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National surveillance of antimicrobial prescription and resistance in companion pet animals - VM0520

Description
Antibacterials are used in human and veterinary healthcare for the treatment of bacterial infections. Antibacterial resistance is an increasing problem, particularly in human healthcare, and this impacts both on disease morbidity and mortality, as well as having significant financial implications. Since the principal driver for the selection of resistant bacterial populations is antibacterial use, the use and stewardship of antibacterials is becoming increasingly important in human and veterinay healthcare. There are concerns that the use of antibacterials in animals may be contributing to resistance in humans. As a result, successive Cheif Medical Officers have first called for the use of those antibacterials critical for human health to be restricted in some animal species, and more recently, for a national approach to tackling antimicrobial resistance, clearly indicating a need for the veterinary sector to play its role, to encourage responsible use of antibacterials and better antimicrobial prescription (AMP) and resistance (AMR) surveillance. Furthermore, it is also crucial to ensure the efficacy of antibacterials for future use in the veterinary sector to protect animal welfare.

Antimicrobial prescription:
In the European Union, prescribing of antibacterials for use in animals must be by a veterinary surgeon (all antibacterials in the POM-V category in the UK). Precriptions of antibacterials for companion animals take place at an individual practice level and therefore there is no central body collating data on precriptions. What data is available on AMP is from the VMD, which publishes information on the overall tonnage of antibacterial products sold in the UK, and where possible, the amounts sold for individual species. In its latest report dated 2012, 2011 total sales of therapeutic antimicrobials were 346 tonnes. Eighty-four percent of products sold were for use in food animals, 10% were for companion (non-food animals), with the remaining 6% licensed for both food and non-food animals. Between 2010 and 2011 there was a 4% increase i the amount of antimicrobials sold for use in dogs only. Data on AMP of these type, whilst valuable to spot national trends, cannot identify the number of animals being treated (products are available for more than one species, and where there is a high degree of weight variability within that species as with dogs, than a defined daily dose cannot be calculated). In addition, VMD sales statistics cannot define the conditions from which the recipient patients were treated, nor can they quantify the use of antibacterial products which are not licensed for animals use.

If the veterinary profession is to show it is using these products responsibly, a new method of collecting AMP data is clearly needed. SAVSNET (the Small Animal Veterinary Surveillance Networkl) is a charitable collaboration between BSAVA and the University of Liverpool, which has developed new methods for collecting UK-wide statistics on disease and treatment in companion animals. SAVSNET does this by collecting clinical data from diagnostic laboratories and direct from vets in practice. In a pilot project, we showed that the proportion of consultations associated with the dispesing of antibacterials was 48%, 35% and 37% for cats, dogs and rabbits respectively. Seventy-six percent of antibacterials precribed were B-lactams, including the most common group, clavulanic-acid potentiated amoxicillin, itself making up 36% of the antibacterials precribed. Other classes included lincosamides (9%), fluouroquinolones and quinolones (6%) and nitroimidazoles (4%). Vancomycin and teicoplanin (glycopeptides), and imipenem and meropenem (carbapenems) precribing was not identified. Precribing behaviour was shown to vary between practives: For dogs and cats, the proportion of consults associated with the precription of antibacterials ranged from 0.26-0.55 and 0.41-0.73 respectively.

Antimicrobial resistance:
Data on AMR in farm animal species is routinely collected and reported by AHVLA and SAC in their disease surveillance reports. In contrast, there is no national surveillance of AMR in companion animals. What data is available are from bespoke epidemiological and microbiological surveys, and highlight the potential transmission of AMR between companion animal species and their owners. For example, the group of clonally related human B2-O25:H4-ST131 CTX-M-15-type extended spectrum B-lactamase (ESBL)-producing E-coli strains has been identified in companion animals from various European countries, including the UK, highlighting the potential of inter-species transmissions of these multi-drug resistant strains. In addition, in the authors' lab, we have identified human-type strains of Pseudomonas aeuriginosa that are resistant to colistin (a last line antibacterial for cystic fibrosis patients with pneumonia) in the ears of dogs. This lack of national scanning surveillance of AMR in companion animals represents a clear defiency in our ability to define patterns and trends and identify threats.

The importance of companion animals:
Based on recent census data, there are an estimated 10 million dogs and 10 million cats in the UK, with ~30% of households owning each species. The close contact between humans and companion animals creates considerable opportunites for the transmission of organisms between them. In the context of this application, this includes AMR, such that the use of antbacterials in small companion animals species could lead to the emergence of resistant bacteria in both them and through zoonotic transmission, to their owners. The overall aim of this project is, through SAVSNET, to collect and analyse routine surveillance data on both AMP and R in small animal veteinary practice, identifying risk factors for each, and providing benchmarking data to practitioners, and bespoke reports to VMD.
Objective
The overall aim of this project is, through SAVSNET, to collect and analyse routine surveillance data on antimicrobial consumption and resistance in small animal veterinary practice, identifying risk factors for each, and providing benchmarking data to practitioners, and bespoke reports to VMD.

Specific objectives are to:
1. Characterise the resistance profile of common bacterial infections of companion animals in space and time.
2. Assess the mechanism and transmission of antimicrobial resistance by selecting a panel of resistant bacteria for detailed phenotypic and genotypic analyses (follows 1).
3. Monitor the use of antimicrobials, in space and time, and identify risk factors for use at the practice, animal and population levels (150,000 consults already available for analyses).
4. Compare data on AMC in veterinary practice with similar data on precriptions be medical practitioners (follows 3 - medical practitioner data is already available to BT).
5. Assess the clinical outcome benefit (or otherwise) of antibacterial treatment using consultation data on, for example, acute diarrhoea (in parallel with 4).
6. Seek correlation between laboratory-confirmed resistance and practive AMC data in space/ time (dependent on 1 and 3).
Time-Scale and Cost
From: 2014

To: 2017

Cost: £98,203
Contractor / Funded Organisations
University of Liverpool
Keywords
Antimicrobial Resistance              
Companion Animals