Antimicrobial prescribing and antimicrobial resistance surveillance in equine practice

Abstract

Background: Antimicrobial resistance (AMR) is an increasingly serious threat to human and animal health, therefore responsible use of antimicrobials in equine practice is vital. There is a need to have accurate, up to date data on antimicrobial prescribing in equine practice in the UK.Objectives: To characterise current antimicrobial prescribing practices by equine veterinarians and to describe surveillance, audit processes and identification of AMR.Study design: Online cross-sectional, questionnaire-based survey.Methods: An online questionnaire targeting veterinarians who treat horses in the UK and Europe was distributed. The questionnaire collected data on participants' country of origin, practice policies, prescribing practices including use of high priority critical antimicrobials. Four common clinical case-based scenarios were included to further explore prescribing practice. Responses were compared using both descriptive statistics and multivariable logistic regression models.Results: Questionnaires were completed by 264 veterinarians from Europe (n = 33/264) and the UK (n = 231/264); 87% respondents worked only with horses and 67% worked at premises with hospitalisation facilities. Approximately half of respondents (54.4%) had a written antimicrobial use or stewardship policy within their practice. Over half of respondents did not perform any environmental surveillance (54.2%), audit of clinical infections (53.1%) or audit of infection control (57.1%).Potentiated sulphonamides were cited as the most used antimicrobial, although 44% reported using enrofloxacin in the last year and 66% used 3rd or 4th generation cephalosporins. Prophylactic antimicrobials before clean surgery were frequently/ always prescribed by 48% respondents and 24% respondents frequently/always prescribed antimicrobials post-operatively in clean surgery. Main limitations: Potential selection bias of respondents, given individuals volunteered to take part in the survey. Conclusions: Compared with a previous similar study conducted in 2009, overall antimicrobial usage appeared to be declining in clinical scenarios and a greater proportion

To improve welfare in the equine species should we place greater emphasis on understanding our own?

“…Veterinary professionals are familiar with the evaluation of clinical actions and outcomes through audit but need to delve deeper to understand the factors that encourage or prevent change. Veterinary behaviour around the use (and misuse) of antimicrobials in equine practice has received some limited investigation 23–26 . Efforts have been made to assess the quality of care in equine practice 27 and we have begun to assess the human factors that can be associated with mistakes in veterinary practice 28 .…”

“…There are notable examples from other fields where theory and practice have not aligned and efforts to change behaviour have been counter‐productive 4 . As campaigns to modify horse owner or veterinary behaviour become more common, so too should audit of their impact; for example, by repeating surveys over time to explore changes in behaviour 24 . There are very few veterinary studies of the impact of interventions targeting behaviour change.…”

“…Veterinary behaviour around the use (and misuse) of antimicrobials in equine practice has received some limited investigation. [23][24][25][26] Efforts have been made to assess the quality of care in equine practice 27 and we have begun to assess the human factors that can be associated with mistakes in veterinary practice. 28 Veterinary communication around obesity has received some attention, with studies highlighting veterinarians' approaches to obesity consults arise from a combination of their past experience, time pressure, professional identity and level of frustration.…”

“…4 As campaigns to modify horse owner or veterinary behaviour become more common, so too should audit of their impact; for example, by repeating surveys over time to explore changes in behaviour. 24 There are very few veterinary studies of the impact of interventions targeting behaviour change. One study compared participants' reported behaviour before and after education on colic management, for example, teaching that allowing a horse to roll will not result in a 'twisted gut'.…”

Highlights of recent clinically relevant papers

“…The aim of this online cross‐sectional, questionnaire‐based survey by Amie Wilson and co‐workers in the UK was to characterise current antimicrobial prescribing practices by equine veterinarians and to describe surveillance, audit processes and identification of antimicrobial resistance (AMR) .…”