Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

Abstract

Background: Antimicrobial use contributes to emergence of antimicrobial resistance. It was hypothesized that antimicrobial prescribing behavior varies between the emergency (ER) and critical care (CC) services in a veterinary teaching hospital. This study aimed to: (i) describe antimicrobial prescribing patterns in the ER and CC services; (ii) assess adherence to stewardship principles; (iii) evaluate the prevalence of multidrug resistant (MDR) bacterial isolates. Methods: Institution electronic medical records were queried for all antimicrobial prescriptions from the ER and CC services between 1/1/2017 and 12/31/2017. Prescriptions were manually reviewed, and the following data recorded: drug, dosage, duration, diagnosis, outcome, hospitalization duration, culture submission, and susceptibility results. Results: There were 5,091 ER visits, of which 3,125 were not transferred to another service. Of these emergency visits, 516 (16.5%) resulted in 613 antimicrobial drug prescriptions. The most commonly prescribed drugs for the ER were amoxicillin/clavulanate (n = 243, 39.6%), metronidazole (n = 146, 23.8%), and ampicillin/sulbactam (n = 55, 9.0%). The most common reasons for antimicrobial prescriptions were skin disease (n = 227, 37.0%), gastrointestinal disease (n = 173, 28.2%), and respiratory disease (n = 50, 8.2%). For ER patients 18 cultures were submitted, equivalent to a 3.5% submission rate. The CC service managed 311 case visits for 822 patient days. Of these, 133 case visits (42.7%) resulted in 340 prescriptions. The most commonly prescribed drugs for the CC service were ampicillin/sulbactam (n = 103, 30.3%), enrofloxacin (n = 75, 22.1%), and metronidazole (n = 59, 17.4%). The most common reasons for antimicrobial prescriptions were gastrointestinal disease (n = 106, 31.2%), respiratory disease (n = 71, 20.9%), and sepsis (n = 61, 17.9%). On the CC service, 46 patients had ≥1 culture submitted, equivalent to a 34.6% submission rate. Of patients prescribed antimicrobials, 13/38 (34%) with urinary tract disease, 2/28 (7%) with pneumonia, 1/11 (9%) with canine infectious respiratory disease complex and 2/8 (25%) with feline upper respiratory infection were compliant with published guidelines. Robbins et al. Antimicrobial Prescribing Emergency Critical Care Conclusions: Antimicrobial prescription was common in both ER and CC services and followed similar patterns. Adherence to published guidelines for urinary and respiratory infections was poor.

Patterns of antimicrobial drug use in veterinary primary care and specialty practice: A 6‐year multi‐institution study

“…The probability of fluoroquinolone prescribing was greater for specialty services, except at hospital 1 where the probability was greatest for ECC. These differences might reflect hospital policies, clinician preference, local AMR patterns, or differences in the proportion of first‐ and second‐opinion cases examined at hospital 1 compared to other centers 31 . Geography might affect local disease prevalence and influence the types of cases presented to ECC because of variation in the availability of other veterinary practices in the catchment area of each hospital.…”

Antimicrobial Resistance in Escherichia coli Strains Isolated from Humans and Pet Animals

“…Robbins et al [ 131 ] investigated the antimicrobial prescribing practices in small animal emergency and critical care. According to authors antimicrobial use contributes to emergence of antimicrobial resistance [ 131 ].…”

“…Robbins et al [ 131 ] investigated the antimicrobial prescribing practices in small animal emergency and critical care. According to authors antimicrobial use contributes to emergence of antimicrobial resistance [ 131 ]. They have assumed that antimicrobial prescribing behavior varies between the emergency and critical care services in a veterinary teaching hospital, so they tried to investigate antimicrobial prescribing patterns, assess adherence to stewardship principles, and to evaluate the prevalence of multidrug-resistant (MDR) bacterial isolates.…”

“…They have assumed that antimicrobial prescribing behavior varies between the emergency and critical care services in a veterinary teaching hospital, so they tried to investigate antimicrobial prescribing patterns, assess adherence to stewardship principles, and to evaluate the prevalence of multidrug-resistant (MDR) bacterial isolates. Robbins et al [ 131 ] after investigation, which showed that the most prescribed antibiotics in emergence was amoxicillin, metronidazole, and ampicillin with the most common reasons for antimicrobial prescriptions being skin disease, gastrointestinal disease, and respiratory disease. Regarding the critical care, authors have recorded most prescribed ampicillin, enrofloxacin, and metronidazole, with the most common reasons for antimicrobial prescriptions such as gastrointestinal disease, respiratory diseases, and sepsis.…”

“…Regarding the critical care, authors have recorded most prescribed ampicillin, enrofloxacin, and metronidazole, with the most common reasons for antimicrobial prescriptions such as gastrointestinal disease, respiratory diseases, and sepsis. Robbins et al [ 131 ] concluded that antimicrobial prescription was common with comparable patterns. However, devotion to guidelines for urinary and respiratory infections was poor.…”