背景:兽医医院抗菌药物管理(AMS)指南可能有助于对抗抗菌素耐药性(AMR)。
目的:确定世界卫生组织(WHO)认为至关重要(CIA)的抗菌药物(AMD)的处方条件和感染类型,并评估医院AMS指南对遵守国际同伴动物传染病学会发布的浅表细菌性毛囊炎治疗指南的影响,呼吸道疾病和尿路感染。
方法:狗和猫在1/21至6/21和9/21至6/22的学术兽医医院管理。
方法:头孢菌素(第三代或第四代)的处方,糖肽,大环内酯/酮内酯,多粘菌素,和喹诺酮类药物被鉴定出来。收集有关培养和易感性(C/S)测试以及先前的AMD暴露的数据。使用Fisher精确检验和Bonferroni校正对不同时间段之间的频率进行比较。
结果:在规定≥1个WHO-CIAAMD的动物中,在犬(567/1724,32.9%)和猫(192/450,42.7%)中,氟喹诺酮类药物是最常用的WHO-CIA类药物.没有动物服用碳青霉烯类药物,二氢叶酸还原酶抑制剂/磺胺类,或者多粘菌素.没有给猫开氨基糖苷类或胺霉素。57.8%(324/561)的病例遵循了机构指南。不依从的最常见原因是未能执行C/S测试46.0%(109/237)和不必要的使用更高级别的AMD43.0%(102/237)。AMS指导机构后,细菌C/S检测更频繁(59.7%vs.46.8%,P=0.0006)。
结论:尽管C/S检测有所增加,但对已发布指南的依从性仍然很差。确诊感染的频率没有变化,时间段之间的阳性培养物或AMD抗性。
BACKGROUND: Veterinary hospital antimicrobial stewardship (AMS) guidelines might help combat antimicrobial
resistance (AMR).
OBJECTIVE: Determine the conditions and types of infection for which antimicrobial drugs (AMDs) deemed critically important (CIA) by the World Health Organization (WHO) were prescribed and assess the effect of hospital AMS guidelines on adherence to International Society for Companion Animal Infectious Diseases published
guidelines for the treatment of superficial bacterial folliculitis, respiratory tract disease and urinary tract infection in these cases.
METHODS: Dogs and cats managed at an academic veterinary hospital from 1/21 to 6/21 and 9/21 to 6/22.
METHODS: Prescriptions of cephalosporins (third or fourth generation), glycopeptides, macrolides/ketolides, polymyxins, and quinolones were identified. Data on culture and susceptibility (C/S) testing and previous AMD exposure were collected. Frequencies were compared between time periods using Fisher\'s exact test with Bonferroni corrections.
RESULTS: In animals prescribed ≥1 WHO-CIA AMD, fluoroquinolones were the most frequently prescribed WHO-CIA class in dogs (567/1724, 32.9%) and cats (192/450, 42.7%). No animals were prescribed carbapenems, dihydrofolate reductase inhibitors/sulfonamides, or polymyxins. No cats were prescribed aminoglycosides or amphenicols. Institutional
guidelines were followed in 57.8% (324/561) cases. The most frequent causes of nonadherence were failure to perform C/S testing 46.0% (109/237) and unnecessary use of a higher-tier AMD 43.0% (102/237). Bacterial C/S testing was more frequently performed after AMS
guideline institution (59.7% vs. 46.8%, P = 0.0006).
CONCLUSIONS: Adherence to published guidelines remained poor despite an increase in C/S testing. There were no changes in the frequencies of confirmed infections, positive cultures or AMD
resistance between time periods.