Antimicrobial Stewardship (not done)

What is antimicrobial stewardship?

Actions veterinarians take individually and as a profession to preserve antimicrobials

What are the AVMA stewardship core principles?

Commit to stewardship

Prevent common diseases

Select and use antimicrobials judiciously

Evaluate antimicrobial drug use practices

Educate and build expertise

How can you commit to stewardship?

Start small but

• Be a team leader in clinic

• Put a sign up saying you support stewardship

• Talk amongst team about why you are choosing an antibiotic plan

Why should you prevent common diseases?

Good preventative medicine and healthcare can minimize need for antibiotics

How can you prevent common disease?

Revisit and update vaccine protocols, infection control, and biosecurity

Educate clients on husbandry and nutrition

Diagnose and manage diseases to prevent secondary infections

What is a problem with clients?

Many clients was a quick fix of antibiotics no matter what

What are some challenges of diagnostics?

Very expensive and pet owners pay out of pocket

Only 20-25% of pet owners are receptive to tests

How can you convince owners to do diagnostics?

Make recommendations and explain why to them

Do procedures in house like nasal biopsies, rectal scrapes, liver biopsies

What some other alternatives to an antibiotic when there is infection?

Remove source of infection by lancing abscess, remove infected implant, manage the underlying disease like DM

Why is it important to remember bacteria ar eopportunistic?

If there is another reason why the bacteria is there you need to fix underlying the cause

Using just antibiotics just makes resistance worse

What animals do not need antibiotics?

Upper respiratory cat with viral ifnection

Young cat with lower UTI signs

Dog with acute diarrhea

What can you do instead of giving antibiotics?

Non-antibiotic prescription

Delayed prescribing

How do we evaluate antibiotic use?

Surveys asking vets what they are using

When can we legally compound a drug?

Pill size does not work for the patient so a pharmacist will reformulate it into smaller pills/tablets/liquid for patient

MUST BE INDIVIDUA AND FDA APPROVED

What are some problems with compounded antibiotics?

Some companies add flavors, with poor quality control, bypass FDA approval, sell in bulk to vets

What is the efficacy of non FDA approved compounding?

Not good and increases resistance

Can we use cheaper generic antibiotics?

Yes legally and pharmacologically and ethically

What are some behavioral influences to prescribing antibiotics?

Client expectations, peer pressure and hospital protocol, time of day, fear of clinical failure, medical knowledge, stewarsip responsibility

How can you overcome behavioral influence to prescribe antibiotics?

Trust and communicationWhat is

What is a common improper use of antibiotics?

Cat comes in owner says UTI but it is not actually a UTI

What should you start with for UTIs?

Cephalexin, amoxi-clav or other 1st generation

Whats the harm in giving wrong antibiotics?

Selection pressure killing normal flora and causing resistant flora to thrive and can easily spread

Should you always give metro for diarrhea?

No, only if hemorrhagic and septic

Should you give antibiotics t a dog with bacteria in urine but not clinical?

No even if the bacteria is resistant

T/F you should culture urine if there are no C/S to rule it out?

False, the bladder is not sterile

What is one of the greatest threats to animals and human health bacterial?

Carbapenem-resistant enterobaceterales (CREs)

DO NOT TREAT THEM

What is the marker for carbapenem resistance?

Imipenem

What is CRO?

Carbapenem resistant organism

What do we do if we see a CRE patient?

Flier to educate vets and staff

Minimize contact with animal

Zoonoses sign on cage door

Add patient alert to medical record

How do we respond to CRE patients?

Isolate patient

Wash hands, wear gloves, and PPE

Separate equipment

Have patient urinate and defecate in separate area

Avoid cross contamination

What do we say to clients with CRE pets?

Tell them it is a public health concern but do not treat reservoirs

Precautions at home

Wash hands often after handling urine/feces/wounds

Minimize spread to others

What are some organisms to look for?

CRE, carbapenem-resistant Pseudomonas, MRSA/MRSP, Corynebacterium ulcerans, Candida auris, MDR Enterococcus