Introducing The 2022 AAFP/AAHA Antimicrobial Stewardship Guidelines

The concept of antimicrobial stewardship is relatively new, but antimicrobial resistance isn’t. “It’s been around since before we had antibiotics,” said  J. Scott Weese, DVM, DVSc, DACVIM. 

An associate professor in the Department of Pathobiology at the University of Guelph (UG) in Ontario, Canada, and a coauthor of the 2022 AAFP/AAHA Antimicrobial Stewardship Guidelines, Weese calls antimicrobial resistance a natural phenomenon. 

“Bacteria and fungi have been practicing biological warfare for millennia,” he told NEWStat, and they’ve been doing it by making antibiotics themselves: “That’s how we got the idea—and most of the antibiotics. Since bacteria and fungi were producing substances to kill each other, they developed ways to avoid that.”  

While antimicrobial resistance is a natural phenomenon, widespread use of antibiotics, sometimes for conditions that did not require them, has caused bacterial populations to develop resistance faster. “What we’ve done is greatly enhance that natural process by providing a lot more exposure to antimicrobials.” Worse, said Weese, it’s impacting our patients: “We’re seeing more resistant infections, and those can result in poor outcomes, longer treatments, more cost, more adverse effects and other challenges.”  

Weese said the 2022 AAFP/AAHA Antimicrobial Stewardship Guidelines dovetail with other efforts in the veterinary space to encourage antimicrobial stewardship by providing the clinical details that companion animal practitioners need: “Broad statements about using antibiotics right, not overusing them, and similar content are fine, but they don’t tell you how to treat that patient in front of you,” noted Weese. “The new Guidelines help us manage patients, and that’s the biggest way to improve antimicrobial stewardship.”  

Tools to help you steward 

According to a groundbreaking 2020 report from the American Veterinary Medical Association (AVMA) Committee on Antimicrobials, antimicrobial stewardship involves: 

  • Preventing common diseases through preventive and management strategies. 
  • Using evidence-based approaches to make decisions about antimicrobial drugs. 
  • Using antimicrobial drugs judiciously and sparingly while evaluating therapeutic outcomes. 

The AAFP/AAHA guidelines contain tools that can help practices better implement antimicrobial stewardship, and Weese calls them a middle ground between general high-level guidance (i.e., use antimicrobials correctly) and specific guidance for specific diseases (e.g., guidance from the International Society for Companion Animal Infectious Diseases (ISCAID), which the AAFP/AAHA guidelines link to).  

What else is new in the guidelines?  

The name, for one thing.  

When the last edition came out in 2014, it had a different title: Basic Guidelines for Judicious Therapeutic Use of Antimicrobials. There’s a reason for the name change, said Erin Frey, DVM, MPH, DACVPM.  

An assistant professor  at the North Carolina State College of Veterinary Medicine and the task force chair of the 2022 AAFP/AAHA Antimicrobial Stewardship Guidelines, Frey told NEWStat that therapeutic use was the focus back then: “What does a veterinarian do at the time of prescribing? How can you thoughtfully consider when to use antibiotics? What to use? And when to stop?”   

That focus changed in 2016 when the AVMA Committee on Antimicrobial Stewardship was tasked  to come up with a definition of antimicrobial stewardship, which involved taking a look at antimicrobial use on a global level—with an emphasis on preventive medicine. 

“Every time you take an antibiotic, you’re changing the flora, opening up the possibility of resistance to infection,” Frey said. She added that a big part of stewardship involves being more deliberate in your choice of treatment.   

The 2022 AAFP/AAHA Antimicrobial Stewardship Guidelines include a definition of antimicrobial stewardship, because many people aren’t sure what exactly it is.  

As first defined in the 2020 AVMA report—a report Frey helped draft—antimicrobial stewardship is “the actions veterinarians take . . . to preserve the effectiveness and availability of antimicrobial drugs through conscientious oversight and responsible decision-making while safeguarding animal, public, and environmental health.”  

The emphasis in the AVMA report—and in the new AAFP/AAHA guidelines—is on preventive medicine. 

Frey said a major goal of both is to make sure that every member of the hospital team understands the importance of antimicrobial stewardship and is able to apply the core principles to their work, regardless of position.  

Those core principles of antimicrobial stewardship as defined by the AVMA and endorsed by AAHA and the AAFP are: 

  • Commit to stewardship 
  • Advocate for a system of care to prevent common diseases 
  • Select and use antimicrobial drugs judiciously 
  • Evaluate antimicrobial drug use practices 
  • Educate and build expertise 

Why the push for awareness? 

Although antimicrobial resistance isn’t new, the concept of antimicrobial stewardship is.  

“It’s not really on the radar for most people,” said Weese, but it’s something veterinary staff do every day without knowing it: “Every time we make a decision to treat or how to treat, we’re applying stewardship tools.”  

Learn more about The 2022 AAFP/AAHA Antimicrobial Stewardship Guidelines at AAHA Guidelines, a curated collection of cutting-edge information with frequent updates that helps veterinary professionals face the demands of a continually shifting industry to ensure pets receive the best possible care. 

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