Clinical Connections  –  Summer 2017

Rosanne Jepson and Zoe Halfacree, co-chairs of the Infection Control Group at the Queen Mother Hospital for Animals

There are worldwide concerns about the use of antibiotics and the development of antibiotic resistance and many made news headlines. It is easy to blame the development of ‘superbugs’ on inappropriate antibiotic use which could occur in many health spheres, but we should all as vets be cognisant of the way that we use antibiotics for every patient that we treat that requires antibiotics.

Every year we treat patients at the RVC that are referred with multi-drug resistant infections and this poses a constant challenge to the way that we manage and care for such patients. It is not that antibiotics should not be used - it is just that they should be used with due consideration.

As vets we all need to ensure that we are prudent with our use of antibiotics to make sure that we try to prevent the development of resistance through inappropriate use.

The RVC Infection Control Group has representation from every hospital service, including the nursing and pharmacy teams

The overall prevalence of multidrug-resistant infections in both general practice and at specialist referral hospitals is difficult to estimate. There are studies showing increasing prevalence of multi-drug resistance in key organisms obtained from sampling specific sites and this is a growing concern. This emphasises the importance of sampling and obtaining cultures from patients prior to use of antibiotics as without this information it is impossible to identify and act accordingly when a multi-drug resistant infection is present.

We have to carefully consider whether antibiotics are needed for a patient i.e. do they have a bacterial infection, the type of antibiotic required depending on the bacterial infection, and the location of the infection (i.e. where the antibiotics have to penetrate). We also have to consider the best route of administration, the duration of treatment and ensuring patient and owner compliance to complete the course prescribed and to monitor for resolution of infection.

Leading organisations like the World Health Organization have developed antibiotic guidelines which put antibiotics into tiers to guide the most appropriate antibiotic usage and help to preserve these very important antibiotics that are used to treat the most severe infections.

Our Infection Control Group has representation from every hospital service, including the nursing and pharmacy teams. This is really important so that everyone is working together with the same common goal and that we consider the different requirements of different disciplines.

We have a tiered antibiotic policy for use in the hospital to help monitor, preserve and audit our antibiotic usage and the occurrence of multi-drug resistant infections. Antibiotics are classified into three tiers ranging from Tier 1, which can be used without restrictions, through to Tier 3 which are considered ‘critical’ antibiotics for use only on the basis of culture results and with careful recording and discussion about the rationale for their use.

The Infection Control Group provides a core team of people available to discuss in a multidisciplinary manner antibiotic choice and whether alternative approaches are available to improve treatment and outcome for patients with bacterial infections.

The group has established in-house culture facilities so that rapid turnaround for identification of bacterial infections. This ensures that appropriate cultures are performed for every patient so that the infection is correctly identified and best choice of antibiotic treatment can be made, if antibiotics are necessary.

The group provides a discussion forum if a multi-drug resistant infection is identified which would require use of what may be considered a ‘critical’ or Tier 3 antimicrobial drug. This is designed to ensure that optimal treatment is provided for each of those patients.

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