Species-specific and Indication-based Use of Antimicrobials in Dogs, Cats, Cattle and Horses in Finland : Data collected using three different methods

Increasing antimicrobial resistance in bacteria has led to the need for better understanding of antimicrobial usage patterns. In 1999, the World Organisation for Animal Health (OIE) recommended that an international ad hoc group should be established to address human and animal health risks related to antimicrobial resistance and the contribution of antimicrobial usage in veterinary medicine. In European countries the need for continuous recording of the usage of veterinary antimicrobials as well as for animal species-specific and indication-based data on usage has been acknowledged. Finland has been among the first countries to develop prudent use guidelines in veterinary medicine, as the Ministry of Agriculture and Forestry issued the first animal species-specific indication-based recommendations for antimicrobial use in animals in 1996. These guidelines have been revised in 2003 and 2009. However, surveillance on the species-specific use of antimicrobials in animals has not been performed in Finland. This thesis provides animal species-specific information on indication-based antimicrobial usage. Different methods for data collection have been utilized. Information on antimicrobial usage in animals has been gathered in four studies (studies A-D). Material from studies A, B and C have been used in an overlapping manner in the original publications I-IV. Study A (original publications I & IV) presents a retrospective cross-sectional survey on prescriptions for small animals at the Veterinary Teaching Hospital of the University of Helsinki. Prescriptions for antimicrobial agents (n = 2281) were collected and usage patterns, such as the indication and length of treatment, were reviewed. Most of the prescriptions were for dogs (78%), and primarily for the treatment of skin and ear infections most of which were treated with cephalexin for a median period of 14 days. Prescriptions for cats (18%) were most often for the treatment of urinary tract infections with amoxicillin for a median length of 10 days. Study B (original publication II) was a retrospective cross-sectional survey where prescriptions for animals were collected from 17 University Pharmacies nationwide. Antimicrobial prescriptions (n = 1038) for mainly dogs (65%) and cats (19%) were investigated. In this study, cephalexin and amoxicillin were also the most frequently used drugs for dogs and cats, respectively. In study C (original publications III & IV), the indication-based usage of antimicrobials of practicing veterinarians was analyzed by using a prospective questionnaire. Randomly selected practicing veterinarians in Finland (n = 262) recorded all their antimicrobial usage during a 7-day study period. Cattle (46%) with mastitis were the most common patients receiving antimicrobial treatment, generally intramuscular penicillin G or intramammary treatment with ampicillin and cloxacillin. The median length of treatment was four days, regardless of the route of administration. Antimicrobial use in horses was evaluated in study D, the results of which are previously unpublished. Firstly, data collected with the prospective questionnaire from the practicing veterinarians showed that horses (n = 89) were frequently treated for skin or wound infections by using penicillin G or trimethoprim-sulfadiazine. The mean duration of treatment was five to seven days. Secondly, according to retrospective data collected from patient records, horses (n = 74) that underwent colic surgery at the Veterinary Teaching Hospital of the University of Helsinki were generally treated according to national and hospital recommendations; penicillin G and gentamicin was administered preoperatively and treatment was continued for a median of three days postoperatively. In conclusion, Finnish veterinarians followed well the national prudent use guidelines. Narrow-spectrum antimicrobials were preferred and, for instance, fluoroquinolones were used sparingly. Prescription studies seemed to give good information on antimicrobials usage, especially when combined with complementary information from patient records. A prospective questionnaire study provided a fair amount of valuable data on several animal species. Electronic surveys are worthwhile exploiting in the future.Kansainvälinen eläinten tartuntatautien järjestö OIE (World Organisation for Animal Health) sekä monet Euroopan maat ovat tiedostaneet eläimille käytettävien mikrobilääkkeiden tarkemman tiedon keruun tarpeen. Tieto on tärkeää arvioidessa eläinten lääkekäytön vaikutuksia resistenssin lisääntymiseen ihmisten ja eläinten tautia aiheuttavissa bakteereissa. Maa- ja metsätalousministeriön asettama työryhmä laati vuonna 1996 ensimmäiset mikrobilääkkeiden käyttösuositukset eläinten yleisimpiin tulehdustauteihin. Suosituksia on päivitetty 2003 ja 2009. Tutkimuksia siitä, ovatko eläinlääkärit noudattaneet annettuja suosituksia, ei kuitenkaan ole tehty. Tämä väitöskirjatutkimus perustuu eläinlaji- ja käyttöaihekohtaiseen mikrobilääkkeiden käyttöön koirilla, kissoilla, naudoilla ja hevosilla Suomessa. Tutkimuksen tarkoituksena oli selvittää, miten ministeriön suosituksia on noudatettu ja mihin suuntaan suosituksia tulisi kehittää. Tietoa mikrobilääkkeiden käytöstä koirilla ja kissoilla kerättiin Yliopistollisen eläinsairaalan potilaille määrätyistä mikrobilääkeresepteistä (n = 2281) sekä potilastiedostoista. Lisäksi käyttöä selvitettiin keräämällä tietoja kaikista Suomen Yliopiston Apteekeista kuukauden ajalta toimitetuista eläinten mikrobilääkeresepteistä (n = 1038). Suurin osa resepteistä oli määrätty koirille. Yleisin käyttöaihe oli iho- ja korvatulehdus. Kissoille määrätyissä resepteissä oli yleisimpänä käyttöaiheena virtsatietulehdus. Kefaleksiini ja amoksisilliini olivat yleisimmin käytetyt lääkeaineet. Kolmas aineisto kerättiin praktiikkaa tekeville eläinlääkäreille suunnatun kyselytutkimuksen avulla. Eläinlääkärit kirjasivat viikon ajan kaikki tiedot antamistaan tai määräämistään mikrobilääkehoidoista. Eniten mikrobilääkkeitä käytettiin naudoille, joilla yleisimmin hoidettiin utaretulehdusta, joko lihaksensisäisellä penisilliinillä tai intramammaareilla. Hevosten lääkekäytöstä koottiin kaksi erillistä aineistoa. Eläinlääkäreille suunnatun kyselytutkimuksen perusteella hevosia hoidettiin useimmiten iho- tai haavatulehduksen takia käyttäen penisilliiniä tai trimetopriimi-sulfadiatsiinia. Toinen hevosia koskeva aineisto kerättiin Yliopistollisen eläinsairaalan potilasasiakirjoista. Aineisto koostui kaikista kolmen vuoden aikana hevossairaalassa ähkyn takia leikattujen hevosten mikrobilääkkeiden käytöstä sairaalahoidon aikana. Lääkekäyttö oli pääosin suositusten mukainen, koska suurin osa potilaista sai penisilliiniä ja gentamisiinia suonensisäisesti ennen leikkausta ja hoitoa jatkettiin keskimäärin kolmen vuorokauden ajan leikkauksen jälkeen. Yhteenvetona voidaan todeta, että Suomen eläinlääkärit noudattivat Maa- ja metsätalousministeriön antamia mikrobilääkkeiden käyttösuosituksia hyvin. Kapeakirjoisia lääkeaineita suosittiin ja esimerkiksi fluorokinolonien käyttö oli maltillista ja perusteltua. Reseptitutkimukset antavat hyvää tietoa mikrobilääkkeiden eläinlaji- ja käyttöaihekohtaisesta käytöstä, erityisesti jos puuttuvia tietoja on mahdollista täydentää esimerkiksi potilasasiakirjojen avulla. Eteenpäin suuntautuva kyselytutkimus antoi runsaasti tietoa mikrobilääkkeiden käytöstä eri eläinlajeilla. Jatkossa elektronisten apuvälineiden käyttöä kyselytutkimuksissa tulee hyödyntää paremmin

Veterinary hygiene : A guideline for veterinary practices

This guide has been drafted as a concrete protocol of the National Action Plan on Antimicrobial Resistance in order to provide practical assistance for the development of hygiene practices at veterinary receptions and prevent the spread of antimicrobial resistance. Increasing antimicrobial resistance is one of the biggest national health threats in the world. The antimicrobial resistance of pathogenic bacteria in animals is also increasing at an alarming rate. Reducing the use of antimicrobials mitigates the development of resistance and improving the level of hygiene at veterinary receptions can also effectively prevent infections and the spread of antimicrobial resistance. Daily hygiene procedures and taking standard precautions form the basis for preventing infections. These precautions must be taken with each and every patient by all reception personnel. Proper hand hygiene is the foundation of hygiene protocols. In addition to proper hand hygiene, hygiene protocols and standard precautions include aseptic technique, the proper use of personal protection equipment, the immediate cleaning of secretions, the prevention of needle stick and cutting injuries, and maintaining reception tidiness and cleanliness. Furthermore, special attention must be given to the treatment and handling of risk patients, i.e. potential carriers of resistant bacteria and animals with contagious diseases. The identification of risk patients, choosing the right treatment room and treatment planning at the reception are crucial to avoiding contamination of the facility and the spread of infection transmitted by the hands of personnel, the environment and the equipment used. This guide will help point out essential factors in the planning of hygiene protocols at different veterinary receptions

Veterinary hygiene : A guideline for veterinary practices

This guide has been drafted as a concrete protocol of the National Action Plan on Antimicrobial Resistance in order to provide practical assistance for the development of hygiene practices at veterinary receptions and prevent the spread of antimicrobial resistance. Increasing antimicrobial resistance is one of the biggest national health threats in the world. The antimicrobial resistance of pathogenic bacteria in animals is also increasing at an alarming rate. Reducing the use of antimicrobials mitigates the development of resistance and improving the level of hygiene at veterinary receptions can also effectively prevent infections and the spread of antimicrobial resistance. Daily hygiene procedures and taking standard precautions form the basis for preventing infections. These precautions must be taken with each and every patient by all reception personnel. Proper hand hygiene is the foundation of hygiene protocols. In addition to proper hand hygiene, hygiene protocols and standard precautions include aseptic technique, the proper use of personal protection equipment, the immediate cleaning of secretions, the prevention of needle stick and cutting injuries, and maintaining reception tidiness and cleanliness. Furthermore, special attention must be given to the treatment and handling of risk patients, i.e. potential carriers of resistant bacteria and animals with contagious diseases. The identification of risk patients, choosing the right treatment room and treatment planning at the reception are crucial to avoiding contamination of the facility and the spread of infection transmitted by the hands of personnel, the environment and the equipment used. This guide will help point out essential factors in the planning of hygiene protocols at different veterinary receptions

Koiran polvinivelen bakteeritulehdus, hoito tähystysavusteisin nivelhuuhteluin yhdistettynä antibioottihoitoon ja implanttien poistoon - tapausselostus : Case report of septic arthritis of the stifle joint in a White German Shepherd dog - treatment with repeated arthroscopic lavage, antimicrobial therapy and implant removal

Peer reviewe

Hygieniaopas eläinlääkärin vastaanotolle

Tämä opas on laadittu Suomen mikrobilääkeresistenssin torjunnan kansallisen toimintaohjelman konkreettisena toimenpiteenä tuomaan käytännönläheistä apua eläinlääkärien vastaanottojen hygieenisen toiminnan kehittämiseksi ja mikrobilääkeresistenssin leviämisen ehkäisemiseksi. Kasvava mikrobilääkeresistenssi on yksi maailman suurimmista kansanterveyden uhista. Myös eläimille infektioita aiheuttavien bakteerien mikrobilääkeresistenssi lisääntyy huolestuttavasti. Mikrobilääkkeiden käytön vähentäminen hillitsee resistenssin kehittymistä ja sen lisäksi myös eläinlääkärien vastaanottojen hygieniaa parantamalla voidaan tehokkaasti ehkäistä infektioiden syntymistä ja mikrobilääkeresistenssin leviämistä. Päivittäinen hygieeninen toiminta ja tavanomaisten varotoimien noudattaminen on tartuntojen ja infektioiden ehkäisemisen perusta. Näitä varotoimia tulee toteuttaa jokaisen potilaan kohdalla kaikkien vastaanotolla työskentelevien toimesta. Hyvä käsihygienia on hygieenisen toiminnan perusta. Asianmukaisen käsihygienian lisäksi hygieeniseen toimintaan ja tavanomaisiin varotoimiin kuuluvat aseptinen työskentely, oikeaoppinen suojainten käyttö, eritetahrojen välitön siivoaminen, pisto- ja viiltotapaturmien ehkäisy sekä vastaanoton siisteyden ja puhtauden ylläpito. Lisäksi on kiinnitettävä erityistä huomiota riskipotilaiden, eli mahdollisten resistenttien bakteerien kantajien ja tarttuvaa tautia sairastavien eläinten käsittelyyn vastaanotolla. Riskipotilaan tunnistaminen, sopivan hoitotilan valitseminen ja hoidon suunnittelu vastaanotolla on tärkeää jotta vältetään tilojen kontaminoituminen ja tartunnan leviäminen niin henkilökunnan käsien, kuin ympäristön ja välineidenkin välityksellä. Tämä opas auttaa huomioimaan olennaiset tekijät erilaisten eläinlääkärivastaanottojen hygieenisten toimintatapojen suunnittelussa

Antimicrobial resistance in Staphylococcus pseudintermedius and the molecular epidemiology of methicillin-resistant S-pseudintermedius in small animals in Finland

Objectives: To investigate antimicrobial susceptibility in Staphylococcus pseudintermedius and the occurrence of methicillin-resistant S. pseudintermedius (MRSP), to explore the molecular structure of the MRSP population and to analyse risk factors for MRSP. Methods: Susceptibility data for clinical S. pseudintermedius isolates in 2011-15 were analysed using WHONET. All MRSP isolates in 2010-14 (n = 362) were typed using PFGE. Representative isolates (n = 87) of clusters were analysed using MLST and staphylococcal cassette chromosome mec (SCCmec) typing. Risk factors were analysed using logistic regression. Results: Of the clinical S. pseudintermedius (n-1958; 98% from dogs), 14% were MRSP. Resistance to other antimicrobials varied between 12% and 39%. No trends were observed over time. Among clinical specimens (from infection sites) and screening specimens (from potential carriers), respectively, 2.5% (267/10813) and 9% (211/2434) revealed MRSP. MLST revealed 42 different STs, including 19 new ones. Clonal complexes 71, 45 and 258 were the most common, but the MRSP population diversified over the years. A clinical S. pseudintermedius isolate was more likely to be MRSP if the patient was on antimicrobials at the time of sampling or was male. The presence of MRSP in screening specimens was more likely if the patient was on multiple antimicrobials at the time of sampling. Specimens from private clinics (versus the Veterinary Teaching Hospital of the University of Helsinki) had a higher likelihood of MRSP in both analyses. Conclusions: Resistance to antimicrobials among S. pseudintermedius in Finland is high, emphasizing the importance of infection control measures and susceptibility testing prior to therapy. The diverse MRSP population indicates non-clonal spread.Peer reviewe

Overcoming Vulnerability in the Life Course - Reflections on a Research Program

This chapter reflects on the twelve-year Swiss research program, “Overcoming vulnerability: Life course perspectives” (LIVES). The authors are longstanding members of its scientific advisory committee. They highlight the program’s major accomplishments, identify key ingredients of the program’s success as well as some of its challenges, and raise promising avenues for future scholarship. Their insights will be of particular interest to those who wish to launch similar large-scale collaborative enterprises. LIVES has been a landmark project in advancing the conceptualization, measurement, and analysis of vulnerability over the life course. The foundation it has provided will direct the next era of scholarship toward even greater specificity: in understanding the conditions under which vulnerability matters, for whom, when, and how. In a process-oriented life-course perspective, vulnerability is not viewed as a persistent or permanent condition but rather as a dormant condition of the social actor, activated in particular situations and contexts

Characterisation of and risk factors for extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) in an equine hospital with a special reference to an outbreak caused by Klebsiella pneumoniae ST307 : CTX-M-1

Background Extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) are important causative agents for infections in humans and animals. At the Equine Veterinary Teaching Hospital of the University of Helsinki, the first infections caused by ESBL-E were observed at the end of 2011 leading to enhanced infection surveillance. Contact patients were screened for ESBL-E by culturing infection sites and rectal screening. This study was focused on describing the epidemiology and microbiological characteristics of ESBL-E from equine patients of the EVTH during 2011-2014, and analysing putative risk factors for being positive for ESBL-E during an outbreak of Klebsiella pneumoniae ST307. Results The number of ESBL-E isolations increased through 2012-2013 culminating in an outbreak of multi-drug resistant K. pneumoniae ST307:bla(CTX-M-1):bla(TEM):bla(SHV) during 04-08/2013. During 10/2011-05/2014, altogether 139 ESBL-E isolates were found from 96 horses. Of these, 26 were from infection-site specimens and 113 from rectal-screening swabs. A total of 118 ESBL-E isolates from horses were available for further study, the most numerous being K. pneumoniae (n = 44), Escherichia coli (n = 31) and Enterobacter cloacae (n = 31). Hospital environmental specimens (N = 47) yielded six isolates of ESBL-E. Two identical E. cloacae isolates originating from an operating theatre and a recovery room had identical or highly similar PFGE fingerprint profiles as five horse isolates. In the multivariable analysis, mare-foal pairs (OR 4.71, 95% CI 1.57-14.19, P = 0.006), length of hospitalisation (OR 1.62, 95% CI 1.28-2.06, P < 0.001) and passing of a nasogastric tube (OR 2.86, 95% CI 1.03-7.95, P = 0.044) were associated with being positive for ESBL-E during the K. pneumoniae outbreak. Conclusions The occurrence of an outbreak caused by a pathogenic ESBL-producing K. pneumoniae ST307 strain highlights the importance of epidemiological surveillance of ESBL-E in veterinary hospitals. Limiting the length of hospitalisation for equine patients may reduce the risk of spread of ESBL-E. It is also important to acknowledge the importance of nasogastric tubing as a potential source of acquiring ESBL-E. As ESBL-E were also found in stomach drench pumps used with nasogastric tubes, veterinary practices should pay close attention to appropriate equipment cleaning procedures and disinfection practices.Peer reviewe

Antimicrobial prophylaxis is considered sufficient to preserve an acceptable surgical site infection rate in clean orthopaedic and neurosurgeries in dogs

Background Surgical site infections (SSI) are associated with increased morbidity and mortality. To lower the incidence of SSI, antimicrobial prophylaxis is given 30-60 min before certain types of surgeries in both human and veterinary patients. However, due to the increasing concern of antimicrobial resistance, the benefit of antimicrobial prophylaxis in clean orthopaedic and neurosurgeries warrants investigation. The aims of this retrospective cross-sectional study were to review the rate of SSI and evaluate the compliance with antimicrobial guidelines in dogs at a veterinary teaching hospital in 2012-2016. In addition, possible risk factors for SSI were assessed. Results Nearly all dogs (377/406; 92.9%) received antimicrobial prophylaxis. Twenty-nine dogs (7.1%) did not receive any antimicrobials and only four (1.1%) received postoperative antimicrobials. The compliance with in-house and national protocols was excellent regarding the choice of prophylactic antimicrobial (cefazolin), but there was room for improvement in the timing of prophylaxis administration. Follow-up data was available for 89.4% (363/406) of the dogs. Mean follow-up time was 464 days (range: 3-2600 days). The overall SSI rate was 6.3%: in orthopaedic surgeries it was 6.7%, and in neurosurgeries it was 4.2%. The lowest SSI rates (0%) were seen in extracapsular repair of cranial cruciate ligament rupture, ulnar ostectomy, femoral head and neck excision, arthrotomy and coxofemoral luxation repair. The highest SSI rate (25.0%) was seen in arthrodesis. Omission of antimicrobials did not increase the risk for SSI (P = 0.56; OR 1.7; CI(95%)0.4-5.0). Several risk factors for SSI were identified, including methicillin-resistantStaphylococcus pseudintermediuscarriage (P = 0.02; OR 9.0; CI(95%)1.4-57.9) and higher body temperature (P = 0.03; OR 1.69; CI(95%)1.0-2.7; mean difference + 0.4 degrees C compared to dogs without SSI). Conclusions Antimicrobial prophylaxis without postoperative antimicrobials is sufficient to maintain the overall rate of SSI at a level similar to published data in canine clean orthopedic and neurosurgeries.Peer reviewe