Cassel Shannon, Fenelon Hannah T, Rott Elizabeth, Blazes Libby, Willess Leah M, Baines Anna E, Ramirez Vickie, Kauber Kelly, Rabinowitz Peter, Burbick Claire R, Fuhrmeister Erica R
Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA.
Center for One Health Research, University of Washington, Seattle, Washington, USA.
Zoonoses Public Health. 2025 Mar;72(2):117-126. doi: 10.1111/zph.13187. Epub 2024 Oct 21.
Judicious antimicrobial use is essential for the continued treatment of infections in small and mixed animal veterinary medicine. To better support Washington (WA) State veterinarians in antimicrobial stewardship, we surveyed licensed small and mixed animal veterinarians and led group conversations regarding antimicrobial prescription practices.
Survey questions included demographic information, factors influencing prescription practices and clinical cases. Responses were summarised and logistic regressions were performed to identify factors associated with antibiotic treatment choices. Group conversations, led by a licensed veterinarian, focused on resource gaps for veterinarians, management of clinical scenarios and interpretation of minimum inhibitory concentrations (MICs) and breakpoints. A systematic qualitative analysis of conversation transcripts identified key themes such as common barriers to stewardship.
Among 53 responses to clinical scenarios, veterinarians selected the most appropriate treatment choice, according to a veterinary microbiologist, 62% of the time. Variability was observed in culture and susceptibility practices and antibiotic choices. Survey respondents reported an influence of the client ability to medicate (92%), considerations of resistance (91%), client finances (75%) and availability of antimicrobials (75%) on their prescription decisions. There were no significant associations between opinions about contributing factors to antimicrobial resistance (AMR) or guidelines used and treatment choices in clinical scenarios. Among 15 veterinarians interviewed in group conversations, a systematic qualitative analysis of conversation transcripts revealed key themes, including reliance on human medicine as a resource and a lack of support for veterinarians in interpreting MICs and breakpoints.
The variability in veterinary antibiotic treatment decisions in this study suggests a need for further dissemination of standardised antimicrobial stewardship resources for veterinarians. Client-related challenges and the cost of culture and susceptibility are major barriers to stewardship. To address these barriers, it is necessary to provide standardised, easy-to-access guidance for veterinarians in interpreting MICs and breakpoints, as well as develop antimicrobial use resources for clients.
明智地使用抗菌药物对于小型和混合动物兽医学中感染的持续治疗至关重要。为了更好地支持华盛顿州的兽医进行抗菌药物管理，我们对有执照的小型和混合动物兽医进行了调查，并就抗菌药物处方实践开展了小组讨论。
调查问卷包括人口统计学信息、影响处方实践的因素和临床病例。对回答进行了总结，并进行了逻辑回归分析，以确定与抗生素治疗选择相关的因素。由一名有执照的兽医主持的小组讨论聚焦于兽医的资源缺口、临床情况的管理以及最低抑菌浓度（MIC）和断点的解读。对谈话记录进行系统的定性分析，确定了关键主题，如管理的常见障碍。
在对53个临床病例的回答中，根据兽医微生物学家的意见，兽医有62%的时间选择了最合适的治疗方案。在培养和药敏试验方法以及抗生素选择方面存在差异。调查对象报告称，客户给药能力（92%）、耐药性考量（91%）、客户财务状况（75%）和抗菌药物的可获得性（75%）对他们的处方决定有影响。在关于抗菌药物耐药性（AMR）的促成因素的看法或所使用的指南与临床病例中的治疗选择之间，没有显著关联。在小组讨论中采访的15名兽医中，对谈话记录进行的系统定性分析揭示了关键主题，包括依赖人类医学作为资源以及在解读MIC和断点方面缺乏对兽医的支持。
本研究中兽医抗生素治疗决策的差异表明，需要进一步为兽医传播标准化的抗菌药物管理资源。与客户相关的挑战以及培养和药敏试验的成本是管理的主要障碍。为解决这些障碍，有必要为兽医提供标准化、易于获取的关于解读MIC和断点的指导，并为客户开发抗菌药物使用资源。
