be a significant risk factor. The bla CTX-M-15 gene was the most frequently identified bla ESBL gene. The bla CTX-M-55 and bla SHV-66 genes were also prevalent and were only found in RMD dogs. The mobile colistin resistance gene, mcr-4 was identified in one ESBL-producing E. coli isolate from a NRMD-fed dog.

Conclusion

This study has shown that dogs fed RMD in the UK are significantly more likely to shed E. coli which is resistant to highest priority critically important antibiotics, and multidrug resistant E. coli, than dogs fed NRMD. Additionally, AMR-E. coli isolates from RMD-fed dogs harbor multiple, diverse, and novel AMR genes. Therefore, provision of RMD to dogs could pose an important potential threat to human and animal health, especially given the close nature of the relationship many owners share with their pets. Awareness of these findings should be shared with pet owners, veterinary and medical professionals, pet food manufacturers and public health to mitigate potential risks.

Horse Sector Participants' Attitudes towards Anthropomorphism and Animal Welfare and Wellbeing

Anthropomorphizing can misinform the making of inferences about animal mental experiences. This is a consideration when implementing the Five Domains Model for animal welfare assessment. An online survey run in 2021 captured horse sector participants' perspectives about anthropomorphism and wellbeing in relation to horses. Most respondents, 82.9% (n = 431/520), believed that anthropomorphism could influence horse welfare and wellbeing. These respondents were then asked how, in their opinion, anthropomorphism might relate to horse welfare. A thematic analysis identified two themes: (1) 'Anthropomorphism can influence how people relate to horses' and (2) 'Anthropomorphism can have consequences for horse welfare and wellbeing'. The results suggested that experienced respondents were aware of the complexities surrounding anthropomorphic attitudes and that anthropomorphism can have beneficial and detrimental consequences on horse welfare and wellbeing. Benefits include a sense of relatedness to a horse, while detriments include the potential to misinterpret horse behaviors. The authors propose that anthropomorphism has a place in horse welfare and wellbeing when used critically and with caution. This study recommends that there is a need to actively manage anthropomorphism when organizations update policies and practices and implement the Five Domains Model. More research is required to understand the effects of anthropomorphism on horse-related practices.

Companion Animal Owners' Knowledge, Attitudes and Perceptions Regarding Antibiotic Use in Portugal

While multiple studies have focused on the motivations surrounding antibiotic prescription among veterinarians, little is known about companion animal owners' knowledge, attitude and perception (KAP) regarding the topic. A nationwide survey directed toward Portuguese dog and cat owners was conducted online and at veterinary practices to characterize their KAP regarding antibiotics. After database curation, a total of 423 valid submissions were considered. Although 97.9% of respondents stated that they knew what an antibiotic was, 23.5% and 19.2% answered that they were used to treat viral and fungal infections, respectively. Antimicrobial effectiveness was favored over cost when 87.7% of owners agreed they would prefer to spend more money to identify the appropriate antibiotic. Around 87% of respondents recognized antibiotic resistance as a significant health problem and 74.6% strongly agreed/somewhat agreed that antibiotic use in pets may contribute to resistance development. However, only 25.3% recognized that this could promote resistance dissemination, showing little awareness of the interconnection between human and animal health. Moreover, 55.6% of respondents were neutral when asked whether antibiotics used in veterinary medicine were also important for humans. These findings suggest that communication between veterinarians and pet owners can still be improved to further clarify the impact that antibiotic use has in pets from a One-Health perspective, also enabling antimicrobial stewardship interventions.

Decision making on antimicrobial use: Cat and dog owners' knowledge and preferences for veterinary communication

BACKGROUND

Veterinarians' understanding of cat and dog owners' perceptions about antimicrobial use will enhance their ability to communicate with clients to uphold antimicrobial stewardship guidelines.

METHODS

A total of 571 cat and dog owners were surveyed via an online platform to understand their antimicrobial knowledge and preferences for veterinary communication in antimicrobial use decision making. Data were analysed descriptively and inferentially to determine relationships between variables.

RESULTS

Cat and dog owners' backgrounds had an impact their antimicrobial knowledge. Women, individuals with a university degree, those with a health/science background and those identifying as white had a higher level of knowledge of antibiotics and antibiotic resistance. Owners' trust in veterinarians positively impacts adherence to recommendations. Where there was a strong preference for one type of messaging regarding antimicrobial use and stewardship, the owner's background was not predictive of a difference in response.

LIMITATIONS

The study population was mostly white, which reflects the US population and the reported distribution of pet owners who own dogs and cats. Respondents may have been susceptible to recall bias and/or social desirability bias.

CONCLUSION

Veterinarians should tailor their communication to meet clients' level of knowledge and rely on competent communication to enhance understanding and facilitate adherence to antimicrobial stewardship guidelines.

Method in limbo? Theoretical and empirical considerations in using thematic analysis by veterinary and One Health researchers

This article spans a number of theoretical, empirical and practice junctures at the intersection of human and animal medicine and the social sciences. We discuss the way thematic analysis, a qualitative method borrowed from the social sciences, is being increasingly used by veterinary and One Health researchers to investigate a range of complex issues. By considering theoretical aspects of thematic analysis, we expand our discussion to question whether this tool, as well as other social science methods, is currently being used appropriately by veterinary and human health researchers. We suggest that additional engagement with social science theory would enrich research practices and improve findings. We argue that considerations of 'big theory' - ontological and epistemological positionings of the researcher - and 'small(er)' theory, the specific social theory in which research is situated, are both necessary. Our point of departure is that scientific discourse is not merely construction or ideology but a unique and continuing arena of debate, in part at least because of the elevation of self-criticism to a central tenet of its practice. We argue for further engagement with the core ideas and concepts outlined above and discuss them in what follows. In particular, and by way of focusing the point, we suggest that for veterinary, One Health, and human medical researchers to use thematic analysis to its maximum potential they should be encouraged to engage with both broader socio-economic theories and with questions of ontology and epistemology.

Evidence for the transmission of antimicrobial resistant bacteria between humans and companion animals: A scoping review

Objective

Transmission of antimicrobial resistant bacteria between people and household pets, such as dogs and cats, is an emerging global public health problem. This scoping review synthesized existing evidence of human-pet bacteria transmission to understand the magnitude and breadth of this issue.

Methods

The search included specific and generic terms for bacteria, resistance, transmission, pets, and humans. Searches were conducted through PubMed, Scopus, Web of Science, CABI Global Health, Networked Digital Library of Theses and Dissertations, Google Scholar. All studies published in English and Mandarin that isolated bacteria from pets (cats and dogs) and humans who had contact with the pets, and reported phenotypic or genotypic antimicrobial sensitivity test results, were included in this review. In cases of bacterial species that are commonly associated with pets, such as Staphylococcus pseudintermedius and Pasteurella multocida, we also included studies that only isolated bacteria from humans.

Results

After removing duplication, the search captured 9355 studies. A total of 1098 papers were screened in the full-text review, and 562 studies were identified as eligible according to our inclusion criteria. The primary reason for exclusion was the lack of sensitivity testing. The included studies were published between 1973 and 2021. The most common study location was the United States (n = 176, 31.3%), followed by the United Kingdom (n = 53, 9.4%), Japan (n = 29, 5.2%), and Canada (n = 25, 4.4%). Most of the included studies were case reports (n = 367, 63.4%), cross-sectional/prevalence studies (n = 130, 22.4%), and case series (n = 51, 8.8%). Only few longitudinal studies (n = 14, 2.4%), case-control studies (n = 12, 2.1%), and cohort studies (n = 5, 0.9%) were included in our review. Most studies focused on Pasteurella multocida (n = 221, 39.3%), Staphylococcus aureus (n = 81, 14.4%), and Staphylococcus pseudintermedius (n = 52, 8.9%). For the 295 studies that used strain typing methods to compare bacteria from humans and pets, most used DNA banding pattern-based methods (n = 133, 45.1%) and DNA sequencing-based methods (n = 118, 40.0%).

Conclusion

Transmission of bacteria could occur in both directions: pets to humans (e.g., S. pseudintermedius and P. multocida) and humans to pets (e.g., S. aureus). The majority of studies provided a low level of evidence of transmission (e.g., case reports), suggesting that more rigorous longitudinal, cohort, or case-control studies are needed to fully understand the risk of human-pet resistant bacterial transmission.

Epidemiology of companion animal AMR in the United States of America: filling a gap in the one health approach

Introduction

Antimicrobial resistance (AMR) is a global health concern that affects all aspects of the One Health Triad, including human, animal, and environmental health. Companion animals, such as cats and dogs, may contribute to the spread of AMR through their close contact with humans and the frequent prescription of antimicrobials. However, research on AMR in companion animals is limited, and there are few surveillance measures in place to monitor the spread of resistant pathogens in the United States.

Methods

This study aims to explore the practicality of using data from commercial laboratory antimicrobial susceptibility testing (AST) services for epidemiological analyses of AMR in companion animals in the United States.

Results

The study analyzed 25,147,300 individual AST results from cats and dogs submitted to a large commercial diagnostic laboratory in the United States between 2019 and 2021, and found that resistance to certain antimicrobials was common in both E. coli and S. pseudintermedius strains.

Conclusion

There has been a paucity of information regarding AMR in companion animals in comparison to human, environmental and other animal species. Commercial AST datasets may prove beneficial in providing more representation to companion animals within the One Health framework for AMR.

Colorado pet owners' perceptions of and attitudes towards antimicrobial drug use and resistance

BACKGROUND

Antimicrobial drug (AMD) use in companion animal medicine may contribute to antimicrobial resistance (AMR) in both pets and humans. However, pet owners' attitudes and perceptions regarding AMD use and AMR have not been extensively studied in the United States.

METHODS

A cross-sectional survey at five Colorado veterinary hospitals collected information about pet owners' knowledge and perceptions of AMD use and AMR, adherence with AMD treatment instructions and the role of the veterinarian in the AMD prescribing process.

RESULTS

The pet owners surveyed did not have an adequate understanding of AMR and were unaware of the potential human health impact of AMD use in pets. However, most pet owners reported adherence with veterinary prescription instructions and indicated that they trusted their veterinarian to make appropriate decisions for their pets.

LIMITATIONS

The cross-sectional design focusing on Colorado pet owners limits the generalisability of the results. Selection and social desirability biases may have occurred, which could have affected who participated and how participants responded to statements.

CONCLUSIONS

Pet owners play an important role in the AMD prescription process, and their lack of AMR understanding should be addressed in antimicrobial stewardship plans. Further research on how to effectively incorporate pet owners into  stewardship interventions is needed.

A Familiar Outbreak of Monophasic Salmonella serovar Typhimurium (ST34) Involving Three Dogs and Their Owner's Children

Salmonella is a Gram-negative enteric bacterium responsible for the foodborne and waterborne disease salmonellosis, which is the second most reported bacterial zoonosis in humans. Many animals are potential sources of salmonellosis, including dogs, cats, and other pets. We report the case of an outbreak of salmonellosis in a family in central Italy, affecting two children and involving their three dogs as carriers. One of the children needed medical care and hospitalisation. Isolation and analysis of stool samples from the sibling and the animals present in the house were carried out. Serotyping allowed the identification of S. enterica subsp. enterica serovar Typhimurium in its monophasic variant for all the isolates. The results of whole-genome sequencing confirmed that the strains were tightly related. The minimum inhibitory concentration (MIC) test documented the resistance to ampicillin, sulfamethoxazole, and tetracycline. The origin of the zoonotic outbreak could not be assessed; however, the case study showed a clear passage of the pathogen between the human and non-human members of the family. The possibility of a transmission from a dog to a human suggests the need for further studies on the potential ways of transmission of salmonellosis through standard and alternative feed.

Antimicrobial Resistance and Prevalence of Extended Spectrum β-Lactamase-Producing Escherichia coli from Dogs and Cats in Northeastern China from 2012 to 2021

(1) Background: there has been a growing concern about pet-spread bacterial zoonosis in recent years. This study aimed to investigate the trend in drug-resistance of canine Escherichia coli isolates in northeast China between 2012-2021 and the differences in drug-resistance of E. coli of different origins in 2021. (2) Methods: E. coli were isolated from feces or anal swab samples from dogs and cats, and their antibiotic susceptibility profiles and phylogenetic grouping were identified. PCR was applied on the extended spectrum β-lactamase (ESBL) E. coli for antibiotic resistance genes. (3) Results: five hundred and fifty-four E. coli isolates were detected in 869 samples (63.75%). The multidrug resistance (MDR) rates of E. coli in pet dogs showed a decreasing trend, but working dogs showed the opposite trend. Resistance genes blaCTX-M and blaCTX-M+TEM were dominant among the ESBL producers (n = 219). The consistency between the resistance phenotypes and genes was high except for fluoroquinolone-resistant ESBL E. coli. All ESBL E. coli-carrying blaNDM were isolated from working dogs, and one of the strains carried mcr-1 and blaNDM-4. Phylogroup B2 was the dominant group in pet cats, and more than half of the isolates from companion cats were ESBL E. coli. (4) Conclusions: the measures taken to reduce resistance in China were beginning to bear fruit. Companion cats may be more susceptible to colonization by ESBL E. coli. The problem of resistant bacteria in working dogs and pet cats warrants concern.

Monitoring antimicrobial usage in companion animals: exploring the use of the Danish VetStat database

BACKGROUND

In the Danish Veterinary Statistics Program, VetStat, sales data on medicinal products prescribed for veterinary consumption is collected. The Danish Food and Veterinary Administration (DVFA) manages the database and each purchase contains detailed product-specific information linked with a species-specific ID. National surveillance systems are also implemented or being developed in the other European Union Member States. By 2029, all Member States are required to report data on antimicrobial usage for companion animals to the European Medicines Agency. This study aimed to assess the challenges encountered when using the VetStat database to quantify antimicrobial use in Danish companion animals. Raw VetStat data were propagated by the DVFA and originated from veterinary practitioners and Danish pharmacies.

RESULTS

Comprehensive estimates of antimicrobial use in Danish companion animals were not readily available due to database construct. Antimicrobials sold for use in companion animals (linked to a companion animal ID) comprised a large number of products licensed solely for horses or livestock, while data assigned a replacement code encompassed both topical and peroral antimicrobials licensed for companion animals. Additionally, antimicrobials sold from pharmacies to veterinary practitioners presented the biggest challenge in data retrieval and validation. Treatment data are only transferred to VetStat through the billing systems when Danish veterinarians are treating livestock, but not companion animals. Information on products sold for in-house use in companion animals is only available from pharmacy records without a species-specific ID. As a result, parenteral antimicrobials with multi-species authorization utilized by small animal veterinary practitioners are not accounted for in the overall estimate for companion animals.

CONCLUSIONS

Owing to the database structure and requirements for data entry, antimicrobial use in companion animals is an approximation. The actual consumption may be significantly higher than what is currently calculated from the database, as the majority of parenteral products are not included. Consumption data can be measured more accurately provided treatment data from veterinary practitioners in small or mixed practices are transferred to the database through the billing system. This would equal the legal requirements for Danish veterinary practitioners treating livestock.

Exploring companion animal caretakers' attitudes, perceptions and behavioural drivers of antimicrobial use within the social context of veterinary care

OBJECTIVE

To explore companion animal caretakers' attitudes, perceptions and behavioural drivers of antimicrobial use within the social context of veterinary care.

MATERIALS AND METHODS

Five semi-structured focus groups were conducted with 26 cat and dog owners. Transcripts were subjected to thematic analysis to systematically code and classify themes related to the study objectives.

RESULTS

Thematic analysis revealed five themes - trust-building/relationships, shared decision-making/empowerment, clear communication, judicious use and concerns surrounding antimicrobial use. Strong veterinarian-client relationships were the underlying factor influencing acceptance of antimicrobial use stewardship principles. Participants viewed themselves as advocates for their animals and preferred a relationship-centred approach to care facilitated through competent communication. They cited the importance of clear communication related to diagnosis and antimicrobial recommendations including using client-friendly terminology, providing explicit instructions for antimicrobial use, and having a shared plan for next steps and follow-up communication. Participants reported challenges with administering antimicrobial drugs, expressed concerns with potential side effects and development of antimicrobial resistance. Consequently, they reported an interest in alternatives to antimicrobial drugs and a focus on preventive medicine that was counterbalanced with concerns for animal comfort and welfare.

CLINICAL SIGNIFICANCE

Conversations about antimicrobial use can be reframed to include alternatives to antimicrobials as part of the treatment plan, and clients can be empowered to play a more active role in their animals' care. Veterinarians can apply core communication skills to advance antimicrobial stewardship principles and thereby contribute to preserving the effectiveness and availability of antimicrobials while preserving the trusting relationship and shared decision-making between clients and veterinarians.

Veterinary Practitioners' Standpoints and Comprehension towards Antimicrobial Use-Are There Opportunities for Antimicrobial Stewardship Improvement?

The main subject of the research is the assessment of the knowledge, attitudes and behaviors of veterinarians regarding the use of antibiotics (AMU) and antimicrobial resistance (AMR) through a questionnaire conducted among veterinarians in the northern region of Serbia. A total of 62 respondents completed the questionnaire, which represents a response rate of 44.3%. Male veterinarians are less likely to be in the group of veterinarians with insufficient knowledge (p < 0.05). Veterinarians engaged in mixed practice (small and large animals) (p < 0.001) and veterinarians who have over 100 patients per month (p < 0.005) are also less likely to be in the group with insufficient knowledge of antimicrobial resistance. The proportion of those with insufficient knowledge is growing among veterinarians whose source is the Internet (p < 0.01), while the proportion of those with insufficient knowledge about antimicrobial resistance is declining among veterinarians whose source of information is continuous education (p < 0.05). The majority of the respondents (n = 59, 95.2%) completely agreed that AMR is a very big issue in the global health sector right now. Unfortunately, there are crucial gaps in the knowledge and attitudes of the surveyed participants. They do not appear to be aware of the importance of AMU in veterinary medicine and its influence on overall AMR, or the crucial part that non-prescribed antibiotics have in all of it. Positively, many veterinarians use good practice AMU guidelines in their everyday practice and in line with the global trend of AMU reduction, respondents have also decreased their AMU compared to the previous year.

Effect of an antimicrobial stewardship intervention on the prescribing behaviours of companion animal veterinarians: A pre-post study

BACKGROUND

Antimicrobial stewardship is a cornerstone of efforts to combat antimicrobial resistance. We evaluated the impact of a formal discussion of antimicrobial stewardship for dogs and cats on systemic antimicrobial prescribing behaviours among companion animal veterinarians.

METHODS

Electronic health records including information about the prescription of antimicrobials were collected from a multisite UK veterinary practice between 2017 and 2020. We undertook interrupted time series analysis using a quasi-Poisson model to compare the pre- and postintervention change in level and slope for multiple outcomes.

RESULTS

After the intervention, there were sustained reductions in the prescription rate of cefovecin to cats and metronidazole to dogs and increases in amoxicillin-clavulanic acid prescribing. There was no evidence for an immediate change in overall prescribing rates in either species, although rates increased over the 12 months after the intervention. There was a transient increase in the proportion of dogs who had their weight recorded at the time of prescription. Results suggest decreases in the prescription of off-licence antimicrobials in both species and the likelihood of underdosing in dogs.

CONCLUSIONS

Discussion of antimicrobial stewardship is more likely to influence the antimicrobial choice than whether to prescribe or not. Interventions may benefit by focusing on appropriate antimicrobial selection rather than overall prescription frequency.

Nonpharmacological Treatment Strategies for the Management of Canine Chronic Inflammatory Enteropathy—A Narrative Review

Chronic inflammatory enteropathy (CIE) refers to a heterogeneous group of idiopathic diseases of the dog characterised by persistent gastrointestinal (GI) clinical signs. If conventional dietary treatment alone would be unsuccessful, management of CIE is traditionally attained by the use of pharmaceuticals, such as antibiotics and immunosuppressive drugs. While being rather effective, however, these drugs are endowed with side effects, which may impact negatively on the animal’s quality of life. Therefore, novel, safe and effective therapies for CIE are highly sought after. As gut microbiota imbalances are often associated with GI disorders, a compelling rationale exists for the use of nonpharmacological methods of microbial manipulation in CIE, such as faecal microbiota transplantation and administration of pre-, pro-, syn- and postbiotics. In addition to providing direct health benefits to the host via a gentle modulation of the intestinal microbiota composition and function, these treatments may also possess immunomodulatory and epithelial barrier-enhancing actions. Likewise, intestinal barrier integrity, along with mucosal inflammation, are deemed to be two chief therapeutic targets of mesenchymal stem cells and selected vegetable-derived bioactive compounds. Although pioneering studies have revealed encouraging findings regarding the use of novel treatment agents in CIE, a larger body of research is needed to address fully their mode of action, efficacy and safety.

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

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.

Understanding Antibiotic Use in Companion Animals: A Literature Review Identifying Avenues for Future Efforts

Addressing antibiotic use is essential to tackle antimicrobial resistance, a major human and animal health challenge. This review seeks to inform stewardship efforts in companion animals by collating research insights regarding antibiotic use in this group and identifying overlooked avenues for future research and stewardship efforts. The development of population-based methods has established that antibiotics are frequently used in companion animal care. Research insights are also contributing toward an in-depth comprehension of the contexts to antibiotic use. Qualitative approaches, for example, have enabled a nuanced understanding in four key areas: interactions with owners, clinical and financial risk management, time pressures, and clinic dynamics. This review identifies that much of the existing research frames antibiotic use as the result of choices made by the individuals at the interface of their use. Future research and policy endeavours could look beyond the moment of prescribing to consider the societal structures and networks in which companion animal antibiotic use is entangled. A diversification in research approaches and frameworks through which antibiotic use is understood will facilitate the identification of additional targets for stewardship initiatives beyond providing information and awareness campaigns.

A Three-Year Biocrime Sanitary Surveillance on Illegally Imported Companion Animals

The illegal trade of companion animals in the European Union poses several legal, ethical and health issues to the entire community. In the framework of the Biocrime Interreg project between Italy and Austria, we surveyed puppies and kittens confiscated at the borders to identify the most frequent pathogens associated with (i) the risk of spread within the shelter, (ii) the development of fatal disease and (iii) the zoonotic potential. From January 2018 to December 2020, we examined a total of 613 puppies and 62 kittens coming from 44 requisitions. Feces, skin specimens and blood sera from confiscated animals were tested to verify the presence of major infections and to assess the rabies post-vaccination immunity. Out of the total of individuals under investigation, necropsies and laboratory investigations were also performed on 79 puppies and three kittens that had died during the observation period. Results indicated a high prevalence of Canine Parvovirus (CPV) and Giardia spp. infections, CPV as the most likely cause of fatal gastroenteritis in puppies and Salmonella and Microsporum canis as major zoonotic pathogens. Conversely, both extended spectrum beta lactamases Escherichia coli and methicillin resistant Staphylococcus pseudintermedius strains as rare findings. Results highlighted that illegal animal trade could expose the human population to potential zoonotic risk and naïve animal population to potentially disrupting epidemic waves, both of these issues being largely underestimated when buying companion animals.

Global prevalence and molecular characterization of extended-spectrum β-lactamase producing-Escherichia coli in dogs and cats - A scoping review and meta-analysis

Antimicrobial resistance (AMR) represents a major threat to human and animal health. Part of the AMR dimension is the circulation of extended-spectrum β-lactamases producing-Escherichia coli (ESBL-E. coli), which is now commonly reported among companion animals. However, the global perspective of the prevalence and population structure of ESBL-E. coli circulating in dogs and cats has not been estimated limiting our understanding of their role in the dissemination of ESBL-E. coli. The aim of this study was to compare the prevalence of ESBL-E. coli between dogs and cats and across countries through meta-analysis. We also performed a scoping review to summarize the current knowledge on ESBL genes and E. coli clones circulating among companion animals. A total of 128 studies published in PubMed, Web of Science, and Scopus up to April 2020 were selected and contained information on prevalence and/or molecular characterization of ESBL genes and ESBL-E. coli clones. Our review shows an increase in the number of publications between 2000 and 2019, concentrated mainly in Europe. Prevalence varied across continents, ranging from 0.63% (Oceania) to 16.56% (Africa) in dogs and from 0% (Oceania) to 16.82% (Asia) in cats. Although there were twice as many studies reporting prevalence on dogs (n = 61) than on cats (n = 32), and only 9 studies focused exclusively on cats, our meta-analysis showed no difference in the global prevalence of ESBL-E. coli between dogs (6.87% [95% CI: 4.46-10.45%]) and cats (5.04% [95% CI: 2.42-10.22%]). A considerable diversity of ESBL genes (n = 60) and sequence types (ST) (n = 171) were recovered from companion animals. ESBL-E. coli encoded by CTX-M-15 (67.5%, 77/114) and SHV-12 (21.9%, 25/114), along with resistant strains of ST38 (22.7%, 15/66) and ST131 (50%, 33/66) were widespread and detected in all continents. While presence of ESBL-E. coli is widespread, the drivers influencing the observed ESBL-E. coli prevalence and the clinical relevance in veterinary medicine and public health along with economic impact of ESBL-E. coli infections among companion animals need to be further investigated.

A randomised controlled trial to reduce highest priority critically important antimicrobial prescription in companion animals

Robust evidence supporting strategies for companion animal antimicrobial stewardship is limited, despite frequent prescription of highest priority critically important antimicrobials (HPCIA). Here we describe a randomised controlled trial where electronic prescription data were utilised (August 2018-January 2019) to identify above average HPCIA-prescribing practices (n = 60), which were randomly assigned into a control group (CG) and two intervention groups. In March 2019, the light intervention group (LIG) and heavy intervention group (HIG) were notified of their above average status, and were provided with educational material (LIG, HIG), in-depth benchmarking (HIG), and follow-up meetings (HIG). Following notification, follow-up monitoring lasted for eight months (April-November 2019; post-intervention period) for all intervention groups, though HIG practices were able to access further support (i.e., follow-up meetings) for the first six of these months if requested. Post-intervention, in the HIG a 23.5% and 39.0% reduction in canine (0.5% of total consultations, 95% confidence interval, 0.4-0.6, P = 0.04) and feline (4.4%, 3.4-5.3, P < 0.001) HPCIA-prescribing consultations was observed, compared to the CG (dogs: 0.6%, 0.5-0.8; cats: 7.4%, 6.0-8.7). The LIG was associated with a 16.7% reduction in feline HPCIA prescription (6.1% of total consultations, 5.3-7.0, P = 0.03). Therefore, in this trial we have demonstrated effective strategies for reducing veterinary HPCIA prescription.

Survey of the Knowledge and Use of Antibiotics among Medical and Veterinary Health Professionals and Students in Portugal

Antimicrobial resistance (AMR) is an urgent and complex problem worldwide, exacerbated by the frequently inappropriate use of antibiotics. The purpose of this study was to survey the levels of knowledge and awareness about antibiotic use and stewardship, among human and veterinary health professionals or students in Portugal, and the associations between antibiotic knowledge factors and socio-professional groups. In cross-sectional survey design, a total of 449 online structured questionnaires were completed in 2018-2019. The statistical analysis was performed dividing the respondents into four groups, A (undergraduate students), B (PhD students and researchers), C (lecturers), and D (technicians and other occupation). Among all respondents, 17% (n = 75) revealed some gap in knowledge about antibiotic resistance and the antibiotics that should be administered for different infection types (bacterial, viral, or fungal). Of the 159 pet owners among the respondents, only half had administered antibiotics to their animal and 64% (n = 102) knew that veterinary prescription is mandatory when administering antibiotics to animals. All groups statistically agreed that the AMR is a major public health problem and the antibiotics should be administrated for bacterial infections and used until the whole pack has been finished (p = 0.00). As expected, only groups B and C demonstrated a higher level of knowledge to recognize the antibiotic name and their active ingredient than undergraduate students (p = 0.00). About the antibiotic use on pets, only group B was statistically significant to no used antibiotics on their pets (p = 0.00). However, groups A, C, and D were statistically significant for the knowledge about the mandatory veterinarian prescription and groups C and D were significantly statistics for fully aware of the transmission of bacteria between animals and humans. In conclusion, in matters related to AMR, the behavior, education, and training of the general public and health professionals, including those who prescribe antibiotics for humans and animals, need to be improved.

Carriage of Extended-Spectrum-Beta-Lactamase- and AmpC Beta-Lactamase-Producing Escherichia coli Strains from Humans and Pets in the Same Households

Extended-spectrum-beta-lactamase (ESBL)- or AmpC beta-lactamase (ACBL)-producing Escherichia coli bacteria are the most common cause of community-acquired multidrug-resistant urinary tract infections (UTIs) in New Zealand. The carriage of antimicrobial-resistant bacteria has been found in both people and pets from the same household; thus, the home environment may be a place where antimicrobial-resistant bacteria are shared between humans and pets. In this study, we sought to determine whether members (pets and people) of the households of human index cases with a UTI caused by an ESBL- or ACBL-producing E. coli strain also carried an ESBL- or ACBL-producing Enterobacteriaceae strain and, if so, whether it was a clonal match to the index case clinical strain. Index cases with a community-acquired UTI were recruited based on antimicrobial susceptibility testing of urine isolates. Fecal samples were collected from 18 non-index case people and 36 pets across 27 households. Eleven of the 27 households screened had non-index case household members (8/18 people and 5/36 animals) positive for ESBL- and/or ACBL-producing E. coli strains. Whole-genome sequence analysis of 125 E. coli isolates (including the clinical urine isolates) from these 11 households showed that within seven households, the same strain of ESBL-/ACBL-producing E. coli was cultured from both the index case and another person (5/11 households) or pet dog (2/11 households). These results suggest that transmission within the household may contribute to the community spread of ESBL- or ACBL-producing E. coliIMPORTANCEEnterobacteriaceae that produce extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamases (ACBLs) are important pathogens and can cause community-acquired illnesses, such as urinary tract infections (UTIs). Fecal carriage of these resistant bacteria by companion animals may pose a risk for transmission to humans. Our work evaluated the sharing of ESBL- and ACBL-producing E. coli isolates between humans and companion animals. We found that in some households, dogs carried the same strain of ESBL-producing E. coli as the household member with a UTI. This suggests that transmission events between humans and animals (or vice versa) are likely occurring within the home environment and, therefore, the community as a whole. This is significant from a health perspective, when considering measures to minimize community transmission, and highlights that in order to manage community spread, we need to consider interventions at the household level.

Vets' and Pet Owners' Views About Antibiotics for Companion Animals and the Use of Phages as an Alternative

Antimicrobial resistance (AMR) is a global health burden. Although a complex and multi-faceted problem, inappropriate antibiotic use has repeatedly been identified as one of the main drivers of the acceleration and spread of AMR. Behaviors associated with antibiotic prescription and use have been extensively investigated in human medicine and in the livestock sector of veterinary medicine. There is now a growing interest in the factors that drive inappropriate antibiotic use in companion animal medicine, as the significance of antimicrobial use in this sector is being recognized. Additionally, the possibility of an alternative antimicrobial, phage therapy, being implemented into companion animal medicine is explored in this study. Interviews revealed complexities in the vet-owner relationship including conflicting perceptions of responsibility regarding antibiotic prescription and use, distrust of vets' intentions, and misconception of clients' needs. A need for alternative antimicrobials was evident, as all vets were able to report difficulties finding antibiotics to treat infections as a common occurrence. Questionnaire results indicated that vets and pet owners are open to the use of phage therapy in companion animals. This study shows that an alternative antimicrobial such as phage therapy could be accepted into companion animal medicine in the UK; however, effective communication between vets and pet owners is vital if antibiotic use is to be reduced and new antimicrobials are successfully implemented.