Page 7 - Clinical Connections - Spring 2023
P. 7

Antimicrobials
        A PRECIOUS RESOURCE: ANTIMICROBIAL
        STEWARDSHIP IN THE QMHA


        Rosanne Jepson, Professor Small Animal Internal Medicine, and Tom Greensmith, Lecturer in Small
        Animal Emergency and Critical Care
          n  November  2022  the  Queen  Mother
          Hospital for Animals (QMHA) participated
        I in  ‘World  Antimicrobial  Awareness
        Week’, an international event coordinated
        by the World Health Organisation. In 2022,
        the theme was ‘Preventing  Antimicrobial
        Resistance Together’. It was an important
        opportunity to consider both the preservation
        of antibiotics for human health and the
        role that the veterinary profession plays in
        preventing antimicrobial resistance.
          Antimicrobial stewardship is always at the
        forefront of the clinical work that we do at the
        QMHA. Ensuring antimicrobial stewardship
        means  that  you  establish  a  coordinated
        programme that promotes appropriate use
        of antimicrobials (including antibiotics), work
        to improve patient outcome, aim to reduce   The antibiotic amnesty took place in Novemeber
        microbial resistance and help to decrease
        the  spread  of  infections  caused  by  multi-  restricted and require authorisation for use   antibiotics, but no data is currently available.
        drug resistant organisms.           (Tier 3). Regular auditing is an important   The  Antibiotic  Amnesty  was  a  national
          Since 2015, the QMHA has had an   part  of  our  antimicrobial  stewardship  to   initiative in conjunction with the NHS, RCVS
        established  antimicrobial  stewardship  ensure hospital-wide compliance and to   Knowledge¹, the BSAVA and RUMA-CA&E
        programme, which includes a hospital-  understand our use of antibiotics.  (Responsible Use of Medicines Alliance –
        based  policy  on  the  use  of  antibiotics  in                        Companion Animal and Equine). During the
        cats and dogs, along with a designated   World Antimicrobial Awareness  Week   amnesty, clients attending the QMHA for
        antimicrobial  stewardship  team.  The  and antibiotic amnesty          an appointment were asked to return any
        QMHA antimicrobial stewardship team is   Antimicrobial Awareness Week provided an   unused antibiotics they had at home so that
        comprised  of  key  clinicians  across  many   opportunity to focus on the importance of   these could be disposed of in a clinically and
        of the hospital’s specialist disciplines, who   careful use of antibiotics. Specific initiatives   environmentally  safe manner.  There  was
        have a keen interest in this area. In addition,   included a hospital-wide  seminar, a  social   also an opportunity for clients to complete
        we  work  very  closely  with  a  veterinary   media  campaign,  podcast  recording,  a survey² to help the veterinary profession
        clinical microbiologist and are fortunate   infographics updating our team and clients   gain a better understanding of why these
        to have an onsite diagnostic microbiology   on the latest progress on our antibiotics use,   antibiotics had been returned.
        service giving rapid turnaround of results,   and increased engagement of our veterinary   Data on the type and amount of unused
        which is critical for decision-making in the   students in all elements of clinical decision-  antibiotics returned to the QMHA has been
        sickest patients.                   making in relation to antibiotic prescribing.   submitted as part of this national veterinary
          Increasingly, as in human medicine,   Together  with  World  Antimicrobial  initiative.  By joining  forces with the wider
        multi-drug  resistant  bacterial  organisms   Awareness Week, the QMHA also joined the   veterinary profession, we were pleased to
        are recognised in some of the pets that we   ‘Antibiotic  Amnesty’ throughout the whole   be part of this  important ongoing work to
        treat, which can create challenging clinical   of  November. Although  unused  antibiotics   keep antibiotics safe for the future.
        situations.  The antimicrobial stewardship   prescribed to humans can be returned to
        team provides an advice service for the   pharmacies, many of them are disposed in   1.  https://knowledge.rcvs.org.uk/amr/
        hospital when these complex cases arise,   household waste or down sinks or drains.   2.  https://rumacae.org.uk/antibioticamnesty/
        with careful consideration for all clinical   This raises concerns about the possibility
        options that may be available.      of environmental contamination. Even low
          To help guide the use of antibiotics, the   levels of antibiotics in the environment can
        hospital has a tier-based system for antibiotic   contribute  to  selection  pressure  for  the
        prescribing.  This tiered system indicates   development of multi-drug resistant bacteria.
        antibiotics that are considered first-line (Tier   Responsible prescribing, administration
        1), those which should always have culture   and disposal of antibiotics where they are     For small animal referrals, please call:
                                                                                     01707 666399
        performed to confirm susceptibility prior to   not used, is of vital importance. The same     Email:
        prescribing (Tier 2) and those which are   situation could be occurring with veterinary   qmhreception@rvc.ac.uk




                                                                                                     Spring 2023   7
   2   3   4   5   6   7   8   9   10   11   12