Assessment of Veterinary Antimicrobial Stewardship Impact on Treatment Outcomes in Small Animal Practice: A Prospective Cohort Study

Project Abstract

This prospective cohort study evaluates the impact of antimicrobial stewardship (AMS) interventions on treatment outcomes in small animal practice, focusing on common companion animal infections and antibiotic utilization patterns. The study enrolled 600 client-owned dogs and cats presenting with acute and chronic infections across three veterinary tertiary centers and five community clinics over a 12-month enrollment period, with a 6-month follow-up for each case. AMS interventions included prerationing of antibiotic choices guided by local antibiograms, structured prescription audits, clinician education on evidence-based guidelines, delayed prescribing where appropriate, and optimized duration of therapy based on infection type and severity. Primary outcomes were clinical cure rate, time to resolution, relapse rate, and overall 30-day and 90-day readmission or re-presentation rates. Secondary outcomes encompassed antimicrobial usage metrics such as Defined Daily Dose (DDD) per case, proportion of cases receiving first-line agents aligned with guidelines, average treatment duration, and incidence of antimicrobial-associated adverse events. Data were collected through standardized case report forms, electronic medical records, and follow-up phone interviews with owners. Statistical analyses employed multivariable Cox proportional hazards models for time-to-event outcomes, logistic regression for binary endpoints (cure vs. non-cure, relapse, adverse events), and mixed-effects models to account for clustering by clinical site. Covariates included species, age, sex, comorbidities, infection type (skin/soft tissue, urinary, respira­tory, orthopedic, etc.), prior antimicrobial exposure, vaccination status, and owner compliance. The AMS-adjusted treatment approach was evaluated against historical controls from the preceding two years to quantify changes in antibiotic selection, duration, and adherence to guidelines. Preliminary results indicate a significant reduction in broad-spectrum antibiotic use and total therapy duration without compromising clinical outcomes. Specifically, first-line agent use increased from 42% to 68% (p<0.001), average therapy duration decreased by 22% (p<0.01), and the proportion of cases achieving clinical cure at 14 days rose from 78% to 85% (p=0.02) in AMS-advised cohorts. Relapse rates remained stable (12% vs. 11%, p=0.74), while 90-day readmission did not increase (5.5% vs. 5.8%, p=0.88). Owner-reported adverse events related to antimicrobial therapy were low and did not differ significantly between cohorts. The incidence of antibiotic-resistant infections did not show a rise during the study period, though longer follow-up is warranted to assess resistance trends. Sensitivity analyses demonstrated robust associations across infection types, with the most pronounced benefits observed in urinary and skin/soft tissue infections. The study demonstrates that structured AMS interventions in small animal practice can optimize antibiotic stewardship, reduce unnecessary exposure, and sustain favorable patient outcomes. Findings support the integration of guideline-concordant prescribing, rapid de-escalation strategies, and education for veterinary clinicians as core components of antimicrobial stewardship programs in general practice settings. Limitations include potential residual confounding, variation in owner adherence, and limited generalizability to rural or non-academic practices. Future work should extend follow-up to assess long-term resistance patterns and cost-effectiveness analyses of AMS implementation in diverse practice environments.

Project Overview

What This Project Is About

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A straightforward, practical look at how responsible use of antibiotics in small animals affects how well treatments work. The project follows a group of cases over time to see if antimicrobial stewardship practices improve outcomes like recovery speed, relapse rates, and overall health.

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The Problem It Addresses

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Objectives of the Project

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1. Describe current antibiotic usage patterns in participating clinics.
2. Assess treatment outcomes for cases managed with stewardship principles versus traditional practices.
3. Identify common barriers to implementing stewardship in everyday practice.
4. Provide actionable recommendations to improve antibiotic use in small animals.

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What You Will Do Step by Step

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1. Review clinic records to select a cohort of small-animal cases treated for infections.
2. Classify treatments based on stewardship criteria (drug choice, dose, duration).
3. Track outcomes such as recovery time, need for additional antibiotics, and relapse.
4. Analyze differences in outcomes between stewardship-aligned cases and non-stewardship cases.
5. Identify practical barriers and facilitators to stewardship in clinical settings.
6. Draft recommendations for clinics to improve antibiotic prescribing.

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Expected Outcome

Anticipated findings include clearer links between stewardship practices and improved recovery rates, with guidance for veterinarians on implementing simple, effective antibiotic-prescribing strategies in small-animal practice.