Research published in Nature to inform new antibiotic stewardship project

A new trial by the Small Animal Veterinary Surveillance Network (SAVSNET) has demonstrated effective strategies for reducing the prescription of ‘last resort’ antibiotics in veterinary practice.

Published yesterday in Nature Communications, the findings will be used to inform our new national small animal antimicrobial stewardship project, in partnership with SAVSNET and CVS Group. The project demonstrates a profession-wide commitment to responsible usage of antimicrobials.

Antimicrobial resistance (AMR) has recently been identified as one of the top ten health threats facing our planet. Currently, over 700,000 people per year die of resistant infections. This is forecast to exceed 10 million people per year by 2050, placing AMR as the leading cause of death worldwide.

“Use of antimicrobials is a key driver for the development of AMR. It is vital that the veterinary profession embraces the responsible use of antimicrobials, to safeguard human and animal health and to preserve the right to prescribe certain antimicrobials that are important in human medicine, such as highest priority critically important antimicrobials (HPCIAs) that includes fluoroquinolones and third-generation cephalosporins,” explained Dr David Singleton, who is a Postdoctoral Epidemiologist at the ‎University of Liverpool clinical lead for our new project.

HPCIAs are frequently prescribed as first-line agents in companion animal practice, particularly to cats. Such antimicrobials should only be used third-line in response to clear evidence of likely or actual treatment failure to other antimicrobials. In recognition of this issue, SAVSNET collaborated with one of the largest integrated veterinary services providers in the UK, CVS Group, on a randomised controlled trial to see if prescription of HPCIAs could be reduced. 

Relatively high frequency HPCIA prescribing veterinary practices were randomly placed into three trial arms: a control group, light intervention group and heavy intervention group, consisting of 20 veterinary practices in each group. The heavy group were allowed to volunteer to participate in the trial, to which most agreed. 

Light and heavy intervention groups were informed of their outlier status and were offered either remote (light group) or in-person (heavy group) support, in addition to their existing access to the SAVSNET portal which offers free benchmarking for antimicrobial prescription. CVS practice teams in the heavy group were asked to reflect on their HPCIA prescription and clinical decision-making to develop their own systems to promote responsible prescribing.

Over eight months following initial intervention both intervention groups were associated with a significant post-intervention decrease in HPCIA prescription frequency in cats; the light group by 17% and the heavy group by 40%.  In dogs, the only significant decrease was seen in the heavy group, which decreased HPCIA prescription frequency by 23%.

“This trial demonstrates that companion animal veterinary practitioners respond to notification of being outside of a 'social norm' (i.e. being a high frequency HPCIA prescriber), and are responsive to involvement in structured antimicrobial stewardship programmes,” said Dr Singleton.

Co-author Angela Rayner, Director of Quality Improvement at CVS Group and a clinical lead for our new project, added: “We are grateful for, and wish to say thank you to, the many people who have supported this trial and to the hard work of the practice teams in CVS, who responded to the call to action and produce these excellent results. Without these caring individuals, this would not have been possible.”

Executive director of RCVS Knowledge Chris Gush said: “RCVS Knowledge is pleased to be working with the University of Liverpool’s SAVSNET to reduce the use of antibiotics in small animal practice.

“Findings from the SAVSNET trial will inform our new small animal antibiotic stewardship project, which builds on our existing antibiotic stewardship work in the areas of equine and farm animal health. There is a need for data to underpin continuous quality improvements in veterinary care and patient outcomes, which is in line with our mission to benefit animals, public and society. The project will allow practices to access a secure and free-to-use national veterinary audit and benchmarking tools. We look forward to continuing to work in collaboration with SAVSNET to present vital information to practices in a meaningful way, supporting evidence-based interventions leading to one health improvements.”

The new small animal antimicrobial stewardship project, will build on our work to tackle antibiotic resistance in animals. In 2020, we launched our Farm Vet Champions project, which will unite and empower UK farm animal veterinary practitioners as they establish good antimicrobial stewardship in practices and on farms.