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Background:  Antimicrobial use contributes to emergence of antimicrobial resistance. It was hypothesized that antimicrobial prescribing behavior varies between the emergency (ER) and critical care (CC) services in a veterinary teaching hospital. This study aimed to: (i) describe antimicrobial prescribing patterns in the ER and CC services; (ii) assess adherence to stewardship principles; (iii) evaluate the prevalence of multidrug resistant (MDR) bacterial isolates.   Methods:  Institution electronic medical records were queried for all antimicrobial prescriptions from the ER and CC services between 1/1/2017 and 12/31/2017. Prescriptions were manually reviewed, and the following data recorded: drug, dosage, duration, diagnosis, outcome, hospitalization duration, culture submission, and susceptibility results.   Results:  There were 5,091 ER visits, of which 3,125 were not transferred to another service. Of these emergency visits, 516 (16.5%) resulted in 613 antimicrobial drug prescriptions. The most commonly prescribed drugs for the ER were amoxicillin/clavulanate ( n  = 243, 39.6%), metronidazole ( n  = 146, 23.8%), and ampicillin/sulbactam ( n  = 55, 9.0%). The most common reasons for antimicrobial prescriptions were skin disease ( n  = 227, 37.0%), gastrointestinal disease ( n  = 173, 28.2%), and respiratory disease ( n  = 50, 8.2%). For ER patients 18 cultures were submitted, equivalent to a 3.5% submission rate. The CC service managed 311 case visits for 822 patient days. Of these, 133 case visits (42.7%) resulted in 340 prescriptions. The most commonly prescribed drugs for the CC service were ampicillin/sulbactam ( n  = 103, 30.3%), enrofloxacin ( n  = 75, 22.1%), and metronidazole ( n  = 59, 17.4%). The most common reasons for antimicrobial prescriptions were gastrointestinal disease ( n  = 106, 31.2%), respiratory disease ( n  = 71, 20.9%), and sepsis ( n  = 61, 17.9%). On the CC service, 46 patients had ≥1 culture submitted, equivalent to a 34.6% submission rate. Of patients prescribed antimicrobials, 13/38 (34%) with urinary tract disease, 2/28 (7%) with pneumonia, 1/11 (9%) with canine infectious respiratory disease complex and 2/8 (25%) with feline upper respiratory infection were compliant with published guidelines.   Conclusions:  Antimicrobial prescription was common in both ER and CC services and followed similar patterns. Adherence to published guidelines for urinary and respiratory infections was poor.

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care