1
|
Prouillac C. Use of Antimicrobials in a French Veterinary Teaching Hospital: A Retrospective Study. Antibiotics (Basel) 2021; 10:1369. [PMID: 34827307 DOI: 10.3390/antibiotics10111369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/13/2021] [Accepted: 10/27/2021] [Indexed: 12/20/2022] Open
Abstract
Antibiotic resistance has become a major concern for not only human health, but also for animal health. To preserve the efficacy of antibiotics, it has become essential to establish measures to regulate the prescription of antibiotics to ensure their prudent use. In France, these measures have been translated into regulations for animal health since 2015, with the publication of three important regulatory texts. The results obtained on a national scale in terms of reducing the use of antibiotics have been satisfactory. The aim of our study was to evaluate the differences related to the prescription of antimicrobials at the veterinary teaching hospital of the Veterinary School of Lyon (CHUV) before and after the implementation of French regulations. Prescriptions and consumption of antimicrobials were examined, along with bacteriological analyses, for the period of 2014–2020, for companion animals and horses. The most frequently prescribed compounds were broad-spectrum antimicrobials, including penicillins with β-lactamase inhibitors, as well as first-generation cephalosporins tetracyclines and sulfamides. The prescription and consumption of critically important antibiotics (CIA) strongly decreased during the study period, with an increase of bacteriological analyses. This study shows the interest of having computerized tools to monitor the use of antimicrobials to implement corrective measures if needed.
Collapse
|
2
|
Lehner C, Hubbuch A, Schmitt K, Schuepbach-Regula G, Willi B, Mevissen M, Peter R, Muentener CR, Naegeli H, Schuller S. Effect of antimicrobial stewardship on antimicrobial prescriptions for selected diseases of dogs in Switzerland. J Vet Intern Med 2020; 34:2418-2431. [PMID: 33112451 PMCID: PMC7694852 DOI: 10.1111/jvim.15906] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 09/01/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) are important tools to foster prudent antimicrobial use. OBJECTIVE To evaluate antimicrobial prescriptions by Swiss veterinarians before and after introduction of the online ASP AntibioticScout.ch in December 2016. ANIMALS Dogs presented to 2 university hospitals and 14 private practices in 2016 or 2018 for acute diarrhea (AD; n = 779), urinary tract infection (UTI; n = 505), respiratory tract infection (RTI; n = 580), or wound infection (WI; n = 341). METHODS Retrospective study. Prescriptions of antimicrobials in 2016 and 2018 were compared and their appropriateness assessed by a justification score. RESULTS The proportion of dogs prescribed antimicrobials decreased significantly between 2016 and 2018 (74% vs 59%; P < .001). The proportion of prescriptions in complete agreement with guidelines increased significantly (48% vs 60%; P < .001) and those in complete disagreement significantly decreased (38% vs 24%; P < .001) during this time. Antimicrobial prescriptions for dogs with AD were significantly correlated with the presence of hemorrhagic diarrhea in both years, but a significantly lower proportion of dogs with hemorrhagic diarrhea were unnecessarily prescribed antimicrobials in 2018 (65% vs 36%; P < .001). In private practices, in 2018 a bacterial etiology of UTI was confirmed in 16% of dogs. Prescriptions for fluoroquinolones significantly decreased (29% vs 14%; P = .002). Prescriptions for antimicrobials decreased significantly in private practices for RTI (54% vs 31%; P < .001). CONCLUSION Antimicrobials were used more prudently for the examined indications in 2018 compared to 2016. The study highlights the continued need for ASPs in veterinary medicine.
Collapse
Affiliation(s)
- Claudia Lehner
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland.,Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Alina Hubbuch
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Kira Schmitt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Barbara Willi
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Meike Mevissen
- Division of Pharmacology and Toxicology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Ruth Peter
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Cedric R Muentener
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Hanspeter Naegeli
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Simone Schuller
- Division of Small Animal Internal Medicine, Department of Clinical Veterinary Science, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Hubbuch A, Schmitt K, Lehner C, Hartnack S, Schuller S, Schüpbach-Regula G, Mevissen M, Peter R, Müntener C, Naegeli H, Willi B. Antimicrobial prescriptions in cats in Switzerland before and after the introduction of an online antimicrobial stewardship tool. BMC Vet Res 2020; 16:229. [PMID: 32620170 PMCID: PMC7333330 DOI: 10.1186/s12917-020-02447-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/26/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship activities are essential to improve prudent antimicrobial use. The aim of the present study was to evaluate changes in antimicrobial prescriptions in cats after the introduction of prudent use guidelines promoted by an online antimicrobial stewardship tool (AntibioticScout.ch) in Switzerland. Data from 792 cats presented to two university hospitals and 14 private practices in 2018 were included and compared to 776 cases from 2016. Cats were diagnosed with acute upper respiratory tract disease (aURTD), feline lower urinary tract disease (FLUTD) and abscesses. Clinical history, diagnostic work-up and antimicrobial prescriptions (class, dosage, duration) were assessed. Type and proportions [95% confidence intervals] of antimicrobial prescriptions were compared between the two evaluation periods and a mixed effects logistic regression model was applied to evaluate compliance with Swiss prudent use guidelines. RESULTS From 2016 to 2018, the proportion of antimicrobial prescription in all included cases decreased from 75.0% [71.8-78.0] to 66.7% [63.3-69.9]; this decrease was most pronounced for treatments at university hospitals (67.1% [59.5-74.0] to 49.3% [40.9-57.8]) and for cats with FLUTD (60.1% [54.6-65.4] to 48.8% [43.2-54.4]). Use of 3rd generation cephalosporins in private practices declined from 30.7% [26.5-35.1] to 22.1% [18.4-26.2], while overall use of non-potentiated aminopenicillins increased from 19.6% [16.4-23.0] to 27.8% [24.1-31.9]. In cases where antimicrobial therapy was indicated, compliance with guidelines did not increase (33.3% [26.6-40.6] to 33.5% [27.2-40.2]), neither at universities nor in private practices. On the other hand, antimicrobial treatment was more often withheld in cases with no indication for antimicrobial therapy (35.6% [30.1-41.4] to 54.0% [47.6-60.4]); this was found for private practices (26.7% [20.8-33.4] to 46.0% [38.4-53.7]) and for aURTD cases (35.0% [26.5-44.2] to 55.4% [44.7-65.8]). CONCLUSIONS Overall proportions of antimicrobial prescription, unjustified antimicrobial therapy and, in private practices, use of 3rd generation cephalosporins decreased from 2016 to 2018 for the investigated feline diseases. However, overall compliance with Swiss prudent use guidelines was still low, implying that further efforts are required to foster prudent antimicrobial use in cats.
Collapse
Affiliation(s)
- Alina Hubbuch
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland.,Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland
| | - Kira Schmitt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland.,Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 272, CH-8057, Zurich, Switzerland
| | - Claudia Lehner
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland.,Division of Small Animal Internal Medicine, Vetsuisse Faculty, University of Bern, Länggassstrasse 128, CH-3012, Bern, Switzerland
| | - Sonja Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 270, CH-8057, Zurich, Switzerland
| | - Simone Schuller
- Division of Small Animal Internal Medicine, Vetsuisse Faculty, University of Bern, Länggassstrasse 128, CH-3012, Bern, Switzerland
| | - Gertraud Schüpbach-Regula
- Veterinary Public Health Institute (VPHI), Vetsuisse Faculty, University of Bern, Schwarzenburgstrasse 161, CH-3097, Liebefeld, Switzerland
| | - Meike Mevissen
- Division of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Bern, Länggassstrasse 124, CH-3012, Bern, Switzerland
| | - Ruth Peter
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland
| | - Cedric Müntener
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland
| | - Hanspeter Naegeli
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland.
| | - Barbara Willi
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland.
| |
Collapse
|
4
|
Lutz B, Lehner C, Schmitt K, Willi B, Schüpbach G, Mevissen M, Peter R, Müntener C, Naegeli H, Schuller S. Antimicrobial prescriptions and adherence to prudent use guidelines for selected canine diseases in Switzerland in 2016. Vet Rec Open 2020; 7:e000370. [PMID: 32201578 PMCID: PMC7064144 DOI: 10.1136/vetreco-2019-000370] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 01/28/2020] [Accepted: 02/07/2020] [Indexed: 12/28/2022] Open
Abstract
Background Antimicrobial resistance is an increasing problem in human and veterinary medicine and is closely linked to the use of antimicrobials. The objective of this study was to describe antimicrobial prescriptions for selected canine diseases in Switzerland during 2016. Methods Dogs presented to two university hospitals and 14 private practices for acute diarrhoea (AD; n=371), suspected or confirmed urinary tract infections (UTIs; n=245), respiratory tract infections (RTIs; n=274) or wound infections (WIs; n=175) were included. Clinical history, diagnostic work-up and antimicrobial prescription (class, dosage and duration) were retrospectively assessed. A justification score was applied to evaluate appropriateness of antimicrobial therapy based on available national and international consensus guidelines. Results Antimicrobials were prescribed in 65 per cent of dogs with AD, 88 per cent with UTI, 62 per cent with RTI and 90 per cent with WI. The most prescribed antimicrobial classes (monotherapy and combination therapy) were potentiated aminopenicillins (59 per cent), nitroimidazoles (22 per cent), non-potentiated aminopenicillins (16 per cent) and fluoroquinolones (13 per cent). Overall, 38 per cent (95 per cent CI 0.35 to 0.41) of the prescriptions were in accordance with consensus guidelines. In dogs with AD, antimicrobial therapy was associated with the presence of haemorrhagic diarrhoea (P<0.05) and complied in 32 per cent with consensus guidelines, which recommend antimicrobial treatment only when sepsis is suspected. A bacterial aetiology was confirmed via culture and/or sediment examination in 36 per cent of dogs with suspected UTI. Conclusions Overall, adherence to consensus guidelines was poor both, at university hospitals and private practices. Antimicrobial stewardship measures are therefore needed to improve prudent use.
Collapse
Affiliation(s)
- Bérénice Lutz
- Department Clinical Veterinary Medicine, Division Small Animal Internal Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Claudia Lehner
- Department Clinical Veterinary Medicine, Division Small Animal Internal Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Kira Schmitt
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Barbara Willi
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Gertraud Schüpbach
- Veterinary Public Health Institute, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Meike Mevissen
- Division of Pharmacology and Toxicology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Ruth Peter
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Cedric Müntener
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Hanspeter Naegeli
- Institute of Veterinary Pharmacology and Toxicology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Simone Schuller
- Department Clinical Veterinary Medicine, Division Small Animal Internal Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Cerquetella M, Rossi G, Suchodolski JS, Schmitz SS, Allenspach K, Rodríguez-Franco F, Furlanello T, Gavazza A, Marchegiani A, Unterer S, Burgener IA, Pengo G, Jergens AE. Proposal for rational antibacterial use in the diagnosis and treatment of dogs with chronic diarrhoea. J Small Anim Pract 2020; 61:211-215. [PMID: 32065388 PMCID: PMC7079140 DOI: 10.1111/jsap.13122] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 01/15/2023]
Abstract
Chronic diarrhoea is a frequent complaint in canine practice and the diagnostic path is often characterised by numerous diagnostic tests and stepwise empirical treatments, often applied before gastrointestinal endoscopy/mucosal biopsies. These include dietary interventions (novel protein, hydrolysed protein diet), parasiticides and still, in many cases, antibacterials. Indiscriminate use of antibacterial drugs risks detrimental consequences for both the individual patient (antimicrobial resistance, long‐term disruption of intestinal bacterial populations, potential worsening of gastrointestinal signs) and the general public. For that reason, in this Perspective essay we advocate use of antibacterials only after histopathologic evaluation of gastrointestinal biopsies or, for those cases in which endoscopy is not possible, after other therapeutic trials, such as diet/pre‐probiotics or anti‐inflammatory drugs have proven unsuccessful. They should be reserved, after appropriate dietary trials, for those canine chronic diarrhoeic patients with signs of true primary infection (i.e. signs of systemic inflammatory response syndrome or evidence of adherent‐invasive bacteria) that justify antibacterial use.
Collapse
Affiliation(s)
- M Cerquetella
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, Matelica, 62024, Italy
| | - G Rossi
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, Matelica, 62024, Italy
| | - J S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA
| | - S Salavati Schmitz
- The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Easter Bush Campus, Midlothian, EH25 9RG, UK
| | - K Allenspach
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50011, USA
| | - F Rodríguez-Franco
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, Madrid, 28040, Spain
| | - T Furlanello
- Veterinary Clinic and Laboratory San Marco, Via dell'Industria 3, Veggiano, 35030, Italy
| | - A Gavazza
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, Matelica, 62024, Italy
| | - A Marchegiani
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, Matelica, 62024, Italy
| | - S Unterer
- Faculty of Veterinary Medicine, Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, LMU Munich, Munich, Germany
| | - I A Burgener
- Department for Small Animals and Horses, VetMedUni Vienna, Veterinaerplatz 1, Vienna, 1210, Austria
| | - G Pengo
- St. Antonio Veterinary Clinic, S.S. 415 Paullese 6, Madignano, 26020, Italy
| | - A E Jergens
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA, 50011, USA
| |
Collapse
|
6
|
Schmitt K, Lehner C, Schuller S, Schüpbach-Regula G, Mevissen M, Peter R, Müntener CR, Naegeli H, Willi B. Antimicrobial use for selected diseases in cats in Switzerland. BMC Vet Res 2019; 15:94. [PMID: 30871537 DOI: 10.1186/s12917-019-1821-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/25/2019] [Indexed: 02/08/2023] Open
Abstract
Background Antibiotic use in human and veterinary medicine is considered a main driver of antimicrobial resistance. Although guidelines to promote appropriate use of antimicrobials in veterinary patients have been developed, antibiotic overprescription is assumed to be a common problem. The goal of this study was to investigate antimicrobial use in cats in Switzerland with acute upper respiratory tract disease (aURTD), feline lower urinary tract disease (FLUTD) and abscesses, and to assess compliance of prescription with consensus guidelines. A total of 776 cases (aURTD, n = 227; FLUTD, n = 333; abscesses, n = 216) presented to two university hospitals and 14 private veterinary practices in Switzerland during 2016 were retrospectively evaluated. Clinical history, diagnostic work-up and antimicrobial prescription (class, dosage, duration) were assessed. Results A total of 77% (aURTD), 60% (FLUTD) and 96% (abscesses) of the cases received antibiotic therapy; 13–24% received combination or serial therapy. The cats were treated for a median of 7 (abscesses) and 10 days (aURTD, FLUTD). Treatments with potentiated aminopenicillins (40–64%), third generation cephalosporins (25–28%), aminopenicillins (12–24%) and fluoroquinolones (3–13%) were most common. Prescriptions were judged in complete accordance with consensus guidelines in 22% (aURTD), 24% (FLUTD) and 17% (abscesses) of the cases. Antibiotics were prescribed although not indicated in 34% (aURTD), 14% (FLUTD) and 29% (abscesses) of the cases. The presence of lethargy, anorexia or fever in cats with aURTD, and the detection of bacteriuria in cats with FLUTD were significantly associated with antibiotic therapy. Although diagnostic work-up was significantly more common (aURTD: university hospitals, 58%; private practices, 1%; FLUTD: university hospitals, 92%; private practices, 27%) and the use of critically important antibiotics significantly less common at the university hospitals (aURTD, 10%; FLUTD, 14%) compared to private practices (aURTD, 38%; FLUTD, 54%), the frequency of antibiotic treatment was not different between the university hospitals and private practices. Conclusions Our results indicate that overprescription of antibiotics in cats in Switzerland is common and accordance with guidelines is poor. The study highlights the need to promote antimicrobial stewardship in small animal medicine.
Collapse
|