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An Urban Experience
 Drivers for appropriate and inappropriate antimicrobial use
      Client interaction
 Effective communication Trusting relationship Poor knowledge of AMR in animals Client demand for antimicrobials Insufficient consultation time Fear of losing the client and income Public education Engagement with Antibiotic Guardian campaigns
 Veterinary interaction
  Practice culture Fear of missing an infection Influence of senior colleagues Lack of audit and comparative data Engagement with Antibiotic Guardian campaigns
 Professional regulation
  Clear national guidance Training Voluntary versus mandatory; impact on uptake and clinical freedom?
 Antimicrobial use guidelines
  Practical Comprehensive Independent and evidence-based
 Recognition of good practice
   National or international accreditation of clinicians and practices Public awareness
 Antimicrobial use guidelines
A variety of guidelines are available. However, implementation varies from mandatory (e.g. in Denmark and Sweden) to professional responsibility (e.g. in the UK) or voluntary. The challenge is to improve engagement
and adherence. Peer discussion of treatment protocols, but these should be evidence-based, follow current recommendations and take into account the resources available.
 Key concepts for responsible antimicrobial use
      You should know or strongly suspect there is a bacterial infection
 Don’t use antimicrobials to treat non-specific clinical signs Understand the clinical signs associated with bacterial infection Use cytology to confirm bacterial involvement Known when to culture
 Are systemic antimicrobials needed?
   Consider topical antimicrobials Manage the underlying condition
   Does the animal require immediate treat- ment?
 How serious is the infection? Can you wait for the culture results?
 Choose an appropriate antimicrobial
  Aim for the lowest tier most narrow spectrum drug Consider penetration to the target tissue Consider topical treatment
 Use the correct dose
   Always weigh animals and round the dose up
   Treatment duration
 Treat to clinical cure and avoid overly long courses of treatment
 Improve compliance
   Explain treatment, using good communication and follow-up
 Veterinary contact and antimicrobial resistant bacteria
Colonisation with AMR bacteria increases with veterinary contact. For example, MRS have been isolated from 0.5% to 10% of vet visiting animals and clinical samples in Europe and Canada. The prevalence was 46% among canine in-patients in Japan, and in the US they have been found in 15-38% of dogs with pyoderma and up
to 20% of clinical samples. Some 7-13% of veterinary staff are colonised with MRS, which reflect their area
of work. MRS can also be isolated from up to 10% of veterinary practice samples, particularly hand touch sites. Fluoroquinolone resistant, ESBL and AmpC E. coli have been found in 5-10% of faecal and environmental samples from UK veterinary hospitals, particularly ward floors, tables and keyboards.
Specific risk factors include:
• Multiple antibiotic courses
• Post-operative infections
• Nosocomial (healthcare-acquired) infections
• Prolonged hospitalisation (especially in ICUs)
• Surgical or nursing implants (e.g. catheters and feeding tubes)

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