What question did this study set out to answer?

To assess the effectiveness of an antimicrobial stewardship program (ASP) in lowering rates of antimicrobial-resistant bacterial colonization in hospitalized horses.

May 14, 2026Equine Veterinary Journal0 citations

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Clinical audit on antimicrobial stewardship effectiveness in reducing antimicrobial‐resistant bacterial colonisation in hospitalised horses

KMKaren MazzolaUniversity of Bologna ALAliai LanciIMA (Italy)SPSilvia PivaUniversity of Bologna

Key Points

To assess the effectiveness of an antimicrobial stewardship program (ASP) in lowering rates of antimicrobial-resistant bacterial colonization in hospitalized horses.
Conducted two audit cycles over a period of 18 months, including active AMR surveillance in specific units.
Collected and tested nasal and rectal swabs for various resistant bacteria types upon admission and discharge.
Analyzed data using Fisher's exact test and Mann-Whitney U test to compare outcomes between audit cycles.
Significant reduction in overall antimicrobial-resistant bacterial colonization rates in both foals and adults after ASP implementation.
Reduction in use of critically important antimicrobials and antibiotic treatment duration with significant statistical evidence.
Hospitalization length decreased for foals ≤30 days old and overall during the second audit cycle.

Abstract

BACKGROUND: International guidelines support the One Health approach and recommend antimicrobial stewardship programmes (ASPs) in veterinary medicine. National data on antimicrobial-resistant bacterial colonisation rates (AMRb CR) in horses remain limited. OBJECTIVES: To evaluate the effectiveness of an ASP in reducing AMRb CR in a Veterinary Teaching Hospital using a clinical audit. STUDY DESIGN: Clinical audit. METHODS: In Autumn 2021 active AMR surveillance in Perinatology/Reproduction and Internal Medicine Units planned; January-July 2022-first audit cycle (A1); Autumn 2022-review and implementation of antimicrobial use and biosecurity policies; January-July 2023-re-audit (A2) after ASP application. In total, 328 hospitalised horses (foals and adults) were included. Nasal and rectal swabs collected at admission/birth and discharge/euthanasia/death were tested for methicillin-resistant Staphylococci (MRS), third-generation cephalosporins-resistant Gram-negative bacteria (3GCR-GNB) and carbapenem-resistant Gram-negative bacteria (CR-GNB). Fisher's exact test and Mann-Whitney U test evaluated differences in AMRb CR, antimicrobial use, and hospitalisation length between A1 and A2. RESULTS: In A2, there was a significant reduction in overall AMRb CR (foals: OR = 0.27, 95% CI 0-0.87, p = 0.03; adults: OR = 0.39, 95% CI 0-0.77, p = 0.01), in MRS CR (foals: OR = 0.30, 95% CI 0-0.57, p < 0.001; adults OR = 0.42, 95% CI 0-0.83, p = 0.01), in 3GCR-GNB CR (adults: OR = 0.47, 95% CI 0-0.89, p = 0.02; total: OR = 0.53, 95% CI 0-0.87, p = 0.01), and in CR-GNB CR (foals: OR = 0.26, 95% CI 0-0.90, p = 0.03; total: OR = 0.24, 95% CI 0-0.78, p = 0.02). Highest priority critically important antimicrobials use decreased (foals: OR = 0.17, 95% CI 0-0.41, p < 0.001; total: OR = 0.20, 95% CI 0-0.43, p < 0.001), as did antibiotic treatment duration (foals: A1 7.75 ± 11.5, A2 3.70 ± 4.63 days, p < 0.001; adults:A1 3.70 ± 4.63, A2 0.74 ± 2.27 days, p = 0.04), and hospitalisation length (foals ≤30 days old: A1 18.1 ± 18.9, A2 9.77 ± 7.01 days, p = 0.05; total: A1 16.0 ± 15.1, A2 12.6 ± 11.4 days, p = 0.03). MAIN LIMITATIONS: Lack of genotypic analysis and exclusion of the surgery unit. CONCLUSION: This clinical audit confirms the effectiveness of the implemented ASP and supports its adoption in comparable veterinary settings.

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Mazzola et al. (Tue,) studied this question.

synapsesocial.com/papers/6a0567fda550a87e60a203e5 https://doi.org/https://doi.org/10.1002/evj.70171

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