One Health AMR Collaboration

One Health Collaborations to Combat Antimicrobial Resistant (AMR) Infections 2021-22

Project title

Use of World Health Organization Critically Important Antimicrobials (WHO-CIA) in horses and the effect of local antimicrobial stewardship guidelines on use of WHO CIA drugs in small animals

Project goals

The overall aim for this project is to implement and evaluate the efficacy of antimicrobial stewardship guidelines in veterinary medicine at the Cornell University Hospital for Animals. As a large referral and teaching facility, we are uniquely placed to make a direct impact on stewardship by incorporating these practices into our teaching of future practitioners. By evaluating and publishing our findings and lessons learned, we also hope to provide a template and guidance for the animal health community.

Our plan for the next project period focuses on analysis, interpretation, and manuscript preparation. We will also leverage a separate project from FDA Vet-LIRN for subsidy of culture and susceptibility testing and will evaluate how antibiograms may have changed. We appreciate the opportunity to have a more long-term trajectory now with the One Health AMR projects integrated in the CoE proposal process.

2021 to 2022

During the 2021-22 period, we focused on collecting antimicrobial administration data for small animals following the launch of use guidelines, including usage and prescribing rationale for high priority drugs and culture submissions. Data were pulled biweekly from hospital electronic records and manually curated in combination with additional targeted searches. There were 1,184 and 235 unique prescriptions given for dogs and cats. At the time of prescription, 37.9% of dogs and 26% of cats had documented infections. These values are both higher than the baseline data (18% for dogs and 16% for cats), and for cats in particular there was an increase in overall culture submissions. Approximately half of cultures for both dogs and cats ultimately yielded Staphylococcus and E. coli, which also made up the majority of non-intrinsic resistant isolates. Antibiotics used most frequently were penicillins and fluoroquinolones, followed by 3rd generation cephalosporins. Our next step will be to compare this data with our baseline data from 2017 to evaluate the impact of implementing local stewardship guidelines on antimicrobial usage in these species.

Concurrently, we collected baseline equine medicine data for the year 2021. Of 1,622 equine patient visits, 615 (37.9%) were prescribed at least one antimicrobial agent. There were a total of 1,267 prescriptions and between 1 and 8 drugs prescribed per patient. The most common classes prescribed were penicillins, aminoglycosides, and folate pathway antagonists. No carbapenems were prescribed. Additional data collected included signalment, hospital stay, diagnosis, culture results, comorbidities, and outcomes. We are particularly interested in usage for peri-operative prophylaxis. As there are no comprehensive guidelines published for equine antimicrobial use, we will be working on publishing these data as a baseline with discussion on indication, dosage, and duration. The culture results will be incorporated into an equine antibiogram that will also be included in the paper. In addition to this study, we presented at a special session and contributed to a white paper for the American Association of Equine Practitioners entitled “Responsible use of antibiotics in equine practice: Strategies in human and veterinary medicine.”