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5 pillars of an antimicrobial stewardship program

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Just as antibiotic resistance is a concern for all of us, antimicrobial stewardship is a responsibility for us all.  Antimicrobial stewardship (AMS) refers to the actions veterinarians take individually and as a profession to preserve the effectiveness and availability of antimicrobial drugs through conscientious oversight and responsible medical decision-making while safeguarding animal, public, and environmental health.1  Below is a brief overview of 5 components of an antimicrobial stewardship program: Commitment, Prevention, Detection, Optimizing Use and Surveillance.   

Commitment: To initiate an AMS program, the practice needs to be committed to the cause. This includes committing resources (staff, time and money) and getting management support. It also involves creating a team that will develop and implement the program, providing guidance and education to the entire staff.   A best practice in developing an AMS program is to identify co-champions to lead the team.  The co-champions should include one veterinarian and one veterinary technician to act as a representative and encourage participation for their respective groups.   Assessment of current antimicrobial practices and resistance patterns provides the information needed to set goals and policies. Establish regular meetings to educate staff, evaluate progress and address concerns.

Prevention: A key concept of AMS is minimizing antibiotics use to situations where there is a true need.  Ensuring that our patients receive the appropriate vaccinations, parasite control, diet and diagnostic testing is the best way to keep our patients healthy and reduce their susceptibility to infectious agents.2  Following infection control protocols within the practice, including hand and surface hygiene can reduce spread of disease between patients.3 

Detection:  Know what you are treating! Perform the necessary diagnostics to rule out non-bacterial pathogen and determine the type of bacteria present.   An AMS program ensures that practitioners interpret C&S results properly and assess whether those results fit the clinical presentation.4

Optimize Use: Once a bacterial infection is confirmed, choose the most appropriate antibiotic, route, dosage, treatment frequency and duration.  Use C&S results and available guidelines or other evidenced based information to select the most appropriate treatment.5,6,7 Topical therapy should be utilized when appropriate.  When using a systemic antibiotic choose the effective antibiotic with the narrowest spectrum.  Treat any underlying or concurrent diseases, such as hyperadrenocorticism, diabetes mellitus, atopy, etc.  Evaluate response to treatment to ensure that the antimicrobial is effective and to determine when to discontinue treatment. 

Surveillance: Monitoring antibiotic use, rate of resistant infections and infection control practices is critical to determine initial AMS program goals and evaluate the impact of your AMS program. Work with your reference laboratory to create antibiograms and learn how to interpret this information properly.  Regularly assess progress and adjust practices accordingly.

Underlying these 5 components is the need to educate, motivate, facilitate and empower all members of the practice to follow through on the AMS program.  Measuring response provides an opportunity to celebrate the success of the AMS program and direct future advancements.

By Sharon L. Campbell, DVM, MS, DACVIM

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References

  • https://www.avma.org/resources-tools/avma-policies/antimicrobial-stewardship-definition-and-core-principles
  • 2019 AAHA Canine Life Stage Guidelines: https://www.aaha.org/aaha-guidelines/life-stage-canine-2019/life-stage-canine-2019/
  • 2018 AAHA Infection Control, Prevention, and Biosecurity Guidelines Am Anim Hosp Assoc 2018; 54. DOI 10.5326/JAAHA-MS-6903.
  • Understanding Susceptibility Test Data as a Component of Antimicrobial Stewardship in Veterinary Settings. 1st ed. CLSI report VET09. Wayne, PA: Clinical and Laboratory Standards Institute; 2019.
  • Weese JS, Blondeau J, Boothe D, et al. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. The Vet Journal 2019; 247: 8-25.
  • Hillier A, Lloyd DH, Weese JS, et al. Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis (Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. Vet Dermatol 2014; 25: 163–e43.
  • Lappin MR, Blondeau J, Boothe D, et al. Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats: Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases. J Vet Intern Med 2017;31:279–294.

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