School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, 90 South Street, Murdoch 6150, Western Australia, Australia.
Cognosco, Anexa, PO Box 21, Morrinsville 3340, New Zealand; School of Veterinary Science, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand.
Prev Vet Med. 2022 May;202:105610. doi: 10.1016/j.prevetmed.2022.105610. Epub 2022 Mar 9.
The aims of this study were to determine antimicrobial prescription patterns and the factors affecting antimicrobial selection amongst Australian dairy veterinarians.
A structured questionnaire was administered to Australian dairy cattle veterinarians using the Qualtrics online survey platform. Questions focused on their (1) demographics; (2) opinions surrounding antimicrobial use, resistance, and stewardship; (3) decision-making drivers of both prescription and selection of commonly prescribed antimicrobials; (4) awareness on the guidelines for antimicrobial usage and sources of information concerning antimicrobials.
A total of 135 responses (14.1% response rate) from all eight dairying regions in Australia were received. The attitudes, perceptions, and concerns of dairy veterinarians towards antimicrobials indicated a high agreement regarding label indications (96%), consequences of off-label prescription (95%), and the presence of an antimicrobial resistance (AMR) risk (73%), when prescribing antibiotics. A four-dimensional categorical principal components analysis (CATPCA) model indicated most of the variation in opinion was due to AMR risk, trade-offs, prescription concerns and active substance concerns. The first active substance most dairy veterinarians chose for a scenario involving mastitis and dry cow therapy (DCT) treatment was cloxacillin. Decision-making drivers for antimicrobial choice when providing advice regarding the supply of antimicrobials for mastitis and DCT treatment were predominately clinical factors; however, diagnostics were rarely used in determining antimicrobial choice due to cost of implementation, diagnostic accuracy (sensitivity, specificity), and benefit issues. Non-clinical decision-making drivers included the perception of practicality for Australian Veterinary Association (AVA) prescription guidelines, opinions surrounding AMR risk and prescription concerns, consideration of Expert Advisory Group on Antimicrobial Resistance (EAGAR) scores, number of years worked with dairy farms, and the number of dairy farms they regularly consult for. When available at the practice, prescription policies were considered to impact on animal welfare outcomes and on the probability of AMR emergence. The major information sources influencing decision making on antimicrobial prescription for the Australian dairy veterinarians were clinical experience (93%) and product labels (81%).
Australian dairy veterinarians are generally aware of the risk of resistance to antimicrobials and the need for stewardship, with clinical factors having the most impact on antimicrobial prescription. However, non-clinical factors incorporating awareness of guidelines and their attitudes on antimicrobial resistance risk and prescription concerns impact on the choice and prescription of antimicrobials.
The development of prescription policy and guidelines, alongside effective communicative extension programs to increase veterinarian uptake, provides an avenue to mitigate AMR risk in Australian dairy cattle.
本研究旨在确定澳大利亚奶牛兽医的抗菌药物处方模式和影响抗菌药物选择的因素。
使用 Qualtrics 在线调查平台向澳大利亚奶牛兽医发放了一份结构化问卷。问题集中在他们的（1）人口统计学特征；（2）对抗生素使用、耐药性和管理的看法；（3）开具处方和选择常用抗菌药物的决策驱动因素；（4）对抗菌药物使用指南的认识以及有关抗菌药物的信息来源。
共收到来自澳大利亚所有 8 个奶牛养殖区的 135 份回复（14.1%的回复率）。奶牛兽医对抗生素的态度、看法和担忧表明，他们在标签指示（96%）、标签外处方的后果（95%）和抗生素耐药性（AMR）风险（73%）方面高度一致。在开具抗生素时。一项四维度分类主成分分析（CATPCA）模型表明，大多数意见差异归因于 AMR 风险、权衡、处方关注和活性物质关注。奶牛兽医在涉及乳腺炎和干奶牛治疗（DCT）治疗的情况下选择的第一种活性物质是氯唑西林。当就乳腺炎和 DCT 治疗供应抗生素提供建议时，抗菌药物选择的决策驱动因素主要是临床因素；然而，由于实施成本、诊断准确性（敏感性、特异性）和效益问题，很少使用诊断来确定抗菌药物的选择。非临床决策驱动因素包括对澳大利亚兽医协会（AVA）处方指南实用性的看法、对抗生素耐药性风险和处方关注的看法、考虑抗菌药物耐药性专家咨询小组（EAGAR）评分、与奶牛场合作的年限以及他们定期咨询的奶牛场数量。在实践中，如果有处方政策，他们认为这会影响动物福利结果和 AMR 出现的可能性。影响澳大利亚奶牛兽医对抗菌药物处方决策的主要信息来源是临床经验（93%）和产品标签（81%）。
澳大利亚奶牛兽医普遍意识到对抗生素耐药性的风险和管理的必要性，临床因素对抗菌药物的开具影响最大。然而，非临床因素包括对抗生素耐药性风险和处方关注的认识以及对指南的态度，都会影响抗菌药物的选择和开具。
制定处方政策和指南，并结合有效的沟通推广计划，以提高兽医的参与度，为减轻澳大利亚奶牛的 AMR 风险提供了途径。
