A Pilot Study of Veterinary Antifungal Use and Resistance in Support of Vet-LIRN's Antimicrobial Stewardship Efforts

Antimicrobial resistance (AMR) is a significant global health concern with implications for both human and animalhealth. Worldwide deaths attributed to AMR are predicted to rise to potentially 10 million people annually by2050. The actions and policies taken to combat the emergence of AMR and prevent the inappropriate use ofantimicrobial drugs are collectively known as antimicrobial stewardship (AMS). Most efforts to characterize AMRand develop AMS strategies have been focused on bacterial pathogens in people; however resistance toantimicrobial drugs has also emerged among other microbial pathogens including viruses and fungi. Antifungaluse and resistance likely play a role in veterinary antimicrobial stewardship but there is a paucity of informationdespite the increase of resistant fungi as a public health threat. The first goal of the proposed work is to developand implement an online survey of companion animal veterinarians working in both general and specialty/referralanimal hospitals. The survey will assess the knowledge attitudes and practices (KAP) of veterinarians on thefollowing: a) emergence of antifungal resistance b) risk factors for infection and colonization with fungi c)diagnosis of fungal infections and current state of antifungal susceptibility testing in veterinary medicine and d)antifungal drug prescribing and stewardship in companion animal medicine. We will also assess whetherantifungal resistant organisms or infections are common among animals by collecting important data on carriageand antifungal resistance rates of Candida sp. in dogs and evaluating clinical outcomes of dogs prescribedantifungal drugs. Enrolled dogs will have samples collected from multiple anatomic sites and cultured for Candidayeasts and confirmed isolates will have antifungal susceptibility testing performed. Additionally dogs prescribedantifungal drugs for fungal otitis externa and dermatitis will be analyzed at follow-up visits to establish rates ofclinical cytologic and culture resolution for both clinical syndromes. This proposal is highly relevant to currentOne Health and antimicrobial stewardship efforts and priorities of the FDA. Data will have implications for effortsfocused on raising awareness of antifungal use and resistance among veterinary practitioners developingeducational tools to improve antimicrobial stewardship programs and informing design of future researchstudies. The proposed work will lay the groundwork to prevent the spread of antifungal resistant organismsamong companion animals and to the people who work and live with them.