Nathan Slovis, DVM, DACVIM, CHT, is the Director of the McGee Center at the Hagyard Equine Medical Institute in Kentucky. He spoke at the 2021 AAEP Convention on the topic of “Antimicrobial Resistance in Farms: The Role of R. equi.”
Huh, Who’d Have Thunk?
Part Six: Door Pulls Are Contributing to Antimicrobial Resistance
Have you ever noticed that people sometimes become so focused on completing a job that they stop actually thinking about what they are doing? Or perhaps they do think about it, realize what they are doing makes no sense, but feel like they have to follow their instructions to a tee regardless?
Let’s take, for example, this sign in one of the restrooms at the Music City Center:
I’m sure most of you noticed these. They’re a great thing! You don’t have to touch the gross bathroom door with your clean hands and risk “catching any germs,” as my mom used to says. Now look closer. The person tasked with the chore of placing these signs in every. single. restroom. was either on autopilot or fearful of not doing exactly as they were told. In case you don’t fully appreciate what is going on in this picture, it is physically impossible to use the door pull to get out of this washroom hands-free. You have to first unlock the door with your hand and turn the handle with your hand before being able to actually use the door pull with your foot. In this specific case, the pedal-powered door pull is therefore a completely useless tool for infectious disease control.
This is the sort of thing that happens when we perform jobs by rote and/or are fearful of change.
In some cases, like with this door pull, the consequences are small. In other cases, like with improperly prescribing antibiotics, the consequences can be dire.
To emphasize this point and encourage new attitudes about antibiotic use, abuse and antibiotic stewardship, the AAEP brought in a human pharmacist, Chris Evans, from the Tennessee Department of Health.
Evans relayed that an estimated 2.8 million people develop antibiotic-resistant infections every year in the United States, and 35,000 die from these infections. And reports of “untreatable infections” aren’t unheard of.
As we know, there are multiple mechanisms by which microbes develop antibiotic resistance, and resistance to one antibiotic can confer resistance to every other antibiotic in that drug class … or even every antibiotic known to the human race.
Ways to minimize/prevent antibiotic resistance may include vaccination (if available), improving infection control strategies and biosecurity protocols, developing novel vaccines (easier said than done) and practicing good antimicrobial stewardship.
In a nutshell, antimicrobial stewardship means prescribing the right antibiotic, at the right dose, for the right duration and at the right time.
Nathan Slovis, DVM, Dipl. ACVIM, CHT, director of the McGee Center at Hagyard Equine Medical Institute in Lexington, Kentucky, then took the stage. Slovis used Rhodococcus equi as a real-world example of how the inappropriate/overuse of antibiotics (i.e., lack of antibiotic stewardship) affects the equine industry.
Slovis said that prevention of R. equi through vaccination would be an ideal solution to this clinical problem. Making vaccines against intracellular pathogens, however, is challenging and something that researchers are working on. In the meantime, we are “stuck” with hyperimmune plasma and thoracic screening for preventing R. equi.
The problem with thoracic screening for R. equi disease prevention is that most of the foals (about 90%) diagnosed with pulmonary lesions on ultrasound screening do not develop pneumonia. Therefore, treating every foal with an abnormal ultrasound exam on routine thoracic screening means that we are massively overtreating.
Why are we doing this? Because, Slovis said, we are scared. Nobody wants a dead foal, especially not one that is extremely valuable in any sense of the word. Maybe we are getting pressure from farm managers, owners or even other veterinarians because “That’s the way we’ve always done it.”
Indeed, despite the recognized rise of antibiotic resistance in both human and veterinary medicine, our experts noted that some practitioners still have “no appetite” for antibiotic stewardship, which is highly concerning. The notion of returning to a pre-antibiotic era really isn’t all that ridiculous.
And speaking of returning to the ways of the past, the conclusion of the 67th Annual Convention of the AAEP means that we all must return to our lives. If you’re like me, the convention provided ample opportunity to brush up on the basics and learn new skills, tips and techniques. Maybe you even came across a few things on your own that made you say “Huh, who’d have thunk?”
As you jump back into your hectic life with two feet, remember to consider your work-life balance and overall mental health.
NOMV.
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