Human CRE infections are 'untreatable,' experts say - DVM
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Human CRE infections are 'untreatable,' experts say
How will this latest superbug impact veterinary patients?


DVM360 MAGAZINE


Taking precautions

In terms of preventing antibiotic-resistant organisms from infecting pets, veterinarians should institute the same basic precautions they would use for any infectious disease, says Mark Papich, DVM, MS, of North Carolina State University's College of Veterinary Medicine. When they identify an infection within an animal, veterinarians and their staff need to be cautious about spreading it from one animal patient to another or to themselves. "Basically, they should practice good normal hygiene," Papich says. "Routine hygiene, washing of hands, is probably the biggest component."

Patients known to be infected with multidrug-resistant bacteria such as CRE should be treated with strict isolation protocols to prevent spread within the hospital environment.

"We always recommend judicious use of the antibiotics that practitioners prescribe," Papich says. "Don't use an antibiotic when it's not indicated, and don't use antibiotics for longer than necessary. That's just part of good antibiotic stewardship and is essential to practicing good-quality veterinary medicine."

Sykes offers some key thoughts regarding antimicrobial selection and use:

1. Test. Whenever possible, verify the presence of a bacterial infection using cytologic examination and bacterial culture before starting antibiotic treatment.

2. Identify primary conditions. Always attempt to identify and treat the underlying cause of a bacterial infection—such as allergic dermatitis in dogs with superficial pyoderma or recessed vulva in dogs with recurrent urinary tract infections (UTIs)—rather than just treating the infection with antibiotics. Treatment with antibiotics without addressing the underlying cause can select for resistance.

3. Target treatment. Select the most narrow-spectrum antibiotic based on cytologic examination, bacterial culture and susceptibility results or a knowledge of organisms that normally cause infections at a particular site. Choose an antibiotic known to be active at the site of the infection.

4. Follow protocol. Be diligent about hand washing (wash all surfaces of the hand and wrist for at least 15 seconds) and wear gloves for procedures involving non-intact skin to prevent nosocomial infections. Using hand sanitizer can help improve compliance. These routine precautions should be practiced before and after handling each patient.

Sykes' Antimicrobial Working Group is working on guidelines for treating common bacterial infections in companion animals because of the emergence of multidrug-resistant bacteria. The UTI guidelines can be found on the society's website at http://iscaid.org/.

Because of heavy antimicrobial use in treating canine and feline UTIs, veterinarians must be aware of how inappropriate treatment contributes to the emergence of multidrug-resistant pathogens, the working group says. At the same time, prudent (and therefore rare) use of certain drugs would constitute a minuscule fraction of overall use. As such, using critically important antimicrobials in companion animals can be justified as long as their use is prudent and proper and based on bacterial culture and susceptibility data as well as patient care and welfare factors. In particular, the use of vancomycin, the carbapenems and linezolid is not justified unless the following criteria are met, the working group says:2

(1) Infection is documented based on clinical bacterial culture results and cytologic abnormalities. (2) Resistance to all other reasonable options and susceptibility to the chosen antimicrobial are documented. (3) The infection is potentially treatable. The use of critical drugs in situations in which there is little realistic chance of eliminating the infection (e.g., failure to remove the underlying cause) is not supported. (4) Consultation with an infectious disease and antimicrobial therapy expert has been obtained to determine if there are any other viable options.


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Source: DVM360 MAGAZINE,
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