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ANTIMICROBIAL STEWARDSHIP
ANTIMICROBIAL STEWARDSHIP continued from page 1
in dogs and cats ). 5 Upcoming revised Canadian Veterinary Medical Association prudent antimicrobial use guidelines expand on a previous document , adding more depth , broad ASP concerns and expanding the scope to include dogs , cats and small ruminants .
Implementation of an antimicrobial stewardship program
Antimicrobial stewardship is a multi-modal approach to the practice of medicine that goes beyond drug , dose and duration . An ASP obviously has a major emphasis on specific aspects of drug prescription and use . However , a strong ASP has broader approaches to reduce the need for antimicrobials through preventing disease and promptly identifying patients that require antimicrobials and those that do not . It also fosters communication and education of all players in the prescribing cascade ( attending clinician , diagnostic laboratory , pharmacy , owner ) to facilitate optimal use and remove pressures to use antimicrobials in situations where they are not indicated . Virtually all clinicians practice some form of antimicrobial stewardship on a daily basis , through decisions about when and how to use antimicrobials , and through measures taken to reduce the risk of disease . Therefore , implementation of an ASP should not be approached as a paradigm shift , but rather an evolution of core principles of veterinary medicine .
Antimicrobial stewardship can be employed in any veterinary practice . The approach to an ASP will vary greatly between facilities , based on a range of factors such as the nature of the caseload , the prevalence of resistant pathogens , the current state of antimicrobial use , access to specialists , access to a pharmacist , clinician motivation , management motivation and level of understanding of the issues . Yet , any practice can implement some components of an effective ASP with little effort , time , cost or access to other personnel . Often , starting with some easy measures ( low
hanging fruit ) is useful to facilitate acceptance of change , with addition of new measures over time as people realize the potential benefits , have increased awareness and understand that an ASP is meant to help , not hamper , patient care .
Why should veterinary medicine embrace antimicrobial stewardship ?
There is no doubt that AMR is here to stay . As a result , scrutiny of antimicrobial use in veterinary medicine will continue ( and probably increase ). The impact of antimicrobial use in animals on AMR in humans is unknown , but it is impossible to deny that a link is present . As public awareness increases , the pressure to ‘ do something ’ will also increase . Veterinary medicine is at a crossroad in our approach to antimicrobial use and stewardship . One path entails veterinary medicine taking a leading role in antimicrobial stewardship , optimizing antimicrobial use in animals and demonstrating that the issues are being taken seriously and acted upon . The other entails limited voluntary change , something that will almost certainly ultimately result in change being enforced from outside . Our relationship with antimicrobials will change over the next decade . A question veterinary medicine must answer is ‘ who will direct that change ’? Will it be guided internally , with veterinarians taking the lead ( as physicians have done in human ASPs )? Or , will a lack of veterinary response lead to changes being enforced from outside sources , minimizing the role of the veterinarian in deciding how changes will be made to veterinary access and use of antimicrobials ? Demonstration of a profession-wide commitment to antimicrobial stewardship will both improve the care of veterinary patients and help reduce the risk of external ( and potentially un-informed ) pressure . Rather than seeing change exerted from the outside in response to a public or political demand to ‘ do something ’, veterinarians will be best served by taking charge of the situation , so that informed changes can be made with interests of patients , the public , agriculture and
veterinarians well considered .
Examples of antimicrobial stewardship program resources :
Australian National Centre for Antimicrobial Stewardship https :// www . ncas-australia . org / BSAVA https :// www . bsava . com / Resources / Veterinary-resources / PROTECT Centers for Disease Control and Prevention https :// www . cdc . gov / antibiotic-use / healthcare / implementation / core-elements . html European Centre for Disease Control https :// ecdc . europa . eu / en / publications-data / directoryguidance-prevention-and-control / antimicrobialstewardship Infectious Diseases Society of America http :// www . idsociety . org / Stewardship _ Policy / Public Health Ontario https :// www . publichealthontario . ca / en / BrowseByTopic / InfectiousDiseases / AntimicrobialStewardshipProgram / Pages / Antimicrobial-Stewardship-Program . aspx Society for Healthcare Epidemiology of America https :// www . shea-online . org / index . php / practice-resources / priority-topics / antimicrobialstewardship
REFERENCES 1 . Bronzwaer S , Lonnroth A , Haigh R . The European Community strategy against
antimicrobial resistance . Euro Surveill 2004 ; 9:1-3 .
2 . McEwen SA , Fedorka-Cray PJ . Antimicrobial use and resistance in animals . Clin Infect Dis 2002 ; 34 Suppl 3 : S93-S106 . 3 . Page S , Prescott J , Weese S . The 5Rs approach to antimicrobial stewardship . Veterinary Record 2014 ; 175:207-208 .
4 . Prescott JF . Antimicrobial use in food and companion animals . Animal health research reviews / Conference of Research Workers in Animal Diseases 2008 ; 9:127-133 .
5 . Weese JS , Blondeau J , Boothe D , et al . Antimicrobial use guidelines for treatment
of urinary tract infections in dogs and cats : antimicrobial guidlines working group of the International Society for Companion Animal Infectious Diseases . Vet Med Int 2011 ; 4:1-9 .
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