title: National surveillance of antimicrobial prescription and resistance in companion animals
Creators: name: Singleton, DA
Publisher: name: University of Liverpool Repository
Year: 2019

description: Antimicrobial resistance (AMR) is a leading global health issue, though the impact on companion animal health remains poorly understood. To address this we used a health informatics approach, focusing on four key objectives: (i) Antimicrobial prescription monitoring: Using data from the Small Animal Veterinary Surveillance Network (SAVSNET), pharmaceutical prescriptions from 1,000,000 canine and 350,000 feline electronic health records (EHRs) collected from 250 voluntary veterinary practices in the UK were summarised. After vaccines and anti-inflammatories, antimicrobials were the third most commonly prescribed pharmaceutical family, though a significant reduction in prescription frequency was observed between 2014 and 2016. Clavulanic acid potentiated amoxicillin and cefovecin were the most commonly prescribed antimicrobials to dogs and cats respectively. Practices that frequently prescribed antimicrobials to dogs also frequently prescribed to cats. In both species, respiratory conditions were commonly associated with systemic antimicrobial prescription. (ii) Antimicrobial resistance monitoring: Antimicrobial susceptibility test (AST) results were summarised from 29,000 canine and 8,000 feline Enterobacteriaceae isolates collected from four veterinary diagnostic laboratories (VDLs). Between 2016 and 2018, phenotypic multi-drug resistance (MDR) was detected in 6.5% of canine and 2.6% of feline E. coli isolates. Temporal prevalence remained fairly static, though geographical; VDL and practice-level variation was noted. Genotypic analyses of 148 MDR Enterobacteriaceae clinical isolates revealed extended spectrum β-lactamase genes to be common (63.5% of isolates). Of these, blaCTX-M-15 was commonly identified, as was the E. coli sequence type 131:O25b pandemic clone (n=6 isolates). blaACC was also detected for the first time in companion animals (n=2). (iii) Exploring factors associated with antimicrobial prescription and resistance: Examining consultations where the animal presented as unwell, a range of prior preventive health care decisions (including vaccination, insurance or neutering) were associated with significantly decreased odds of systemic antimicrobial prescription, as were Royal College of Veterinary Surgeons (RCVS) accredited veterinary practices. Considering AST results, practices examining referral cases alone or practices that employed RCVS-certified specialists were associated with significantly increased odds of phenotypic E. coli MDR in dogs. (iv) Gathering clinical evidence: A cohort of 3,000 dogs primarily presenting with acute diarrhoea were followed longitudinally through their EHR. Nearly 50% of cases were prescribed a systemic antimicrobial; increased case severity was associated with heightened odds of prescription. Most cases were considered resolved by 10 days post-initial presentation. No association between antimicrobial prescription and resolution was found, though nearly a quarter of cases were lost to follow-up. By taking a health informatics approach, these studies have identified unique and important opportunities for future strategic clinical antimicrobial stewardship interventions. Together these studies create a vision for how a health informatics approach can effectively monitor and characterise antimicrobial prescription and resistance in companion animals across the UK, a group of animals that has previously largely been neglected in population level statistics. To further build on this work, we recommend five areas for future development including: (1) further one health-focused collaboration and cohesion; (2) continued development of effective surveillance methodologies; (3) expanding scope of informatics-focused surveillance projects; (4) ensuring that academic findings inform surveillance and policy at governmental and inter-governmental levels, and (5) developing interventions that can encourage antimicrobial stewardship within veterinary practice.