National Antimicrobial Resistance Forum 2-3 November 2017 – The University of Queensland, Australia

  • Discuss the importance and potential outcomes of developing antimicrobial stewardship programs in veterinary practice in Australia
  • Outline proposed AMS training program for veterinary graduates
  • Seek stakeholder feedback on the training program’s proposed content and delivery methods in order to optimise uptake and impact

Program and Registration Form

Invited speakers:

  • Dr Stephen Page – Veterinary Pharmacologist, Director of Advanced Veterinary Therapeutics
  • Professor Glenn Browning – Veterinary Microbiologist, Director Asia-Pacific Centre for Animal Health, University of Melbourne

About National Antimicrobial Resistance Forum 2-3 November 2017

The National AMR Forum  Brisbane Friday 3 November, 2017.

The AMR Forum will be preceeded by free workshops on Thursday 2 November. Please register your interest for the workshops further down the page.

View the Forum Program Schedule

The Forum will be held at the Pharmacy Australia Centre of Excellence (PACE) L4, 20 Cornwall St Woolloongabba, QLD.

Keynote speakers:

Alison Holmes – Professor of Infectious Diseases at Imperial College and the Director of Infection Prevention and Control (DIPC) and Associate Medical Director for Imperial College Healthcare NHS Trust

Anton Peleg – Professor of Infectious Diseases and Microbiology; Director, Department of Infectious Diseases The Alfred Hospital and Monash University, Melbourne

The scientific meeting is a collaboration between Queensland Statewide Antimicrobial Stewardship Program, CRE REDUCE, the UQ’s Institute for Molecular Bioscience, the National Centre for Antimicrobial Stewardship (NCAS) based at the Peter Doherty Institute for Infection and Immunity and Queensland University of Technology.

To attend the Forum via a videoconference please register here.

This forum will bring together groups from varying scientific disciplines, including medicine, veterinary science, nursing, the pharmaceutical and agricultural industry, reflecting the ambitions to respond to the challenges of AMR with a unified One Health approach.

To present a poster at the Forum, please apply here.

Source: National Antimicrobial Resistance Forum 2-3 November 2017 – CRE REDUCE – The University of Queensland, Australia

1 hour challenge: Antimicrobial stewardship in companion animal practice

As part of my ACVPM training, I am required to pump out a number of essays (at a rate of 1 per hour). To try and facilitate this, I am going to adhere to getting a frequent blog on various subjects on veterinary careers to get into the zone. Feel free to comment on our Facebook page or whatever pathways you can reach me. At some point, we’ll open up the comments section in this website. The main aim is to pump out a one-pager that is concise and engaging. So what better way than to start than something that is quite close to my heart (at least in clinical practice). I’ll be setting these challenges myself, but if anyone has any requests, I’ll be happy to take them up. 

Challenge: Antimicrobial stewardship is quickly being adopted within human hospitals to encourage judicious use of antibiotics. Veterinary hospitals and clinics have been a little slower in the uptake. The Journal of Internal Veterinary Medicine has recently released its guidelines on Antimicrobial use for the treatment of respiratory tract disease in dogs and cats. The has been produced by the International Society for Companion Animal Infectious Diseases

The Australian Veterinary Association has a selection of antimicrobial resources including the Australasian Infectious Diseases Advisory Panel (AIDAP), safe handling of antimicrobials and animals, a list of antimicrobials for veterinary use that prioritises according to human health and guidelines for personal biosecurity. The Australian Department of Agriculture and Water Resources has collaborated with the Department of Health to establish a One Health National Antimicrobial Resistance Strategy (2015-2019).

Your assignment is to write a letter to the editor targeting small animal veterinarians to encourage them to review their use of antimicrobials, with a focus on the treatment of respiratory disease as well as encourage the establishment of antimicrobial stewardship in companion animal hospitals and clinics. 

Antimicrobial Stewardship in companion animal practice – no sneezing matter

In early 2017, the Journal of Internal Veterinary Medicine released its latest guidelines for antimicrobial use in the treatment of respiratory tract diseases in dogs and cats. This was a collaborative effort from the Antimicrobial working group from the International Society for Companion Animal Infectious Diseases. Whilst each medical case seen by a veterinarian should be approached in a first principles manner, using all diagnostic tools available including culture and sensitivity tests, guidelines are critical for veterinarians to be up to date with recommended empirical therapies.

I would recommend every companion animal veterinarian as well as mixed practitioners to review these latest guidelines and assess whether the recommendations match with the prescribing habits of your clinic. Do your habits or the habits of your associate veterinarians match with these guidelines?

Antimicrobial resistance is a critical issue for the health of not only our patients but also human health as well.

Just recently the WHO published a list of 12 bacterial species that were regarded as antibiotic-resistant “priority pathogens”:

The WHO list:

Priority 1: Critical

1. Acinetobacter baumannii, carbapenem-resistant
2. Pseudomonas aeruginosa, carbapenem-resistant
3. Enterobacteriaceae, carbapenem-resistant, ESBL-producing

Priority 2: High

4. Enterococcus faecium, vancomycin-resistant
5. Staphylococcus aureus, methicillin-resistant, vancomycin-intermediate and resistant
6. Helicobacter pylori, clarithromycin-resistant
7. Campylobacter spp., fluoroquinolone-resistant
8. Salmonellae, fluoroquinolone-resistant
9. Neisseria gonorrhoeae, cephalosporin-resistant, fluoroquinolone-resistant

Priority 3: Medium

10. Streptococcus pneumoniae, penicillin-non-susceptible
11. Haemophilus influenzae, ampicillin-resistant
12. Shigella spp., fluoroquinolone-resistant

In clinical veterinary practice we may encounter a number of these bacterial species in our own patients – either as pathogens that may be explicitly affecting our patients, or as commensals that are existing as the natural flora. Yet how many of them are identified with the resistance profiles that are described by the WHO? There are a few papers out there, however they do carry a bias due to often being produced by specialist centres or universities. In day-to-day, companion animal general practice, the capacity for bacterial resistance surveillance is reliant on the finances of our clients. My personal preference is to always offer a culture and sensitivity profile on the majority of each suspect/confirmed bacterial infection. Yet, when presented with an estimate that often ranges between $100-200, a significant number of clients will baulk and request for empirical therapy. And this is the worth of the above-mentioned guidelines.

Moving to a clinic-wide approach, the release of the ISCAID guidelines on respiratory tract infections should serve as a talking point within the veterinary team to ensure that there is consistency with how empirical antibiotics are prescribed. Such discussions could serve as a perfect launching point to raise the subject of antimicrobial stewardship within the clinic/hospital.

Within the US human hospitals, antimicrobial stewardship seek to improve antibiotic use with goals to optimise appropriate antibiotic selection, dose and duration of therapy. Often the stewardship team is made up of the following individuals:

  • A lead physician
  • A pharmacist
  • Nurses
  • Infection prevention and control staff
  • Laboratory staff
  • and Information Technology representatives

Given the size of many veterinary clinics, what can be done by our practitioners?

  1. Encourage a culture of stewardship amongst the whole team – include the veterinarians, nurses, practice managers and reception staff.
  2. Establish a champion of stewardship within the clinic.
  3. Establish clinic policies and protocols – differentiate between the non-antibiotic diseases that can be managed with supportive therapy vs those that will require appropriate antibiotics. Various tools are available to do that including the in-clinic PROTECT poster
  4. Promote a culture of Infection, Prevention and Control (IPC). Place a veterinary nurse in charge of IPC and establish metrics to identify areas for improvement and success.
  5. Establish appropriate in-clinic surveillance, monitoring and feedback systems to ensure that the stewardship program is operating well. Some metrics that could be used may include clinic antibiograms (these can be sourced from your diagnostic laboratory), the frequency of culture and sensitivity submissions and clinician notes on the selection process.

Over the coming years, more formalised stewardship programs will be released. This is the way of the future for veterinary practice and it is critical that we prepare to play our role in preventing the rise of antibiotic-resistant bacteria.

Ok, that’s done… 1hr and 10min… Granted I was writing this whilst plugging in links and checking my work. Probably not something I can get away with in the exam. I think next time, I’ll write and then for the sake of the blog, I’ll populate it with links.  Reviewing this, I think I lost my way in the middle there, probably didn’t need the WHO list or a ramble about costs of culturing. Plus, I probably should have established a shorthand for some words, for example, C&S for culture and sensitivity. The inclusion of the hospital team make up was also superfluous unless I provided more details on the roles and how they operated together. 

For further details, and if you are an AVA member, feel free to log into the website and go to this link to watch a webinar the AVPH ran at the end of 2016.

Antimicrobial resistance in veterinary practice

“Ruin is the destination toward which all men rush, each pursuing his own best interest in a society that believes in the freedom of the commons. Freedom in a commons brings ruin to all.”
Garrett Hardin, The Tragedy of the Commons

“If we fail to address this problem quickly and comprehensively, antimicrobial resistance will make providing high-quality universal healthcare coverage more difficult if not impossible…It will undermine sustainable food production. And it will put the sustainable development goals in jeopardy.”Ban Ki-moon, outgoing UN Secretary General

 

its-complicated

 

Antimicrobial resistance is a critical issue for both human and animal health. As practitioners who are able to prescribe and dispense antibiotics, we (veterinarians) need to ensure that our practices are up to date and we are doing our best to limit the risk of antimicrobial resistance – not only for the sake of our patients, but also our clients and our staff. For too long have we put our use of antimicrobials as a side thought, reflecting that it would not be an issue in our realm of practice – a true tragedy of the commons.

In light of that, I feel the need to highlight that next week is Antibiotic awareness week – a week to raise awareness about the problem at hand, get up to speed on what our respective countries are doing, address our respective knowledge gaps and to develop solutions collectively. You might say it is a “One Health” issue (yes, cross-linking to earlier blogs is the “new black”).

The Australian Veterinarians in Public Health (a special interest group under the Australian Veterinary Association), a group I am proud to be a committee member of, is hosting its next webinar during Antibiotic Awareness Week on the 16th of November. The webinar will feature Dr. Laura Hardefeldt, a large animal internal medicine specialist, who is currently working on her PhD with the National Centre for Antimicrobial Stewardship and The University of Melbourne. The aim of this webinar is to update veterinary practitioners about the mechanisms of resistance in bacteria, discuss how stewardship programs are being implemented internationally in veterinary practices and in agriculture, and some ideas of how stewardship could look within Australian veterinary practices.

This is a critical webinar for all veterinarians from all fields of practice. One hopes that such a webinar will inspire some veterinarians (if not all) to have an open discussion about the judicious use of antimicrobials in their respective clinics and help develop their own stewardship programs (1). Go on, sign up and bring on the new wave of awesome in Antimicrobial stewardship.

Register here: Australian Veterinary Association

Guy is a Director for Veterinary Careers – he secretly works in clinical veterinary practice (and his opinions are reflective of his own and not of his place of work), whilst completing his Masters in Veterinary Public Health. He enjoys the interface of clinical practice and case management whilst unleashing his VPH-nerdiness onto the unsuspecting public. 

1 – I fully appreciate that it’s not just veterinarians who need to be part of the solution and that there are other drivers that push resistance in microbes – and that will be the subject of a future 1 hour blog in due time. Needless to say, “it’s complicated”.

Australia winning against superbugs in animals

Always good to see an old Professor of mine getting the message out there. Perfect space for practitioners with a research-leaning mind to get involved.

“We think we’ve got a grade-A report within companion animals and in livestock that we’ve got low levels of resistance particularly to critically important drugs used for serious or complicated infections.

“But without vigilance, without good study you can flip the report card very quickly and very easily.

“So it’s really important across the level governments, industry, universities that we’re all working together to keep these rates at this really low level.” – Prof Darren Trott, University of Adelaide

Source: Australia winning against superbugs in animals, researchers find

Vets urge Northern Ireland Assembly candidates to take ‘One Health’ action – Farming Life

With campaigning for next month’s election (5 May) in full swing, the British Veterinary Association (BVA) and BVA Northern Ireland Branch have launched a manifesto urging incoming parliamentarians to take action on animal health and welfare as part of a One Health government agenda.BVA’s ‘The veterinary profession’s manifesto for Northern Ireland 2016–2021’ was developed drawing on the expertise and experiences of BVA’s members working throughout Northern Ireland and in all areas of the veterinary profession, and makes clear recommendations in three key areas: safeguarding animal health, promoting animal welfare and recognising the vital role of veterinary surgeons.

“Delivering positive change for animal health and welfare requires partnership working – and the announcement last year that Northern Ireland had been granted Officially Brucellosis Free status is testament to the effectiveness of that joined up working between government, farmers and vets to eradicate the disease. And we must continue to work together to tackle other endemic diseases, and health and welfare issues like the breeding and sale of dogs.” Seamus O’Kane, President, BVA Northern Ireland Branch

The Northern Ireland manifesto sets out almost 20 policy recommendations that provide a clear pathway towards improving animal health and welfare, and challenges the next government to:

* Support vets and farmers in combating endemic livestock diseases, for example through the compulsory bovine viral diarrhoea (BVD) testing scheme in Northern Ireland and the voluntary all-island control programme to tackle Johne’s disease.

* Protect the welfare of animals by requiring all animals to be stunned before slaughter to ensure they are insensible to pain: there is no non-stun slaughter currently carried out in Northern Ireland but, while non-stun is permitted under the EU derogation, the next government should introduce measures to label meat as stunned or non-stunned to allow consumers to make an informed choice.

* Review the outcomes of the Test and Vaccinate or Remove (TVR) project; moving towards a comprehensive programme to eradicate bovine TB that includes a regime of controls such as risk-based biosecurity measures, cattle controls, badger vaccination where appropriate and available, and the humane culling of badgers via cage trapping and shooting only.

* Increase collaboration and integration of the veterinary and medical professions to promote the responsible use of antimicrobials.

* Ensure robust enforcement of existing legislation to tackle illegal import of puppies across borders due to the associations with disease, dog welfare and behavioural problems.

* Ban the keeping of primates as pets and the use of wild animals in travelling circuses, as their welfare needs cannot be met.

* Embrace partnership working between government and the veterinary profession, recognising the unique skills, knowledge and expertise of veterinary surgeons across animal health and welfare and public health.

BVA Northern Ireland Branch President Seamus O’Kane said: “Delivering positive change for animal health and welfare requires partnership working – and the announcement last year that Northern Ireland had been granted Officially Brucellosis Free status is testament to the effectiveness of that joined up working between government, farmers and vets to eradicate the disease. And we must continue to work together to tackle other endemic diseases, and health and welfare issues like the breeding and sale of dogs.

As vets, we carry out our roles for the public good and, as such, we are in a unique position from which to offer evidence-based and informed advice and policy recommendations. We are on the frontline caring for animals, detecting and treating disease, and undertaking pioneering research into animal and public health – and we look forward to working with the next government in Northern Ireland.”

BVA President Sean Wensley said: “Through our daily work, and these manifestos, we believe vets are in a unique position from which to offer the next government in Northern Ireland evidence-based advice and recommendations for animal health and welfare policy. The forthcoming elections affect us all and, as a nation that prides itself on high and continuously improving animal welfare standards, we urge the incoming government to put animal health and welfare on their agenda and champion the concept of One Health in recognition of the inextricable links between animals, humans and our shared living environment.” 

BVA’s manifesto will be sent to all candidates who are standing for election, relevant animal health and welfare government groups, BVA honorary associate MPs, Peers & MEPs, and Chief Veterinary Officer Robert Huey. Following the election, BVA will also share the document with newly elected Members.

For more information about BVA’s ‘The veterinary profession’s manifesto for Northern Ireland 2016–2021’, please visit http://www.bva.co.uk/News-campaigns-and-policy/Campaigns/Northern-Ireland-Assembly/.

Farming News
Read more: http://www.farminglife.com/news/farming-news/vets-urge-northern-ireland-assembly-candidates-to-take-one-health-action-1-7311699#ixzz452vxV0ub

Source: Vets urge Northern Ireland Assembly candidates to take ‘One Health’ action – Farming Life