The American Veterinary Medical Association (AVMA) yesterday released a new report on the antibiotic-resistant pathogens affecting animal health in the United States.
Like the Centers for Disease Control and Prevention's 2019 report on antibiotic resistance threats, which highlighted the impact of antibiotic-resistant bacteria on human medicine, the AVMA report summarizes the issue for veterinary medicine. It highlights the bacterial pathogens that cause disease in food-producing and companion animals, with a focus on pathogens identified as a concern for elevated antibiotic resistance.
The report provides a host-species–specific breakdown of pathogens of concern, with summary reports for dogs and cats, cattle, chicken and turkeys, horses, fish and shrimp, sheep and goats, and swine, and detailed report cards for each specific bacterial pathogen identified as a potential resistance threat. The information is intended to help veterinarians evaluate the potential for resistance in clinical cases and inform antibiotic therapy and other treatment approaches.
The AVMA report also provides guidance for veterinarians on how they can combat antibiotic resistance, encouraging appropriate antibiotic prescribing, use of diagnostic testing to inform treatment, infection prevention and control strategies, and collaboration with producers to develop comprehensive herd health programs.
"Slowing and limiting the emergence and spread of antimicrobial resistance can only be achieved with widespread engagement, especially among leaders in veterinary medicine, animal agriculture, and public health," the report states. "Only through concerted commitment and action will those caring for the health and welfare of animals be able to succeed in reducing this threat."
Policy at VHA hospitals lowers unnecessary urine cultures
Policies that limit unnecessary urine culturing were associated with a decrease in urine cultures without negative consequences at Veterans Health Administration (VHA) hospitals, US researchers reported today in Infection Control & Hospital Epidemiology.
The retrospective, quasi-experimental study compared rates of urine cultures at six VHA hospitals from August 2013 through January 2018. Three of the hospitals implemented conditional urine reflex testing policies under which urine cultures are performed only if a preceding urinalysis met prespecified criteria, and three of the hospitals served as control sites.
Participants included all adult patients with at least one urinalysis ordered. The primary outcome was the rate of urine cultures performed per 1,000 patient-days, and the secondary outcome was the rate of gram-negative bloodstream infections—the most common severe outcome of untreated urinary tract infections (UTIs)—per 1,000 patient-days.
During the study period, there were 50,901 patient admissions from 24,759 unique patients, and a total of 224,573 urine cultures were performed. At the intervention sites, the overall average number of urine cultures performed did not significantly decrease relative to the pre-intervention period (5.9% decrease, P = 0.8), but the researchers observed a 21% decrease in the rate of urine cultures performed compared to the control hospitals. Analysis of gram-negative bloodstream infection rates found no significant difference between infection and control sites (P = .49)
The findings are noteworthy because asymptomatic bacteriuria—defined as a positive urine culture in the absence of symptoms of a UTI—is a significant driver of inappropriate antibiotic prescribing.
"Conditional urine reflex testing policies in the acute-care setting was associated with reduced unnecessary urine culturing without adverse effects," the authors of the study concluded.
Aug 25 Infect Control Hosp Epidemiol abstractSource : umn.edu