Examining antimicrobial stewardship through a case study

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Adam Christman, DVM, MBA: I understand that you have a case that you're going to share with us. Right. So talk to us a little bit about that.

Shelley Rankin, PhD: Yeah. So So I chose this really, as an example of this diagnostic antimicrobial stewardship. Kind of a general idea. And so I joined Zoetis in August last year. And so this case came to me as a customer concern in right at the end of December. And so I and it took me by surprise, and that was one of the reasons why I wanted to highlight it. Because it's a very simple case, it was it was a skin swab that was submitted from a four year old male neutered Bulldog. And, and that was all the information we go. So again, in terms of better medicine, you know, it's a skin swab, but you could have told me it was a pyoderma or folliculitis, or, you know, post surgical wound infection. So the more information you give me upfront, the more information I can provide back. But again, you know, we processed the swab and, and then the customer got in touch to tell us that they had sent the same specimen to another reference lab. And they had compared the results and they wondered why we only reported a single organism and the other reference lab reported 3 bacteria. And then they were concerned because our antimicrobial susceptibility test report had fewer antimicrobial choices than the report from from the other lab. And so I looked at the sent the, the lab report for me to look at so I compare their results with our results and was just it was, I just think it's a really interesting report. And again, it goes back to relevance. So often when you culture, skin swabs, there may be, you know, a couple of odd bacteria that I would consider to be contaminants. And in this particular situation, we isolated a single organism. So it was a methicillin resistant staphylococcus pseudintermedius. It's the primary pathogen of skin infections and dogs. We run our AST report, and we reported the results 2 days after we received the specimen. The other lamp reported, staff stood intermedius, they never told the customer that it was methicillin resistant, which I think they probably should have. And then they reported another two organisms. And so what that meant was, by the time they got to the anti microbials, the susceptibility test report, one of those organisms was the staff. The other was an issue Russia Hurmati A, which is a an organism that is not pathogenic in companion animals, and a bacillus species, they provided the AST results for both of those organisms. And so I'm looking at this large report, where they had come combined the antimicrobials like from two panels, so of course, it looked like 30 drugs instead of my 18. But there was nothing really in there, they added anything that would help the veterinarian treat this patient better than my small report, if you will. And so we looked at it. And again, you know, I'm not criticizing anything that they did. The inferred some antimicrobial choices from other antimicrobials on the same class, from the report. And so they kind of beefed up the report. But again, everything that they added was resistant. So there was no, there was no useful information, unless you're of the opinion that you want to know all the drugs that you can't use. And I think maybe there are some veterinarians in that group. They're like, show me what I can't use. And I've always just taken the approach that it's my job to show you what you can use. Andso as far as this case was concerned, there were actually only two or, sorry, two antimicrobials that were useful for the treatment of the pyoderma. And by adding the the susceptibility testing for the gram negative organism for the Escherichia, that organism was resistant. And so one of those choices was removed. And so we essentially, they presented to the customer, a single drug choice for a drug that was probably in a, you know, a little more risky, like to use and systemic administration rather than an oral so they kind of changedthe recommendation for the veterinarian. And so it really got me thinking about is that how we should be doing this. And interestingly, the report, there was some dialogue between me and the veterinarian and the organization that the veterinarian worked for. And I'll never forget this, the medical director for that organization was like, Well, I completely understand your perspective, Dr. Rankin, but they did test more antimicrobials. And it just kind of blew my mind. And I was like, and it just formalized for me that for, you know, the 20 years I've been doing this, I've always taken that reductive approach. So find the pathogen that is clinically significant. And then report antimicrobial drugs that veterinarians can use. And so that's the approach that I think we're planning to take with the Zoetis Reference Lab approach.

Adam Christman, DVM, MBA: Yeah. Wonderful. That's a great case, by the way. It really is. It's wonderful.

Shelley Rankin, PhD: Thank you.

Adam Christman, DVM, MBA: Well, this is wonderful. Dr. Rankin, thank you so much for joining us. This was my pleasure. So up next, we're going to be joined by a Board Certified anatomical pathologist and technical manager at Zoetis Dr. Gailbreath. So we'll be right back.