Factors associated with antimicrobial drug prescription in dogs receiving outpatient care at a veterinary teaching hospital.

Abstract

BACKGROUND: Benchmarking small animal antimicrobial use is limited by lack of data on factors associated with prescribing of antimicrobial medications. HYPOTHESIS/OBJECTIVES: To identify factors associated with prescription of antimicrobial drugs (PAD) in dogs receiving outpatient care. ANIMALS: Nine thousand six hundred eighty-five dogs with 19 597 outpatient visits. METHODS: Electronic medical record data from dogs receiving outpatient care at a veterinary teaching hospital in 2022 were retrospectively analyzed. Study outcomes were receipt of any systemic PAD at the visit, and receipt of "Watch" or "Reserve" (WR) PAD using World Health Organization (WHO) Access-Watch-Reserve (AWaRe) classification. Multivariable models including independent variables related to signalment, hospital service, and pet owner sociodemographic factors were built using generalized estimating equations yielding odds ratios (ORs) with 95% CIs. RESULTS: Approximately 10% of outpatient visit records (1871/19 597) were associated with ≥ 1 PAD. Factors significantly associated with prescription of antimicrobials included age, male sex, intact status, hospital service visited, visit duration, diagnostics performed, lower estimated owner income, visit date, and prescriber training level. Factors most strongly affecting odds of receiving any PAD were hospital service visited (OR 0.08 [0.05-0.13] to 1.55 [1.18-2.05] for visits to services other than emergency) and having urine culture performed (OR 4.32 [3.06-6.08]). Factors most strongly affecting odds of receiving WHO-WR PAD were higher total count of discrete PAD during visit (OR 10.1 [6.41-15.8]) and undergoing computed tomography or magnetic resonance imaging during the visit (OR 3.41 [1.50-7.76]). CONCLUSIONS AND CLINICAL IMPORTANCE: This evaluation of companion animal prescribing practices supports facility-level monitoring and development of normalized antimicrobial use benchmarks and One Health antimicrobial stewardship efforts.