Use of a point prevalence survey to measure antimicrobial use and antimicrobial resistance in equine veterinary hospitals

Background: Antimicrobial resistance (AMR) is increasingly recognised in equine medicine. Antimicrobial use (AMU) is a key driver of AMR. Objectives: To pilot a point prevalence survey (PPS), based on the Global-PPS used in human hospitals, to obtain data on antibiotic prescribing and AMR in equine hospitals and to identify targets for improvement in AMU. Study Design: Point prevalence survey. Methods: Eight equine hospitals located in Australia, Belgium, South Africa, the United Kingdom and the United States were recruited. Data on AMU were collected from all in-patients on antibiotic treatment at 08h00 on four selected study days throughout the study year (2022). Results: In total, 742 patients, 310 (41.8%) surgical and 432 (58.2%) nonsurgical cases, were evaluated and 58.7% (182/310) surgical and 25.9% (112/432) nonsurgical patients were on antibiotics. The most prescribed antibiotics were penicillin, gentamicin and trimethoprim sulfonamides. In 45.2% (215/476) of prescriptions, use was prophylactic. Therapeutic use was based on a biomarker in 48.8% (127/260) of treatments. A sample was submitted for culture in 56.9% (148/260) of therapeutic treatments. A positive culture result was reported from 49.3% (73/148) of samples, with an antibiogram available for 90.4% (66/73) of the positive cultures. An antibiotic use stop/review date was not recorded in 59.5% (283/476) of uses. Main Limitations: This PPS was a pilot study with a relatively small sample size and likely does not reflect AMU in all types of equine hospitals in all geographic locations. Conclusions and Clinical Relevance: The PPS identified multiple ways in which antibiotic prescribing could be improved. Targets identified for stewardship interventions included empiric use of European Medicines Agency Category A and B antibiotics, the high prevalence of prophylaxis and the lack of use of a stop/review date. The survey could be used as a repeatable tool to assess stewardship interventions in equine hospitals.