Rethinking the way we fight infections in horses – The Horse

The emergence of “superbugs”, bacteria resistant to multiple antibiotics, has become a global health threat, forcing equine veterinarians to rethink their infection treatment strategies.

At the 2021 American Association of Equine Practitioners convention, held Dec. 4-8 in Nashville, Tennessee, Emily Feyes, DVM, MPH, Dipl. ACVPM, described the multi-pronged approach veterinarians at The Ohio State University Veterinary Medical Center (VMC) are using to combat this problem. Feyes is the former director of VMC’s new Antimicrobial Stewardship Program (ASP), which is shared with state veterinarians through a partnership program, the Buckeye ASP. Responsible antimicrobial stewardship builds on the foundations of good care, effective vaccines, infection control and prevention, and biosecurity measures that protect people, animals, and the environment.

Feyes explained that antimicrobial stewardship is about using “the right drug at the right dose for the right duration” to maximize success, minimize adverse effects, and reduce the risk of bacteria developing resistance. Sometimes that means not using antibiotics at all and opting instead for other measures to manage an illness or injury.

The VMC has modeled its antimicrobial stewardship program on those developed in human medicine. Prescription drug monitoring, environmental monitoring and education are key. The idea isn’t to police vets, Feyes said, but rather to review prescribing practices, promote effective hygiene strategies and share better data.

Antibiotic use drives antimicrobial resistance, even when these drugs are prescribed appropriately. Feyes said an ongoing challenge for many practitioners is the lack of rapid (and cost-effective) diagnostic tests. She suggested the use of “susceptibility testing” as an alternative to better target pathogens (pathogenic organisms) when individual test results are not available. Essentially, an antibiogram is a summary of antimicrobial susceptibility data from isolated organisms within certain patient populations, which veterinarians can use to guide treatment. Veterinarians can use susceptibility testing from their own practice or geographic region.

Veterinarians are often reluctant to delay starting antibiotics while awaiting lab results from their patients; they want to give the horse every chance to improve quickly. They may also feel pressure from anxious owners. Nonetheless, Feyes suggests practitioners ask themselves the following questions when evaluating treatment options:

  • What type of infection is it?
  • Where is the infection located?
  • What are the typical organisms cultured in this region of the body?
  • Does it require an antibiotic or could it resolve with supportive treatment?
  • Does it have to be a broad-spectrum antibiotic or could it be a narrow-spectrum drug?
  • Should it be administered systemically or can the treatment be localized?

The idea here is to encourage critical thinking rather than reflexively doing what the practitioner (and probably their peers) have always done. Feyes also borrowed a phrase from human medicine known as “antibiotic delay,” meaning to reevaluate the patient 48 hours after starting treatment. Is the animal better, the same or worse? Have lab results come back and do these results support the initial treatment plan?

Feyes also recommended having infection control plans in place that include protocols for cleaning and disinfecting, isolating and moving animals, and surveillance to monitor the effectiveness of protocols to ensure the safety of animals. people and animals.

Antibiotics have revolutionized medicine. Today, the imperative is to preserve the effectiveness of these drugs so that they remain powerful allies against the infection in the future. That’s reason enough to implement an antimicrobial stewardship program, and Ohio State’s VMC is leading the way.

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