EJCAP Editorial – July 2009
Development of Multi-resistant Bacteria and the Threat to Small Animal Practice
There is now ample evidence that bacteria with multi-resistance to therapeutic antimicrobials are
becoming more and more common both in animals and man. This is a consequence of increasing
and ill-considered use of antimicrobials, particularly certain broad-spectrum agents, and there is
growing pressure from the human field to restrict their use by veterinary surgeons. In his annual
report for 2008, the Chief Medical Officer of England, Sir Liam Donaldson stated that “every
inappropriate use [of antimicrobials] in medicine or agriculture is a potential source of harm or
death in a future patient” and he made the specific recommendation that use of quinolones and
cephalosporins in animals should be banned. Sir Liam was referring particularly to farm animal use
but the close relationship between small animals and their owners and growing evidence of transfer
of resistant organisms between animals and man is now focusing attention on small animal practice.
It is clear that small animal practitioners need to take action not only to demonstrate that they can
use antibiotics wisely but also to deal with the threat which well-recognised multi-resistant bacteria
such as Escherichia coli, Pseudomonas aeruginosa and meticillin-resistant Staphylococcus aureus
(MRSA), and more recently the emergence in Europe of multi-resistant Staphylococcus
pseudintermedius (formerly known as S. intermedius) pose. Such organisms can be resistant to all
licensed veterinary antibacterials, making treatment difficult or impossible, and can be carried by
owners and veterinary staff leading to infection of in-contact people and animals. MRSA carriage
amongst veterinary staff has been shown to be as high 27% in small animal referral hospitals and up
to 10% of small animal practitioners sampled at a conference in Europe, whereas levels of carriage
amongst the general public are typically 3% or less.
Guidelines for hygiene and the use of antimicrobials in veterinary practice are available in certain
countries and provide practical and effective ways of reducing the levels of nosocomial infection and
the development of antimicrobial resistance. Typically, they focus on appropriate use of
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EJCAP Editorial – July 2009
antimicrobials (use of sensitivity testing, selection of agents with maximum efficacy, use for
minimum effective duration), cleanliness and disinfection, principles that are commonly taught at
veterinary schools but too often not observed in veterinary practice. In the human field more
rigorous implementation of such guidelines and effective publicity informing the public about
rational use of antimicrobials has been associated with significant improvements; in Belgium, for
example, high profile publicity during the autumn and winter months during 2000-2007, reduced
outpatient prescription of antibiotics by 36% and erythromycin resistance in Streptococcus
pyogenes, a common cause of tonsillitis, fell from 17% in 2001 to 2% in 2007.
There is a need now for such guidelines to be actively put into place at the individual practice level
by small animal practitioners throughout Europe, combining efficient use of antimicrobials,
enhanced personal and practice hygiene, and client education. Such actions need to be combined
with studies evaluating antimicrobial use and resistance levels in indicator pathogens, such as those
listed above, demonstrating clearly that veterinarians can be trusted to handle these valuable
agents.
To facilitate these objectives the FECAVA Working Group on Hygiene and Use of Antimicrobials in
Veterinary Practice is bringing together guidelines and recommendations from all member
associations with the aim of establishing a unified approach that can be promoted to inform and
educate both veterinarians and owners and provide a mechanism that will reduce inappropriate
antimicrobial prescription, and decrease levels of antimicrobial resistance and nosocomial infection.
The Working Group will present its initial studies in the FECAVA Symposium at the
WSAVA/FECAVA/SVK-ASMPA Congress, Geneva, in June 2010.
David H. Lloyd, Didier-Noel Carlotti, Katerina Loukaki, Ana Mateus, Peter A Murphy, Alexandra
Vilen,
FECAVA Working Group on Hygiene and Use of Antimicrobials in Veterinary Practice
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