Evaluation of antimicrobial purchasing by companion animal veterinary facilities in Canada, the United Kingdom, and the United States of America (2019-2021).

BACKGROUND: Measuring antimicrobial use is a core component of antimicrobial stewardship. Purchasing data may be easier to obtain than prescription data in some situations, but differences in clinic size, caseload and collection timeframes must be considered. OBJECTIVE: Our objective was to evaluate purchases of systemic antibacterial agents by small animal veterinary facilities in 5 networks across 3 countries, using a mg/veterinarian full time equivalent (FTE)/week as the metric. METHODS: Data were obtained from purchasing records of 2194 veterinary facilities from networks from the United States (US, n = 3: US-A, 1036 facilities; US-B, 101 facilities; US-C, 886 facilities), Canada (n = 1: 117 facilities) and the United Kingdom (UK, n = 1: 54 facilities) during 2019-2021. RESULTS: In total, 20 020 269 767 mg (20.02 t) of antimicrobials were purchased. Overall differences between the UK and North America were driven by significantly higher purchases of amoxicillin-clavulanic acid in the UK (P < .001), with substantially less purchasing of third generation cephalosporins in the UK (P < .0001). A significant association was found between FTE and purchasing, with decreased purchasing (mg/FTE/week) as facility FTE increased. Significant differences also were found among US regions. Facilities in the top 10% of total purchasing accounted for 23%-30% of purchases, compared to only 1.6%-3.8% for the bottom 10%. CONCLUSIONS AND CLINICAL IMPORTANCE: These data provide useful information about general purchasing trends, inter- and intraregional differences and differences among facility types and identify high purchasing outliers for further investigation.

Age at gonadectomy, sex, and breed size affect risk of canine overweight and obese outcomes: a retrospective cohort study using data from United States primary care veterinary clinics.

OBJECTIVE: To examine the risk of developing an overweight or obese (O/O) body condition score (BCS) in gonadectomized versus intact dogs and, separately, the impact of age at gonadectomy on O/O outcomes among sterilized dogs. ANIMALS: Dogs were patients of Banfield Pet Hospital in the US from 2013 to 2019. After exclusion criteria were applied, the final sample consisted of 155,199 dogs. PROCEDURES: In this retrospective cohort study, Cox proportional hazards models evaluated associations between O/O and gonadectomy status, sex, age at gonadectomy, and breed size. Models were used to estimate the risk of becoming O/O in gonadectomized versus intact dogs and, separately, to estimate risk of O/O BCS according to age at surgery among gonadectomized dogs. RESULTS: Gonadectomy increased O/O risk for most dogs compared to intact dogs. Unlike most prior findings, O/O hazard ratios among gonadectomized versus intact dogs were larger for males than females. O/O risk varied according to breed size but not linearly. Sterilizing at 1 year old tended to yield a lower O/O risk compared to doing so later. Comparative O/O risk among dogs gonadectomized at 6 months versus 1 year varied by breed size. Overall patterns for obesity related to size were similar to patterns in the O/O analysis. CLINICAL RELEVANCE: Veterinarians are uniquely positioned to help prevent O/O in their patients. Results extend understanding of risk factors for O/O development in dogs. In combination with information about other benefits and risks associated with gonadectomy, these data can help tailor recommendations regarding gonadectomy in individual dogs.

Life expectancy tables for dogs and cats derived from clinical data.

There are few recent and methodologically robust life expectancy (LE) tables for dogs or cats. This study aimed to generate LE tables for these species with clinical records from >1,000 Banfield Pet hospitals in the USA. Using Sullivan's method, LE tables were generated across survey years 2013-2019, by survey year, and for subpopulations defined by sex, adult body size group (purebred dogs only: toy, small, medium, large and giant), and median body condition score (BCS) over life. The deceased population for each survey year comprised animals with a recorded date of death in that year; survivors had no death date in that year and were confirmed living by a veterinary visit in a subsequent year. The dataset totaled 13,292,929 unique dogs and 2,390,078 unique cats. LE at birth (LEbirth) was 12.69 years (95% CI: 12.68-12.70) for all dogs, 12.71 years (12.67-12.76) for mixed-breed dogs, 11.18 years (11.16-11.20) for cats, and 11.12 (11.09-11.14) for mixed-breed cats. LEbirth increased with decreasing dog size group and increasing survey year 2013 to 2018 for all dog size groups and cats. Female dogs and cats had significantly higher LEbirth than males: 12.76 years (12.75-12.77) vs. 12.63 years (12.62-12.64), and 11.68 years (11.65-11.71) vs. 10.72 years (10.68-10.75), respectively. Obese dogs (BCS 5/5) had a significantly lower LEbirth [11.71 years (11.66-11.77)] than overweight dogs (BCS 4/5) [13.14 years (13.12-13.16)] and dogs with ideal BCS 3/5 [13.18 years (13.16-13.19)]. The LEbirth of cats with BCS 4/5 [13.67 years (13.62-13.71)] was significantly higher than cats with BCS 5/5 [12.56 years (12.45-12.66)] or BCS 3/5 [12.18 years (12.14-12.21)]. These LE tables provide valuable information for veterinarians and pet owners and a foundation for research hypotheses, as well as being a stepping-stone to disease-associated LE tables.

Prevention and long-term outcomes of naturally occurring canine heartworm infection in primary care settings.

Background: This study had two objectives: first, to examine the association between the history of heartworm preventive purchase compliance and the risk of positive heartworm tests, and second to preliminarily investigate the long-term cardiac outcomes of heartworm disease in dogs that had undergone successful adulticidal therapy. Methods: A retrospective cohort study design was used for both analyses, using anonymous transaction data from Covetrus (retrospective analysis 1) and anonymized medical records from Banfield Pet Hospital (retrospective analysis 2), both including canine patients across the USA. The first analysis examined the relative risk (RR) of a positive heartworm test in dogs with lapses in heartworm preventive purchase history compared to dogs that had no history of a preventive purchase six to 24 months prior to the test. In the second analysis, a long-term evaluation of structured diagnostic codes pertaining to cardiac diseases and risk assessment of outcomes was performed in dogs that had previously been successfully treated for heartworm disease compared to dogs that never had a positive heartworm test. Results: 83,478 unique patients were included in the first analysis. Compared to 32,413 dogs with no history of a heartworm preventive purchase, 44,410 dogs with lapses in monthly preventive purchases had a reduced risk of testing positive for heartworm disease (RR = 0.36, p < 0.0001). Dogs (n = 6,655) with lapses in injectable heartworm preventive administration had a decreased risk of a positive test versus dogs with no preventive purchases (RR = 0.15, p < 0.0001), as well as versus dogs with lapses in monthly heartworm preventive purchases (RR = 0.28, p = 0.0024). In the second analysis, 6,138 patients treated for heartworm infection were found to have significantly (p < 0.001) elevated risks of right heart failure (RR = 3.59), left heart failure (RR = 1.83), or cardiomyopathy (RR = 2.79) compared to 4,022,752 patients that never had a positive heartworm test. Conclusion: This study highlights the importance of compliance with heartworm preventive guidelines, to reduce the risk of heartworm disease in dogs, which is not only a potentially life-threatening condition in the short-term but also associated with long-term negative cardiac outcomes.

Development and implementation of veterinary anesthesia medical quality standards for primary care.

OBJECTIVE: The provision of general anesthesia is common in veterinary hospitals and procedures include some level of risk, up to and including mortality. A quality initiative was introduced with a focus on reducing canine and feline anesthesia mortality. This paper describes the development and implementation of risk-based medical quality standards (MQS) and resultant impacts on anesthesia mortality. STUDY DESIGN: This was a qualitative observational study. MQS focused on the provision of anesthesia were researched, developed and implemented. Anesthesia mortality rates, captured via an automated process based on the electronic medical record, were recorded before and after implementation. Compliance to standards was determined via hospital auditing. ANIMALS: Client-owned dogs and cats presenting to Banfield Pet Hospital (a national network of primary care hospitals) for elective and nonelective general anesthesia procedures. Over the course of the study, 2,038,318 dogs and 350,410 cats had a general anesthesia event. METHODS: Literature reviews and analysis of veterinary patient medical records identified risk factors associated with anesthesia mortality. Risk factors informed the development of MQS. Evidence-based standards focused on the provision of general anesthesia were written, reviewed, evaluated and edited. Implementation occurred over 6 months via a robust communication plan. Anesthesia mortality rates were continuously monitored before, during and after the introduction of standards. Compliance with all quality standards was assessed via hospital-based auditing performed on an annual basis. RESULTS: Prior to quality standards implementation, anesthesia mortality rates for dogs and cats combined was 7.4 deaths/10,000 procedures. At 6 months after implementation, the mortality rate was 6.24 deaths/10,000 procedures, representing a 16% decrease. Compliance with standards improved over time with continued focus and education. CONCLUSIONS AND CLINICAL RELEVANCE: Development, implementation and continued focus on MQS can improve anesthetic safety and reduce anesthesia mortality in primary care veterinary hospitals.

Effect of 6-8 weeks of oral ursodeoxycholic acid administration on serum concentrations of fasting and postprandial bile acids and biochemical analytes in healthy dogs.

BACKGROUND: Ursodeoxycholic acid (UDCA) is commonly used for the treatment of hepatobiliary disease. UDCA is a bile acid that can be detected in the bile acid assay. Its effect on biochemical analytes is unknown. OBJECTIVES: The aim of this study was to determine the effect of 6-8 weeks of UDCA administration on fasting and postprandial concentrations of serum bile acids (SBA), cholesterol, triglycerides, bilirubin, and liver enzyme activities in healthy dogs. METHODS: Twenty healthy dogs received UDCA for 6-8 weeks. CBC, biochemistry profile, urinalysis, fasting and postprandial SBA, and hepatobiliary ultrasound examination were performed prior to starting UDCA (timepoint 0) and after 6-8 weeks of therapy, while animals were still receiving UDCA (timepoint 1). Timepoint 0 and timepoint 1 values were compared with a paired t-test. SBA were remeasured 72 hours after UDCA discontinuation. RESULTS: Only mean fasting SBA at timepoint 1 increased significantly (P = .03) from timepoint 0 (2.26 µmol/L at time 0 and 3.81 µmol/L at time 1) but were not elevated above the normal reference interval (0-9 µmol/L). Two dogs had timepoint 1 fasting SBA above the reference interval (10 and 11.7 µmol/L). One dog had timepoint 1 postprandial SBA above the reference interval at 20.1 µmol/L (reference interval 0-17 µmol/L). Repeat SBA 72 hours after UDCA discontinuation were normal. CONCLUSIONS: Long-term administration of UDCA to healthy dogs may increase fasting SBA above pretreatment values (typically within the reference interval). Long-term administration of UDCA to healthy dogs does not alter liver enzyme activities, and bilirubin, cholesterol, or triglyceride concentrations.

Olfactory neuroblastoma in a cat.

CASE SUMMARY: A 12.5-year-old castrated male domestic shorthair cat was presented for evaluation of dyspnea. Physical examination suggested upper airway disease. Computed tomography revealed the presence of a nasopharyngeal mass. Biopsies obtained via rhinoscopy led to a diagnosis of olfactory neuroblastoma. CLINICAL CHALLENGES: Olfactory neuroblastoma (or esthesioneuroblastoma) is a rare malignant neoplasm that arises from olfactory neuroepithelium. It was first described in human medicine in 1924. Clinical signs are variable, and diagnosis may prove challenging as this tumor, which is a differential for spontaneous intranasal tumors in cats, may be mistaken for poorly differentiated carcinomas or round cell tumors. Given its rarity, treatment options for this neoplasm have not been thoroughly evaluated and there is no standard treatment protocol. LITERATURE REVIEW: A review of veterinary and human literature is provided, encompassing clinical signs, staging and grading systems, treatment options and prognostic factors.

Percutaneous endoscopic gastrojejunostomy tube placement in healthy dogs and cats.

BACKGROUND: Pancreatitis, hepatobiliary disease, and proximal gastrointestinal tract disorders are clinical situations where delivery of nutrients via jejunostomy tube is preferable to a feeding gastrostomy. A thorough description of the percutaneous endoscopic gastrojejunostomy (PEG-J) technique and practical guidelines for its use in small animals have not been reported. HYPOTHESIS: That a simple technique of PEG-J tube placement in humans would be useful and safe in healthy dogs and cats. ANIMALS: Twelve healthy dogs and 5 healthy cats were included in the study. MATERIALS AND METHODS: Commercially prepared PEG-J tubes were modified for use in animals and positioned in the small intestine by endoscopic guidance. Eight dogs and 5 cats were bolus fed enteral diets for 14 days. Complications associated with the use of the PEG-J tube and responses to bolus feedings were assessed. RESULTS: Jejunostomy tubes were placed distal to the caudal duodenal flexure in all dogs and cats. Complications associated with PEG-J tubes occurred in 5/12 dogs and 4/5 cats and included J-tube removal, local pain/inflammation, retrograde tube migration, and diarrhea. Bolus feeding (daily maintenance energy requirement [MER] divided q8h) through the jejunostomy catheter was well tolerated, maintained normal body weight, and was not associated with adverse gastrointestinal signs. CONCLUSIONS AND CLINICAL IMPORTANCE: Placement of a PEG-J tube is an effective, noninvasive technique for providing enteral nutritional support of healthy dogs and cats. Bolus-feeding techniques via PEG-J tubes maintain normal nutritional status in healthy dogs and cats. This procedure for jejunostomy feeding may be easily adapted for use in clinical practice outside of an intensive care facility.

Evaluation of the use of subcutaneous implantable vascular access ports in feline blood donors.

OBJECTIVE: To compare the ease and effects of collecting blood from cats by use of subcutaneous totally implantable vascular access ports (VAPs) with collection via conventional jugular phlebotomy. DESIGN: Prospective randomized experimental study. ANIMALS: 8 healthy cats. PROCEDURES: Cats in the port group (n = 4) underwent monthly blood donation by use of VAPs and manual restraint, and cats in the nonport group (4) underwent monthly blood donation by use of conventional jugular phlebotomy and sedation, for 6 months. RESULTS: Postsurgical VAP-related complications developed in 3 cats and included port erosion (n = 1), disconnection of the port from the catheter (1), and seroma formation (1). Blood was successfully collected 24 of 24 and 20 of 20 times in the nonport and port groups, respectively. Results of bacterial culture of blood were negative in 22 of 24 and 15 of 20 nonport and port collections, respectively. No differences in RBC morphology were observed between groups. Mean blood collection and total donation times were significantly longer for the nonport group. Collection time was more variable in the nonport group, and cats were less tolerant of handling during venipuncture, compared with cats in the port group. Blood collection required a mean of 2.4 persons for the nonport group and 2.1 persons for the port group. CONCLUSIONS AND CLINICAL RELEVANCE: Positive results for blood collections via VAPs were increased donor acceptance, decreased number of personnel required, and decreased collection time. Drawbacks included contamination of blood products and port-related complications.

Hypernatremia associated with intracranial B-cell lymphoma in a cat.

An 8-year-old, spayed female, domestic shorthair cat with a history of hyperthyroidism, anorexia, dehydration, cervical ventroflexion, and behavioral changes was referred to the Iowa State University College of Veterinary Medicine. The cat was obtunded, with severe dehydration (15%) and hypothermia (86 degrees F), and severe muscle atrophy and fasciculations. Serum biochemical abnormalities included severe hypernatremia (195 mmol/L, reference interval 155-165 mmol/L), hyperchloridemia (161 mmol/L, reference interval 123-131 mmol/L), and hypokalemia (3.6 mmol/L, reference interval 4.0-5.7 mmol/L). Calculated osmolality was 418 mOsm/kg (reference interval 280-305 mOsm/kg), attributable to the hypernatremia. The cat was kept warm and given fluid and glucocorticoid therapy and supportive measures but remained unresponsive. Hypernatremia and hyperosmolality improved through day 3, when the cat died suddenly. At necropsy, a 1.25-cm mass was found in the area of the thalamus and interthalamic adhesion that extended to the ventral aspect of the cerebrum. The histologic and immunohistochemical diagnosis was B-cell lymphoma. Hypernatremia and hyperosmolality in this cat were attributed to primary adipsia and hypothalamic dysfunction secondary to effacement of central nervous system tissue by neoplastic lymphocytes. To the authors' knowledge, this is the first reported case of central nervous system lymphoma, confirmed by use of immunohistochemical analysis as a B-cell phenotype, associated with hypernatremia. It also is the first reported case of lymphoma in animals limited to the thalamus, hypothalamus, and cerebrum, with no involvement of the spinal cord.