Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, UK.
CVS (UK) Limited, 1 Owen Road, Diss, UK.
Nat Commun. 2021 Mar 11;12(1):1593. doi: 10.1038/s41467-021-21864-3.
Robust evidence supporting strategies for companion animal antimicrobial stewardship is limited, despite frequent prescription of highest priority critically important antimicrobials (HPCIA). Here we describe a randomised controlled trial where electronic prescription data were utilised (August 2018-January 2019) to identify above average HPCIA-prescribing practices (n = 60), which were randomly assigned into a control group (CG) and two intervention groups. In March 2019, the light intervention group (LIG) and heavy intervention group (HIG) were notified of their above average status, and were provided with educational material (LIG, HIG), in-depth benchmarking (HIG), and follow-up meetings (HIG). Following notification, follow-up monitoring lasted for eight months (April-November 2019; post-intervention period) for all intervention groups, though HIG practices were able to access further support (i.e., follow-up meetings) for the first six of these months if requested. Post-intervention, in the HIG a 23.5% and 39.0% reduction in canine (0.5% of total consultations, 95% confidence interval, 0.4-0.6, P = 0.04) and feline (4.4%, 3.4-5.3, P < 0.001) HPCIA-prescribing consultations was observed, compared to the CG (dogs: 0.6%, 0.5-0.8; cats: 7.4%, 6.0-8.7). The LIG was associated with a 16.7% reduction in feline HPCIA prescription (6.1% of total consultations, 5.3-7.0, P = 0.03). Therefore, in this trial we have demonstrated effective strategies for reducing veterinary HPCIA prescription.
尽管经常开具最高优先级的重要抗菌药物（HPCIA），但支持伴侣动物抗菌药物管理策略的有力证据有限。在这里，我们描述了一项随机对照试验，该试验利用电子处方数据（2018 年 8 月至 2019 年 1 月）来确定高于平均水平的 HPCIA 处方实践（n=60），这些实践被随机分配到对照组（CG）和两个干预组。2019 年 3 月，轻度干预组（LIG）和重度干预组（HIG）被告知他们的 HPCIA 处方水平高于平均水平，并提供了教育材料（LIG，HIG）、深入的基准测试（HIG）和后续会议（HIG）。通知后，对所有干预组进行了为期八个月的随访监测（2019 年 4 月至 11 月；干预后期间），但如果需要，HIG 组在前六个月可获得进一步的支持（即后续会议）。干预后，与 CG 相比，HIG 犬科动物（0.5%的总咨询量，95%置信区间，0.4-0.6，P=0.04）和猫科动物（4.4%，3.4-5.3，P<0.001）HPCIA 处方咨询量分别减少了 23.5%和 39.0%，而 CG 组则分别减少了犬科动物（0.6%，0.5-0.8）和猫科动物（7.4%，6.0-8.7）。LIG 与猫科动物 HPCIA 处方减少 16.7%相关（6.1%的总咨询量，5.3-7.0，P=0.03）。因此，在这项试验中，我们证明了减少兽医 HPCIA 处方的有效策略。
