What Does a Rise in Antimicrobial Resistance Mean?
Welcome to VET Report Vitals, a column focused on the results of the groundbreaking Banfield Veterinary Emerging Topics (VET) Report™ “Are We Doing Our Part to Prevent Superbugs? Antimicrobial Usage Patterns Among Companion Animal Veterinarians.” This report, a collaboration between the NAVC and Banfield Pet Hospital, focuses on a critical topic: antimicrobial resistance (AMR). It aims to promote prudent antimicrobial use among companion animal practitioners by contributing a baseline of antimicrobial usage data to the discussion on how to achieve better concordance with published guidelines.
This article examines the issue of AMR within the larger “One Health” context by exploring the implications of AMR for veterinary practitioners, clients, and patients. An upcoming article will discuss effective strategies for improving guideline concordance in daily practice.
IMPLICATIONS OF ANTIMICROBIAL RESISTANCE FOR COMPANION ANIMAL PRACTICE
Antimicrobial resistance (AMR) arises when bacteria develop the ability to grow in the presence of antimicrobial drugs. This phenomenon is a natural evolutionary process of bacteria but develops more rapidly through misuse and overuse of antimicrobials.1 Resistance minimizes the medication options to treat bacterial infections and can challenge veterinarians’ ability to provide effective therapy.
Antimicrobial-resistant bacteria pose disease management concerns not only because resistant organisms can be directly transmitted between hosts, but also because resistance may be transmitted between bacterial species. Evidence indicates that antimicrobial-resistant bacteria are transmitted bidirectionally between humans and household animals. This has implications for the health of companion animal patients, their owners, and their caretakers. Infection with resistant organisms can lead to longer and more severe infections, increased mortality, and higher costs for treatment.1,2 The growing threat of AMR has contributed to an increased scrutiny of antibiotic use practices in both human and veterinary medicine (FIGURE 1).
Given the importance of antimicrobial drugs in combatting infectious disease, the veterinary profession will undoubtedly continue to use antimicrobials to promote animal health. However, given the implications for companion animal veterinary practice and public health, antimicrobial use will ideally become more judicious and specific to minimize AMR. Although the concept of judicious use of antibiotics has been clearly defined3 and recommendations for antimicrobial use in certain companion animal disease situations have been developed,4,5 there remain opportunities to promote better awareness of and alignment with these guidelines.6
THE TEAM APPROACH
As a veterinary technician, you may be wondering how you can promote prudent use of antimicrobials in your practice. From the receptionist to the veterinary assistant, the entire team can play an important role in antimicrobial stewardship.
Veterinary technicians have a unique role on the team that enables them to recognize risk factors for infection (BOX 1), support veterinarians in antimicrobial stewardship, and act as primary client educators. Although the veterinarian is responsible for the diagnosis and treatment plan, veterinary technicians assist with diagnosis and care and can help prevent nosocomial infections in the clinic, thus reducing the potential need for antimicrobials. Specific examples of supporting antimicrobial stewardship include7:
- Performing diagnostics to aid in establishing a definitive diagnosis
- Knowing proper protocols for culture and susceptibility testing and Gram stains
- Providing supportive or symptomatic care
- Protecting sterile field during clean surgical procedures
Client education is key to both preventing the need for antimicrobials and reinforcing the treatment plan (BOX 2), which could include symptomatic care for patients not needing antimicrobials or proper antimicrobial administration, when appropriate.
The receptionist is the first and last team member clients usually have contact with in the clinic. This sets receptionists apart as the team members who can begin setting expectations for clients (BOX 2) and who can reinforce the treatment plan and home care instructions at the end of the visit. For this reason, receptionists should be educated on the importance of AMR and be able to address basic questions or concerns that clients may have. With receptionist support, the client can better receive and understand the concept of judicious use of antimicrobials.
Veterinary assistants’ responsibilities commonly include providing a clean, safe environment for patients. This includes prevention of nosocomial infections through the following tasks:
- Proper cleaning of areas within the clinic, such as ensuring treatment and surgery areas are sanitized
- Ensuring good hygiene of pets under the clinic’s care, such as keeping kennels and bedding clean
Veterinary assistants commonly keep the surgery suite clean and can monitor sterile technique, minimizing the risks for infection during surgery. They also have the ability to reinforce client education from the veterinarian, veterinary technician, and receptionist so that a consistent message is given throughout the visit.
Use of antimicrobials has serious implications for both veterinary and human healthcare. By taking a team approach, each team member can contribute to antimicrobial stewardship. For more information, see the companion piece on the implications of AMR for companion animal practitioners in the July/August issue of Today’s Veterinary Practice.
- World Health Organization. Global action plan on antimicrobial resistance. 2015. www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_eng.pdf Accessed September 2016.
- Weese JS, Giguere S, Guardabassi L, et al. ACVIM consensus statement on therapeutic antimicrobial use in animals and antimicrobial resistance. J Vet Intern Med 2015;29(2):487-498.
- American Veterinary Medical Association. Judicious therapeutic use of antimicrobials. avma.org/KB/Policies/Pages/Judicious-Therapeutic-Use-of-Antimicrobials.aspx. Accessed October 2016.
- 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 Diseases. Vet Med Int 2011;2011:263768.
- 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(3):163-175.
- American Veterinary Medical Association Task Force for Antimicrobial Stewardship in Companion Animal Practice. Understanding companion animal practitioners’ attitudes toward antimicrobial stewardship. JAVMA 2015;247(8):883-884.
- American Association of Feline Practitioners/American Animal Hospital Association. Basic guidelines of judicious therapeutic use of antimicrobials. January 2014. catvets.com/public/PDFs/PracticeGuidelines/Guidelines/2014AntimicrobialsGuidelines%20AAHA_AAFP.pdf. Accessed April 2017.