What is antimicrobial stewardship and why is it important?

Content sponsored by Zoetis

Adam Christman, DVM, MBA: Welcome back friends, where we're gonna be talking about microbiology and joining us is the Dr. Shelley Rankin. I think we have to put the word "the" in front of your name, my friend. Yeah, my pleasure, my honor. So to those that are living under a rock, Dr. Rankin obtained her PhD in molecular epidemiology from the University of Glasgow in Scotland while working full time at the Scottish salmonella reference laboratory as a disease detective investigating outbreaks of foodborne disease in humans. She came to the United States in 1999. As a research assistant professor of the University of Pennsylvania School of Veterinary Medicine to study the surveillance of salmonella in livestock from a One Health perspective. She was the chief of clinical microbiology for the Pennsylvania animal diagnostic laboratory systems on Penn Vet's new Bolton Center campus from 2006 to 2013. So many of you probably know her from that I know that many that follow you. They're passionate about her why, which is to make infectious disease diagnostics faster and more accurate. She designed, developed and validated many molecular diagnostics s over the years. She is a Wharton Mack technology fellow and an American Association of Veterinary Medical College's One Health scholar from 2013 2021, Shelly was the head of diagnostic services, and the Chief Clinical microbiology at Penn Vet's Ryan Veterinary Hospital in Philadelphia. She spent her entire academic career at Penn vet attaining the rank of full professor in 2018. Her research focus was the wicked problem of antimicrobial resistance in bacteria. She has published more than 100 peer reviewed papers on that topic. She has also caught co authored numerous guidelines on antimicrobial use for veterinarians, in addition to multiple book chapters on the diagnosis of infectious diseases in animals. In 2019, Shelley and her colleagues described the prevalence of carbapenem resistant bacteria from dogs and cats in the US. She is now more committed than ever to medical education for veterinarians on the practice of antimicrobial stewardship. To prevent the continued emergence and spread of those antibiotic resistant superbugs and pets. She joined Zoetis in August 2021 and the director of microbiology of molecular diagnostics, the microbiology labs at ZRL will use the principles of diagnostic stewardship to ensure that results are clinically relevant and delivered with supportive antimicrobial susceptibility test reports. This will enable veterinarians to practice the best medicine they can, while continue to preserve the use of critically important antimicrobials for many years to come. She lives right here in Philadelphia with her cat Jack, who is a monster, monster monster, but she loves him. She enjoys working out daily casual dinners with friends, and loud electronic dance music high five to that Yay. So you know, before we I asked you, congratulations. So you've done so many wonderful things, my friends. So how did you transition from the road from where you were to where you are now at Zoetis.

Shelley Rankin, PhD: So I think many people in my field, really thought about their careers. I had trained an incredible microbiologist between 2015 and 2021. And this great opportunity at Zoetis came up for me. And I figured it was an opportunity for me like to go do something that I'm very, very passionate about on a very large scale. And it was also time for me like to step away and let my protege, like come to the table and develop his own academic career. So it was a couple of different things.

Adam Christman, DVM, MBA: It's absolutely wonderful. Well, I know that you oversee the microbiology team for Zoetis Reference Labs. So would you be able to share some of the efforts our team is making to change the world of microbiology.

Shelley Rankin, PhD: So I think you touched on it briefly. One of the most important things for me is and I've had many years to think about my mission statement and it really as to develop, you know, good antimicrobial use guidelines. And as a service provider, that means I'm in a position to look at the lab reports that we generate, that is my product, that is my sole product. So how that looks is what we get from the specimens. And so to try and deliver that in a way that is useful to veterinarians, to allow them to optimize patient care. And so I've taken I think I would probably call it a refinement or reductive approach to that. So rather than issue a report that has 40, antimicrobials on it, with lots of S's and R's that can be very confusing for veterinarians, I'm trying to think about how we can deliver this information in a way that is clinically useful. I see my role really as a diagnostician as being, you know, to help you make a diagnosis to rule things in and then provide choices rather than a list of drugs that you can use. That just doesn't seem useful to me. So here's a couple of drugs that you can use, and hopefully that improves medical care.

Adam Christman, DVM, MBA: Wonderful. And just to back up a little bit. I mean, this might sound like a simple question, but it's so good to just really timely to talk about it. What is stewardship, can you just to the viewers that are tuning in, talk to us a little bit about what that means.

Shelley Rankin, PhD: I'm going to talk about 2 types of stewardship. So the first one is diagnostic stewardship, which is, it's actually pretty popular in human medicine. And it's really the concept of everybody working together to make a diagnosis. The veterinarian has lots of information about the animal. We don't always get that information in the lab. But the more information you provide for me, the better the better medicine that we can do. So we can, we can look and say is this organism relevant from this site, if you send me a swab, and you don't tell me where it's from, and we isolate a bunch of bacteria, then we don't know if they're relevant. So the more information we get from you. So this whole concept of selecting the right test at the right time for the right patient, is the simple definition of diagnostic stewardship. But it's much bigger than that, because it ties into antimicrobial stewardship. And in the last 20 years of my career, I've seen because I worked in livestock for the first 10 years of that, and so I've seen things like swing from antimicrobial stewardship in in agriculture, we do a very good job of that now. And so now, there's a focus on antimicrobial use in companion animal medicine. And there are critics. And, and so we have to make sure that we're, you know, we're developing programs that can educate veterinarians, about those good antimicrobial choices.

Adam Christman, DVM, MBA: Yeah, well said. I mean, at the time, it's certainly different times that we're living in right now.