Antibiotic Practices in Equine Surgery: A Tertiary Referral Hospital'S Adherence to Current International Guidelines

Objectives: In the face of the continued emergence of antibiotic resistance, appropriate antibiotic use, based on current international standards should be practiced clini- cally. This study aims to assess antibiotic administration practices in the clinical setting and compares them with current guidelines to identify possible areas for improvement. Methods: A retrospective analysis of medical records of horses, admitted to the surgical department and treated with antibiotics over 6 months was conducted. Interna- tional antibiotic stewardship guidelines were applied to evaluate whether there was a clear indication for antibi- otic use. Simple and multivariable logistic regression models examined associations between an indication for antibiotics and clinical treatment factors. Results: Of the 319 horses included in the study, 193 (60.5%) had a clear indication for antibiotic use. Mul- tivariable analysis showed that horses undergoing clean- contaminated procedures were significantly more likely to receive antibiotics with a clear indication than those undergoing clean procedures (OR 5.49, 95% CI: 3.39–8.89, p < .001). Further, there was a positive correlation between horses admitted as emergencies and longer dura- tions of antibiotic administration, resulting in greater odds of receiving antibiotics with a clear indication (OR 2.29, 95% CI: 1.07–4.90, p= .033). Additionally, signs of pain upon admission were also significantly associated with an indication to receive antibiotics (OR 3.2, 95% CI: 1.11–9.02, p= .031). Conclusions: Compared to international guidelines, many clinical cases lacked a clear indication for antibiotic use. Areas of improvement include reducing antibiotic use in clean (elective) procedures and estab- lishing clear rationales for initiating antibiotic treatment in emergencies. Collected information can be used to improve compliance with antibiotic stewardship guide- lines by sharing results with stakeholders.

City University of Hong Kong