Intervention with impact: Reduced isolation of methicillin-resistant Staphylococcus pseudintermedius from dogs following the introduction of antimicrobial prescribing legislation in Germany.
Journal
The Veterinary record
ISSN: 2042-7670
Titre abrégé: Vet Rec
Pays: England
ID NLM: 0031164
Informations de publication
Date de publication:
15 Dec 2023
15 Dec 2023
Historique:
revised:
03
11
2023
received:
05
07
2023
accepted:
21
11
2023
medline:
15
12
2023
pubmed:
15
12
2023
entrez:
15
12
2023
Statut:
aheadofprint
Résumé
Legislation was introduced in Germany in 2018, requiring bacterial culture and antimicrobial susceptibility testing before the prescription of fluoroquinolones and third-generation cephalosporins to dogs. We hypothesised that, following this intervention, the number of clinical samples testing positive for methicillin-resistant Staphylococcus pseudintermedius (MRSP) would reduce. Reports of S. pseudintermedius isolated from canine clinical samples by three German veterinary diagnostic microbiology laboratories during the 38 months before the introduction of the legislation and the 46 months after were compared. Bacterial identification was performed by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry, and antimicrobial susceptibility testing followed recognised recommendations but with changes during the study period. Among a total of 120,571 S. pseudintermedius isolates, MRSP accounted for 7.1% overall. Following the legislative intervention, monthly submissions yielding S. pseudintermedius increased at all three laboratories. The MRSP percentage was lower in the period after the intervention in two of the three laboratories (p < 0.001); in the third laboratory, there was no change between periods, but a year-on-year reduction in MRSP percentages occurred after the intervention (p = 0.0004). Changing susceptibility testing methods limited the direct comparison of resistance patterns among laboratories. The reduction in MRSP in canine clinical samples following the introduction of this legislation suggests a positive impact of compulsory laboratory testing on reducing antimicrobial resistance.
Sections du résumé
BACKGROUND
BACKGROUND
Legislation was introduced in Germany in 2018, requiring bacterial culture and antimicrobial susceptibility testing before the prescription of fluoroquinolones and third-generation cephalosporins to dogs. We hypothesised that, following this intervention, the number of clinical samples testing positive for methicillin-resistant Staphylococcus pseudintermedius (MRSP) would reduce.
METHODS
METHODS
Reports of S. pseudintermedius isolated from canine clinical samples by three German veterinary diagnostic microbiology laboratories during the 38 months before the introduction of the legislation and the 46 months after were compared. Bacterial identification was performed by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry, and antimicrobial susceptibility testing followed recognised recommendations but with changes during the study period.
RESULTS
RESULTS
Among a total of 120,571 S. pseudintermedius isolates, MRSP accounted for 7.1% overall. Following the legislative intervention, monthly submissions yielding S. pseudintermedius increased at all three laboratories. The MRSP percentage was lower in the period after the intervention in two of the three laboratories (p < 0.001); in the third laboratory, there was no change between periods, but a year-on-year reduction in MRSP percentages occurred after the intervention (p = 0.0004).
LIMITATIONS
CONCLUSIONS
Changing susceptibility testing methods limited the direct comparison of resistance patterns among laboratories.
CONCLUSION
CONCLUSIONS
The reduction in MRSP in canine clinical samples following the introduction of this legislation suggests a positive impact of compulsory laboratory testing on reducing antimicrobial resistance.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3714Informations de copyright
© 2023 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.
Références
Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-655. Erratum in: Lancet. 2022;400(10358):1102.
Veterinary Medicines Directorate. Veterinary antimicrobial resistance and sales surveillance (VARSS). 2021. Available from: https://www.gov.uk/government/publications/veterinary-antimicrobial-resistance-and-sales-surveillance-2021. Accessed 2 July 2023.
World Health Organization (WHO). Critically important antimicrobials for human medicine, 6th revision. Geneva: World Health Organization; 2019.
Responsible Use of Medicines in Agriculture Alliance (RUMA). RUMA targets task force 2: two years on. 2022. Available from: https://www.ruma.org.uk/wp-content/uploads/2022/11/RUMA-TTF-Report-2022-FINAL.pdf. Accessed 2 July 2023.
Schmerold I, van Geijlswijk I, Gehring R. European regulations on the use of antibiotics in veterinary medicine. Eur J Pharm Sci. 2023;189:106473.
Canadian Veterinary Medical Association (CVMA). CVMA veterinary guidelines for AMU-firstline app. 2023. Available from: https://www.canadianveterinarians.net/veterinary-resources/antimicrobial-stewardship-resources/cvma-veterinary-guidelines-for-amu-firstline-app/. Accessed 21 June 2023.
Bundestierärztekammer. Leitlinien für den sorgfältigen Umgang mit antibakteriell wirksamen Tierarzneimitteln. Dt TÄBl. 2015;58:2.
Australasian Infectious Diseases Advisory Panel (AIDAP). Antibiotic prescribing detailed guidelines. 2nd ed. 2022. Available from: https://www.amrvetcollective.com/assets/guidelines/2022-AIDAP-Prescribing-Guidelines-2nd-edition-Final.pdf. Accessed 16 June 2023.
World Veterinary Association. Global repository of available guidelines for responsible use of antimicrobials in animal health. 2019. Available from: https://worldvet.org/uploads/news/docs/list_of_available_guidelines_on_amu_-aug2019.pdf. Accessed 9 June 2023.
British Small Animal Veterinary Association (BSAVA). PROTECT ME poster. Available from: https://Users/anetteloeffler/Downloads/bsava_samsoc_protectmeposter_011118web%20(1).pdf
British Veterinary Association (BVA). Responsible use of antimicrobials in veterinary practice: the 7-point-plan. Available from: https://www.vettimes.co.uk/app/uploads/2019/05/20190508-BVA-AMR-poster-2019-v4.pdf. Accessed 2 July 2023.
Responsible Use of Medicines in Agriculture Alliance (RUMA). RUMA companion animal and equine-annual progress report. 2022. Available from: https://rumacae.org.uk/wp-content/uploads/2022/12/RUMA-CAE-Annual-Progress-Report-December-2022-FINAL.pdf. Accessed 2 July 2023.
Allerton F, Prior C, Bagcigil AF, Broens E, Callens B, Damborg P, et al. Overview and evaluation of existing guidelines for rational antimicrobial use in small-animal veterinary practice in Europe. Antibiotics. 2021;10(4):409.
Gerber JS, Prasad PA, Fiks AG, Localio AR, Grundmeier RW, Bell LM, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA. 2013;309(22):2345-2352.
Lehner C, Hubbuch A, Schmitt K, Schuepbach-Regula G, Willi B, Mevissen M, et al. Effect of antimicrobial stewardship on antimicrobial prescriptions for selected diseases of dogs in Switzerland. J Vet Intern Med. 2020;34(6):2418-2431.
European Commission. Commission Implementing Regulation (EU) 2022/1255. Designating antimicrobials or groups of antimicrobials reserved for treatment of certain infections in humans, in accordance with Regulation (EU) 2019/6 of the European Parliament and of the Council (text with EEA relevance). 2022. Off J Eur Union L 191/58. Available from: https://eur-lex.europa.eu/eli/reg_impl/2022/1255/oj. Accessed 28 June 2023.
Finnish Food Safety Authority, Evira, and the Faculty of Veterinary Medicine at the University of Helsinki. Recommendations for the use of antimicrobials in the treatment of the most significant infectious and contagious diseases in animals. 2018. Available from: https://www.ruokavirasto.fi/globalassets/viljelijat/elaintenpito/elainten-laakitseminen/hallittu_laakekekaytto/mikrobilaakekaytonperiaatteet/mikrobilaakkeiden_kayttosuositukset_en.pdf. Accessed 9 June 2023.
Public Health Agency of Sweden. Swedish work on containment of antibiotic resistance: tools, methods and experiences. 2014. Available from: https://www.folkhalsomyndigheten.se/contentassets/dae82c7afd424a57b57ec81818793346/swedish-work-on-containment-of-antibiotic-resistance.pdf. Accessed 9 June 2023.
Bundestierärztekammer. Die neue TÄHAV ist in Kraft. Dt TÄBl. 2018;66(4):484-489.
EFSA Panel on Animal Health and Welfare (AHAW), Nielsen SS, Bicout DJ, Calistri P, Canali E, Drewe JA, et al. Assessment of animal diseases caused by bacteria resistant to antimicrobials: dogs and cats. EFSA J. 2021;19(6):e06680.
Morris DO, Loeffler A, Davis MF, Guardabassi L, Weese JS. Recommendations for approaches to methicillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures: clinical consensus guidelines of the World Association for Veterinary Dermatology. Vet Dermatol. 2017;28:304-e69.
CLSI. Performance standards for antimicrobial disk and dilution susceptibility tests for bacteria isolated from animals. 3rd ed. CLSI supplement VET01S. Wayne, PA: Clinical and Laboratory Standards Institute; 2015.
CLSI. Performance standards for antimicrobial disk and dilution susceptibility tests for bacteria isolated from animals. 4th ed. CLSI supplement VET08. Wayne, PA: Clinical and Laboratory Standards Institute; 2018.
CLSI. Performance standards for antimicrobial disk and dilution susceptibility tests for bacteria isolated from animals. 5th ed. CLSI standard VET01. Wayne, PA: Clinical and Laboratory Standards Institute; 2018.
Leclercq R, Cantón R, Brown DF, Giske CG, Heisig P, MacGowan AP, et al. EUCAST expert rules in antimicrobial susceptibility testing. Clin Microbiol Infect. 2013;19(2):141-160.
Moerer M, Merle R, Bäumer W. A cross-sectional study of veterinarians in Germany on the impact of the TÄHAV amendment 2018 on antimicrobial use and development of antimicrobial resistance in dogs and cats. Antibiotics. 2022;11(4):484.
Kurita G, Tsuyuki Y, Murata Y, Takahashi T. Veterinary Infection Control Association (VICA) AMR Working Group. Reduced rates of antimicrobial resistance in Staphylococcus intermedius group and Escherichia coli isolated from diseased companion animals in an animal hospital after restriction of antimicrobial use. J Infect Chemother. 2019;25(7):531-536.
GERMAP 2015. Bundesamt für Verbraucherschutz und Lebensmittelsicherheit, Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. Bericht über den Antibiotikaverbrauch und die Verbreitung von Antibiotikaresistenzen in der Human- und Veterinärmedizin in Deutschland. Antiinfectives Intelligence, Rheinbach. Infektionen des Respirationstraktes/Infektionen von Haut. Ohr, Maul; Hund/Katze. 2016. pp. 146-147.
Loeffler A, Linek M, Moodley A, Guardabassi L, Sung JM, Winkler M, et al. First report of multiresistant, mecA-positive Staphylococcus intermedius in Europe: 12 cases from a veterinary dermatology referral clinic in Germany. Vet Dermatol. 2007;18(6):412-421.
Menandro ML, Dotto G, Mondin A, Martini M, Ceglie L, Pasotto D. Prevalence and characterization of methicillin-resistant Staphylococcus pseudintermedius from symptomatic companion animals in Northern Italy: clonal diversity and novel sequence types. Comp Immunol Microbiol Infect Dis. 2019;66:101331.
Grönthal T, Eklund M, Thomson K, Piiparinen H, Sironen T, Rantala M. Antimicrobial resistance in Staphylococcus pseudintermedius and the molecular epidemiology of methicillin-resistant S. pseudintermedius in small animals in Finland. J Antimicrob Chemother. 2017;72(4):1021-1130. Erratum in: J Antimicrob Chemother. 2017;72(7):2141.
Feng Y, Tian W, Lin D, Luo Q, Zhou Y, Yang T, et al. Prevalence and characterization of methicillin-resistant Staphylococcus pseudintermedius in pets from South China. Vet Microbiol. 2012;160(3-4):517-524.
Burke M, Santoro D. Prevalence of multidrug-resistant coagulase-positive staphylococci in canine and feline dermatological patients over a 10-year period: a retrospective study. Microbiology. 2023;169(2):001300.
Beever L, Bond R, Graham PA, Jackson B, Lloyd DH, Loeffler A. Increasing antimicrobial resistance in clinical isolates of Staphylococcus intermedius group bacteria and emergence of MRSP in the UK. Vet Rec. 2015;176(7):172.
Papich MG. Selection of antibiotics for methicillin-resistant Staphylococcus pseudintermedius: time to revisit some old drugs? Vet Dermatol. 2012;23(4):352-360.
VetCAST. Veterinary committee on antimicrobial susceptibility testing. 2019. Available from: https://www.eucast.org/ast_of_veterinary_pathogens. Accessed 10 June 23.
Lloyd DH, Page SW. Antimicrobial stewardship in veterinary medicine. Microbiol Spectr. 2018;6(3).