Antimicrobial prescribing and antimicrobial resistance surveillance in equine practice
Wilson, A, et al. (2022) Antimicrobial prescribing and antimicrobial resistance surveillance in equine practice. Equine Veterinary Journal.
The aim of this online questionnaire-based survey study was to characterise the current antimicrobial prescribing practices and behaviours of veterinary surgeons in equine practice, to evaluate the frequency of antimicrobial resistance (AMR) infections encountered and describe surveillance, audit processes and infection control activities in equine hospitals.
The survey ran for three months between September and December 2019, having been launched at BEVA Congress and promoted to all BEVA members and via social media channels. The survey collected data on antimicrobial usage, including practice policies, prescribing practices, the use of high-priority critical antimicrobials (HPCIAs) and antimicrobial resistance. In addition, respondents were asked to consider four common clinical scenarios and, for each, state if they would use antimicrobials and if so, what would their antimicrobial of choice would be.
A total of 264 responses were received from the UK (n=231) and Europe (n=33), 86.7% of respondents worked exclusively with horses and 67.4% worked at premises with hospitalisation facilities.
54.4% of respondents had a written antimicrobial use or stewardship policy in their practice and 88.9% stated they were aware of antimicrobial usage guidelines. Potentiated sulphonamides were reported as the most commonly used antimicrobial. When asked about the use of HPCIAs, 43.9% reported use of enrofloxacin and 66% had used 3rd or 4th generation cephalosporins. The most common indications cited for use of these antimicrobials were based on culture and sensitivity and for use in foals.
48% of respondents prescribed pre-operative antimicrobials prior to clean surgery and 24.5% prescribed antimicrobials post-operatively in clean surgery. 54.2% of respondents did not perform any environmental surveillance, 53.1% did not audit clinical infections and 57.1% did not audit infection control.
15.8% of respondents had encountered confirmed cases of infection with methicillin resistant Staphylococcus aureus (MRSA) in the last 12 months and 13.0% had encountered confirmed cases of infection with extended spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae in the same period. Cases of infection with multiple drug resistant (MDR) bacteria had been encountered by 41.9% of respondents in the last 12 months. The clinical cases where MDR infections occurred included wounds (often with reference to bone involvement), surgical site infections, uterine infections, respiratory infections, urogenital infections, and synovial sepsis.
Limitations of the study are the potential selection bias of the respondents, as those attending BEVA Congress or who are BEVA members may be more likely to have an increased awareness of AMR and biosecurity and to be more aware of best practice and prescribing recommendations.
This study provides some evidence of current antimicrobial prescribing in equine practice and indicates that there has been a reduction in antimicrobial use when compared to previous studies and an increase in antimicrobial policies in practice. The study highlights several areas where further improvement is needed, including the use of bacterial cultures and sensitivity testing, perioperative antimicrobial usage, environmental surveillance, and biosecurity in equine hospitals to reduce the impact of AMR infection.
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