Estimation of defined daily doses of antimicrobials for dogs and cats treated for bacterial cystitis.

Objective: To calculate prescribed daily doses (PDDs) for selected antimicrobials and evaluate application of defined daily doses (DDDs) using an antimicrobial purchasing dataset. Animals: Data from dogs and cats treated for bacterial cystitis at a veterinary practice network were evaluated. Procedure: A dataset containing antimicrobial prescriptions for dogs and cats diagnosed with bacterial cystitis was evaluated. Median dose and frequency and median weight of treated animals were used to calculate PDDs. To account for differences in use between dogs and cats, an adjusted DDD was calculated based on adjustment for proportional use in dogs versus cats. Results: PDDs for dogs and cats were determined and adjusted DDDs were calculated and applied to an antimicrobial purchasing dataset from 886 veterinary clinics, demonstrating the difference between mass-based and DDD data. Conclusions: DDDs can be estimated using prescription datasets, accounting for differences in weights (between and within species) and relative use between dogs and cats. These can be applied to broader (sales, purchase) datasets to provide a more detailed understanding of how antimicrobials are used. Clinical relevance: DDDs could be a useful measure for assessing mass-based antimicrobial use datasets as part of antimicrobial stewardship surveillance efforts.

Objectif: Calculer les doses quotidiennes prescrites (PDDs) pour certains antimicrobiens et évaluer l'application de doses quotidiennes définies (DDDs) à l'aide d'un ensemble de données d'achat d'antimicrobiens. Animaux: Les données de chiens et de chats traités pour une cystite bactérienne dans un réseau de pratiques vétérinaires ont été évaluées. Procédure: Un ensemble de données contenant des prescriptions d'antimicrobiens pour les chiens et les chats diagnostiqués avec une cystite bactérienne a été évalué. La dose et la fréquence médianes et le poids médian des animaux traités ont été utilisés pour calculer les PDDs. Pour tenir compte des différences d'utilisation entre les chiens et les chats, une DDD ajustée a été calculée sur la base d'un ajustement pour une utilisation proportionnelle chez les chiens par rapport aux chats. Résultats: Les PDDs pour les chiens et les chats ont été déterminées et les DDDs ajustées ont été calculés et appliqués à un ensemble de données d'achat d'antimicrobiens provenant de 886 cliniques vétérinaires, démontrant la différence entre les données basées sur la masse et les données DDD. Conclusions: Les DDD peuvent être estimées à l'aide d'ensembles de données de prescription, en tenant compte des différences de poids (entre et au sein des espèces) et de l'utilisation relative entre les chiens et les chats. Celles-ci peuvent être appliquées à des ensembles de données plus larges (ventes, achats) pour fournir une compréhension plus détaillée de la façon dont les antimicrobiens sont utilisés. Pertinence clinique: Les DDDs pourraient être une mesure utile pour évaluer les ensembles de données sur l'utilisation massive d'antimicrobiens dans le cadre des efforts de surveillance de la gestion des antimicrobiens.(Traduit par Dr Serge Messier).

A multicenter study of antimicrobial prescriptions for cats diagnosed with bacterial urinary tract disease.

OBJECTIVES: The aim of this study was to evaluate initial antimicrobial therapy in cats diagnosed with upper or lower bacterial urinary tract infections at veterinary practices in the USA and Canada. METHODS: Electronic medical records from a veterinary practice corporation with clinics in the USA and Canada were queried between 2 January 2016 and 3 December 2018. Feline patient visits with a diagnosis field entry of urinary tract infection, cystitis and pyelonephritis, as well as variation of those names and more colloquial diagnoses such as kidney and bladder infection, and where an antimicrobial was prescribed, were retrieved. RESULTS: Prescription data for 5724 visits were identified. Sporadic cystitis was the most common diagnosis (n = 5051 [88%]), with 491 (8.6%) cats diagnosed with pyelonephritis and 182 (3.2%) with chronic or recurrent cystitis. Cefovecin was the most commonly prescribed antimicrobial for all conditions, followed by amoxicillin-clavulanic acid. Significant differences in antimicrobial drug class prescribing were noted between practice types and countries, and over the 3-year study period. For sporadic cystitis, prescription of amoxicillin-clavulanic acid increased significantly and cefovecin decreased between 2016 and 2018, and 2017 and 2018, while fluoroquinolone use increased between 2017 and 2018. CONCLUSIONS AND RELEVANCE: The results indicate targets for intervention and some encouraging trends. Understanding how antimicrobials are used is a key component of antimicrobial stewardship and is required to establish benchmarks, identify areas for improvement, aid in the development of interventions and evaluate the impact of interventions or other changes.

Evaluation of antimicrobial prescriptions in dogs with suspected bacterial urinary tract disease.

BACKGROUND: Antimicrobials are commonly used to treat urinary tract disease in dogs. Understanding antimicrobial use is a critical component of antimicrobial stewardship efforts. HYPOTHESIS/OBJECTIVES: To evaluate antimicrobial prescriptions for dogs diagnosed with acute cystitis, recurrent cystitis, and pyelonephritis. ANIMALS: Dogs prescribed antimicrobials for urinary tract disease at veterinary practices in the United States and Canada. MATERIALS AND METHODS: A retrospective review of antimicrobial prescriptions was performed. RESULTS: The main clinical concerns were sporadic bacterial cystitis (n = 6582), recurrent cystitis (n = 428), and pyelonephritis (n = 326). Amoxicillin/clavulanic acid (2702, 41%), cefpodoxime (1024, 16%), and amoxicillin (874, 13%) were most commonly prescribed for sporadic bacterial cystitis. The median prescribed duration was 12 days (range, 3-60 days; interquartile range [IQR], 4 days). Shorter durations were used in 2018 (median, 10 days; IQR, 4 days) compared to both 2016 and 2017 (both median, 14 days; IQR, 4 days; P ≤ .0002). Amoxicillin/clavulanic acid (146, 33%), marbofloxacin (95, 21%), and cefpodoxime (65, 14%) were most commonly used for recurrent cystitis; median duration of 14 days (range, 3-77 days; IQR, 10.5 days). Amoxicillin/clavulanic acid (86, 26%), marbofloxacin (56, 17%), and enrofloxacin (36, 11%) were most commonly prescribed for pyelonephritis; however, 93 (29%) dogs received drug combinations. The median duration of treatment was 14 days (range, 3-77 days; IQR, 11 days). CONCLUSIONS AND CLINICAL IMPORTANCE: Decreases in duration and increased use of recommended first-line antimicrobials were encouraging. Common drug choices and durations should still be targets for antimicrobial stewardship programs that aim to optimize antimicrobial use, concurrently maximizing patient benefits while minimizing antimicrobial use and use of higher tier antimicrobials.

The network and its role in digital imaging and communications in medicine imaging.

The elements of a digital imaging system are bound together by the network, so careful attention must be paid to this essential component. Networking hardware and cable choice will affect the speed of image transmission between devices within a network. Wireless networking offers convenience at the expense of speed and potentially, security. If a facility allows its network to connect to the Internet, security precautions are essential. Firewalls prevent unauthorized and destructive access to the network; virtual private networks allow encrypted communication with the network; and email and web browser encryption allow data transmitted from the network to other users on the Internet safely. This article presents an overview of this broad array of technologies. Readers are encouraged to seek additional depth as needed to address individual networking needs.

Introduction to DICOM for the practicing veterinarian.

Digital Imaging and Communication in Medicine (DICOM) is a communication protocol that imaging devices use to communicate. The universal acceptance of the DICOM standard by the major medical vendors means that the digital transition in veterinary medicine should be relatively smooth provided DICOM is used. DICOM service objects, roles, service classes, and conformance standards are discussed. The authors strongly encourage the use of image acquisition software and image archive systems that support the DICOM standard.