Dr. Jennifer Granick’s research started with an important question: Where’s the national data on antibiotic use (AU) in cats and dogs? The answer, as she already knew, was: It doesn’t exist. She thinks it should.
Granick, an internist and associate professor in the Department of Veterinary Clinical Sciences, is committed to fighting the growing problem of antimicrobial resistance (AMR), in which bacteria, viruses, or parasites adapt over time to no longer respond to medication—rendering antibiotics and other antimicrobial medicines ineffective and increasing the risk of disease spread. The World Health Organization has called AMR “one of the top 10 global public health threats facing humanity.” It’s also a significant threat to animal health.
The Centers for Disease Control collects and disseminates data on antibiotic prescription use in humans, but no such repository exists for companion animals. So Granick and her team, including Dr. Amanda Beaudoin with the Minnesota Department of Health and epidemiologist Emma Leof Bollig, created the Antimicrobial Resistance and Stewardship Initiative (ARSI) and set out to collect that data.
To gather a robust dataset without imposing a burden on vet clinics, the team determined a point-prevalence survey, in which antibiotic use is collected from numerous clinics on a single day, was the best research method. It’s the same way the CDC collects its AU data.
“So we decided, ‘That’s great methodology. Why don’t we take that and apply it to vet settings and adjust it to our needs?’” Granick said.
A sampling from a broad contingent of vet hospitals was important—and so was distinguishing between types of hospitals. The ARSI group wanted to look at teaching hospitals separately from general practice clinics, because teaching hospitals are training future veterinarians.
“We thought it was important to take a look at what AU prescribing behavior is in these settings,” Granick said. “If the teaching hospitals aren’t optimally prescribing antibiotics, where are these students going to learn appropriate prescribing? In their clinical year, are the students seeing us modeling the prescribing behavior that we lecture to them about in the didactic years of the curriculum?”
Granick’s team ran its first survey of academic hospitals—14 clinics in 14 states—on a single day in 2020. They plan to submit the results for publication this summer. Among the findings: 37% of cats and dogs were prescribed at least one antibiotic on the survey date, 94% of which were systemic medications and 6% were topical. Nearly all were given in response to an infection (65%) or in order to prevent one (25%); 6% were prescribed an antibiotic despite an unclear motive; and 4% for drug effects distinct from their ability to kill bacteria (to improve movement of the gastrointestinal tract, for example).
The team followed in 2021 with a survey of non-academic general and referral vet practices. These studies were funded by the U.S. Food and Drug Administration and, thanks to this ongoing support, the ARSI team will conduct another teaching-hospital survey in 2022, including Canadian teaching hospitals. They will also conduct another general practice survey the following year.
The goal is a better understanding of what antibiotics are prescribed for what diseases and at what frequency. Over time, the shared knowledge gleaned from new survey data will allow small-animal veterinarians to make more informed decisions about prescribing antibiotics—so that our pets receive the level of compassion and care they deserve.
“Most reports of antibiotic prescribing in cats and dogs are limited to single institutions, so we don’t know at a large scale how we are doing in the U.S. in terms of antibiotic prescribing,” Granick said. “What this data allows us to do is to get baseline or benchmarking info on those prescribing habits—which is crucial for antibiotic stewardship. It allows us to identify the needs of the profession and to create goals around prescribing.”