EXPRESS: Factors associated with antimicrobial drug prescription in cats receiving outpatient care at a veterinary teaching hospital

OBJECTIVES: Investigation of factors associated with antimicrobial drug prescription (ADP) in cats receiving outpatient care is lacking, which limits antimicrobial stewardship efforts and benchmarking of veterinary antimicrobial use. This study aimed to identify factors associated with ADP in cats receiving outpatient care at a veterinary teaching hospital. METHODS: A retrospective analysis of electronic medical record data from cats receiving outpatient care at a veterinary teaching hospital in 2022 was performed. Subjects included 2,245 cats with 3,973 outpatient visits. The primary study outcome was receipt of systemic ADP during or immediately following an outpatient visit; an exploratory outcome was receipt of a "Watch" or "Reserve" (WR) ADP using the World Health Organization (WHO) Access-Watch-Reserve (AWaRe) classification adapted to include veterinary agents. Independent variables including patient demographics, hospital service, and owner sociodemographic factors were identified for model fitting using univariable logistic regression; multivariable models were built using generalized estimating equations. RESULTS: 9.2% of outpatient visit records (367/3,973) were associated with ≥1 ADP. Factors significantly associated with receipt of ADP included patient sex, hospital service visited, veterinarian training status, visit duration, and urine culture performed. Among patients receiving any antimicrobial, factors associated with receipt of WHO-WR ADP included hospital service, visit date, receipt of >1 ADP, and history of a visit to any hospital service within the prior month. DISCUSSION AND CONCLUSIONS: These findings expand our understanding of antimicrobial usage in cats. This knowledge identifying factors associated with antimicrobial use can be used to refine local prescribing practices and supports the development of veterinary and One Health antimicrobial stewardship initiatives and veterinary antimicrobial use benchmarking metrics.