AUTHOR=Robbins Sarah N. , Goggs Robert , Lhermie Guillaume , Lalonde-Paul Denise F. , Menard Julie 

TITLE=Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

JOURNAL=Frontiers in Veterinary Science

VOLUME=7

YEAR=2020

URL=https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2020.00110

DOI=10.3389/fvets.2020.00110

ISSN=2297-1769

ABSTRACT=<p><bold>Background:</bold> Antimicrobial use contributes to emergence of antimicrobial resistance. It was hypothesized that antimicrobial prescribing behavior varies between the emergency (ER) and critical care (CC) services in a veterinary teaching hospital. This study aimed to: (i) describe antimicrobial prescribing patterns in the ER and CC services; (ii) assess adherence to stewardship principles; (iii) evaluate the prevalence of multidrug resistant (MDR) bacterial isolates.</p><p><bold>Methods:</bold> Institution electronic medical records were queried for all antimicrobial prescriptions from the ER and CC services between 1/1/2017 and 12/31/2017. Prescriptions were manually reviewed, and the following data recorded: drug, dosage, duration, diagnosis, outcome, hospitalization duration, culture submission, and susceptibility results.</p><p><bold>Results:</bold> There were 5,091 ER visits, of which 3,125 were not transferred to another service. Of these emergency visits, 516 (16.5%) resulted in 613 antimicrobial drug prescriptions. The most commonly prescribed drugs for the ER were amoxicillin/clavulanate (<italic>n</italic> = 243, 39.6%), metronidazole (<italic>n</italic> = 146, 23.8%), and ampicillin/sulbactam (<italic>n</italic> = 55, 9.0%). The most common reasons for antimicrobial prescriptions were skin disease (<italic>n</italic> = 227, 37.0%), gastrointestinal disease (<italic>n</italic> = 173, 28.2%), and respiratory disease (<italic>n</italic> = 50, 8.2%). For ER patients 18 cultures were submitted, equivalent to a 3.5% submission rate. The CC service managed 311 case visits for 822 patient days. Of these, 133 case visits (42.7%) resulted in 340 prescriptions. The most commonly prescribed drugs for the CC service were ampicillin/sulbactam (<italic>n</italic> = 103, 30.3%), enrofloxacin (<italic>n</italic> = 75, 22.1%), and metronidazole (<italic>n</italic> = 59, 17.4%). The most common reasons for antimicrobial prescriptions were gastrointestinal disease (<italic>n</italic> = 106, 31.2%), respiratory disease (<italic>n</italic> = 71, 20.9%), and sepsis (<italic>n</italic> = 61, 17.9%). On the CC service, 46 patients had ≥1 culture submitted, equivalent to a 34.6% submission rate. Of patients prescribed antimicrobials, 13/38 (34%) with urinary tract disease, 2/28 (7%) with pneumonia, 1/11 (9%) with canine infectious respiratory disease complex and 2/8 (25%) with feline upper respiratory infection were compliant with published guidelines.</p><p><bold>Conclusions:</bold> Antimicrobial prescription was common in both ER and CC services and followed similar patterns. Adherence to published guidelines for urinary and respiratory infections was poor.</p>