Balancing Feline Care and Antimicrobial Stewardship: The Dual Fight Against Resistance and Disease in Cats

Discover the crucial balance between caring for our feline companions and protecting our shared future on this enlightening episode with Casey Cazer and Amelia Safi to unpack the findings of their latest JAVMA articles. Prepare to be informed about the responsible use of the antibiotic cefovecin in cats, as we navigate through the divergent views of veterinarians and cat owners and address the broader implications of antimicrobial resistance. You'll gain insights into our discussions about the pressures vets face, such as client expectations and the financial reality of diagnostics, and hear firsthand how Amelia and Casey's research sheds light on the necessity for comprehensive guidelines and better information dissemination.

This conversation isn't just for the vets and pet lovers; it reaches into the heart of community health. Together, we highlight the importance of considering the long-term impacts of antibiotic use, as we share our own stories and experiences in the ever-evolving field of veterinary medicine. Join us for a journey into the intersection of immediate care and sustainable health practices for our beloved pets.

JAVMA article: Pathways to sustainable antimicrobial use in cats in: Journal of the American Veterinary Medical Association Volume 261 Issue 12 (2023) (avma.org)

JAVMA article: Divergent veterinarian and cat owner perspectives are barriers to reducing the use of cefovecin in cats in: Journal of the American Veterinary Medical Association Volume 261 Issue 12 (2023) (avma.org)

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Transcript

Speaker 1: 0:00

You are listening to Veterinary Vertex, a podcast of the AVMA journals. In this episode we chat about sustainable antimicrobial use in cats with KC Kaser and Amelia Safi.

Speaker 2: 0:17

Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have my Cornell colleagues KC and Amelia joining us from their very, very cool recording studio at Cornell. Kc and Amelia, thank you so much for taking time out of your busy schedules to be with us today.

Speaker 3: 0:35

Thank you.

Speaker 4: 0:36

Delighted to be here.

Speaker 1: 0:39

All right, let's learn more about sustainable antimicrobial use in cats KC. Your Javma article discusses sustainable antimicrobial use in cats and divergent veterinarian and cat owner perspectives on the use of cephovesin in cats. Please share with our listeners the background on these studies.

Speaker 3: 0:57

So cephovesin or cephovesin, which is maybe more familiar to veterinary listeners as convenient, is one of the most or the most commonly used antimicrobials in cats, even though we don't recommend it as a first-line treatment for any common feline bacterial diseases. So we really wanted to understand why that's the case and then how we could help veterinarians to reduce unnecessary use of convenient and other antimicrobials. So this study used what we would call a mixed methods approach, where we collected both quantitative data from surveys as well as qualitative data from interviews with veterinarians. And because we had these two study populations of cat owners and veterinarians, we were able to understand differences in their perspectives and their experiences giving antibiotics to cats.

Speaker 1: 1:49

And it's really easy to think about having that knee jerk reaction to reach for convenience, especially if we have, like a fractious cat, where oral medication may be quite challenging. So this is definitely a very important study and thank you for sharing it with Yavma and Amelia. What were some of the important findings from the study?

Speaker 4: 2:06

Question. So I'm going to highlight four. I think the first that we found comes from the veterinarians we interviewed, and it was both the desire and need that exists for more information on antimicrobial use guidelines, the drawbacks on antibiotics in general and specifically on convenience. We found a lot of people weren't really aware of any drawbacks, and so in our interviews we also found that people were revealing inappropriate use. We didn't ask directly about you know what's some time that you've used this problematically. It just came up in their responses and there was also explicit requests for more information on antimicrobial resistance, how to better use antibiotics, how to, and more information on what the drawbacks of convenience might be.

Speaker 4: 2:54

The second finding was how many opportunities there are to limit the use of antimicrobials that are critically important for human, for human health. The third thing would be the very real interpersonal and structural barriers that can interfere in a veterinary practice with appropriate use. So there's pressure from clients. People are worried that a cat might get sick, but there's also structural concerns in terms of the time of the visits and the cost of diagnostics. Which leads me really to the fourth finding, which is the strategies and opportunities that are available to make these best practices easier, so that could be things like more affordable diagnostics so people know whether or not an antibiotic is needed and then which one would be most effective. And another thing would be relevant information for clients about antimicrobial resistance and also why an antibiotic might actually not be the best choice in a particular case to help their cat feel better.

Speaker 2: 3:49

A lot of education, education, education for the veterinarians and the clients. Yes, casey, you said a little bit earlier about how this might not be the first. It isn't the first antibiotic for most of the diseases in cats. Is that, or what, sparked your research interest in antimicrobial stewardship in cats?

Speaker 3: 4:10

So I think you know I observed this in my own practice, right In veterinary practices. I saw how myself and others, how we use antimicrobials in cats and I really kind of understood from the vet's perspective how some of the barriers that Amelia mentioned, like clinical uncertainty and those structural barriers between the client and the veterinarian, how that can lead to inappropriate antimicrobial use. Because I think we've all been there when the cat is sick and the owners can't afford diagnostics and you're kind of you know, not sure what else to do other than give it an antibiotic and it just happens that sephobiasin or convenient is very convenient to give. So that's sort of what sparked my interest in overall antimicrobial use in cats and antimicrobial stewardship. But I'm also sort of more broadly interested in antimicrobial use and resistance from a one health perspective and thinking about have we overlooked the role that our pets play in antimicrobial resistance and transmission between human and animal populations?

Speaker 2: 5:19

You just hit the. You kind of teed me up for my next question. This is very, very one health, and you know it's not obviously not just cats, I think, for you know, exotics mean horses. All kinds of this applies very, very broadly to one health. So why did you choose to submit your manuscript to Javma? We're very grateful for it, but why did you pick Javma?

Speaker 3: 5:41

Well, really, because we wanted to share these findings with the veterinary community, and we know that Javma is reaching those practicing vets who are looking for, you know, more information and continuing education on their antimicrobial use.

Speaker 2: 5:56

Yeah, Well, thank you again. It's a really important manuscript and for anybody who's tried to pill a cat or give oral medications, it's easy to prescribe that if you haven't tried to do it yourself. Yep, I remember the first time I before I had my own horse with a really bad foot abscess and I was like, well, just soak it in a bucket and then I did it myself. I was like that's the dumbest thing ever to ask somebody to do.

Speaker 3: 6:21

Yeah, and so I think you know part of what we found I think Amelia will touch on this as well is that there is different perceptions between veterinarians and clients, and I think, veterinarians, we can do a lot to help our clients with those hard asks like giving your pet an antibiotic or soaking your horse's foot.

Speaker 2: 6:42

Yeah, Well now, thank you for teeing up the next question, Amelia. You outlined four or five really important findings in the manuscript, but every time we dive into writing a scientific manuscript, there's always things that surprise us. What were some of the most surprising findings from this manuscript?

Speaker 4: 7:00

Yeah, I will highlight kind of the one big one that stood out because it's such a concrete nugget and it was how it was.

Speaker 4: 7:07

Again, our observation just in the study, that the veterinarians we interviewed tend to underestimate the cat owner's willingness and ability to administer oral antibiotics.

Speaker 4: 7:19

So they thought that cat owners would find it, you know, extremely or very difficult most of the time, where, when we surveyed our cat owners, they found it extremely difficult or very difficult at half the rate that the veterinarians predicted. And the reason that this is important is if a veterinarian is assuming that their client is going to find it difficult to administer oral antibiotics, then there's, it leads much more easily to just administering convenient or not. Having those conversations about well, even though this might be a little difficult, like here's the reason why you want to do this instead of this other option. So you give people the risk benefit profile so they can make a good decision. So of course, this is one study. We'd want to confirm this with additional studies. But that underestimation of cat owner interest or willingness or ability to do it or figure it out is really important and something that I hope we can, you know, start to challenge and work on.

Speaker 1: 8:23

So, casey, how did your advanced training prepare you to write these manuscripts?

Speaker 3: 8:28

So after I finished my veterinary degree I did a PhD in epidemiology and a lot of my focus was on antimicrobial resistance. So that really gave me some skills, both in sort of the biologic background of antimicrobial resistance and how it pertains to one health, but also in things like study design and statistics, which I put to use in designing this study and other projects that we have on antimicrobial resistance.

Speaker 1: 8:57

Yeah, thank you. It's super important and for our listeners. Just joining us. We're chatting about antimicrobial use in cats with our guests Casey and Amelia, so this next set of questions is very important for our listeners. Casey, what is the one piece of information the veterinarian should know before discussing antimicrobial use in cats with a client?

Speaker 3: 9:20

So I think I'll go back to kind of what Amelia pointed out as a surprising finding that I think veterinarians should think about, that their cat owners can learn to pill or give oral antibiotics to their cats right. It's a learnable and teachable skill and so it's something that we can invest time in and I know that time is always precious in a veterinary appointment but this would be a great opportunity to fully utilize, for example, our veterinary technicians to help give cat owners the skills so that they can give antibiotics and other medications appropriately, so that then as a veterinarian we can choose the best drug for that pet. Considering antimicrobial stewardship I think sort of related to that is we found that cat owners they want to do what is best for their cat and they're very open to learning about antimicrobial resistance and so vets can educate them about the importance of resistance and diagnostic testing and appropriate antimicrobial use.

Speaker 1: 10:19

Very important information. Thank you again. Now going to Amelia. Amelia, how did your advanced training prepare you to write this manuscripts?

Speaker 4: 10:30

Yeah, so one of the things I loved about this project was how interdisciplinary it is. So Casey is a veterinarian, I am not. I have a PhD in social and behavioral sciences with an emphasis on public health. I also have a master's in communication, which is really an understanding of the influence of information audience needs, and so those are great backgrounds for designing a study like this. That's looking at social processes. So what are the factors involved and why people do what they do, what interventions might help with behavior change? And the work and research and partnerships I've pursued over the I don't know past 17 years are very focused on translational work and how I define that is research that can influence practice and policy, and I just I love working under their disciplinary teams and figuring out how to marry different expertise and methods, so that management experience and training with a bunch of different teams has led to this work flowing really nicely, to working with different partners and to training graduate students.

Speaker 1: 11:34

The communication piece is so important. I'm actually working on a project for one of my own research articles where I have to boil it down to how my research changes the world and the audience is general public. I didn't realize how really research world is almost like another language and it's so hard to put that down. It is so on the client perspective, amelia, what's one thing clients should consider around antibiotic use in their cats?

Speaker 4: 12:00

Yeah, so I'd echo what Casey said, but I'd boil it down to one thing, and it's thinking about both the short and long-term benefit for their cat. What is going to help the cat feel better now and also make sure that they will be able to get an antibiotic they really need in the future? Because the thing that might make the most sense for the cat right now to help them feel better may not be an antibiotic.

Speaker 2: 12:28

Well, thank you both again, I learned a ton reading your manuscripts and, amelia, I couldn't agree with you more the interdisciplinary aspects and so much respect across the board and especially in the area of One Health. So thank you both for teaming up and then again sharing this with the journals. Absolutely, as we wind down a little bit, we ask a kind of fun personal question. I'm gonna start with you, amelia, and this kind of dates most people. But what was the first concert you?

Speaker 4: 12:56

attended. Oh man, this is so funny. So I grew up in the Midwest, I grew up in Nebraska, and someone I knew back then loved country music, and so my first concert was a Garth Brooks concert at Memorial Stadium in Lincoln, nebraska. How fun, it was really fun. I'm not a huge country music fan, but it was a great way to start my concert world.

Speaker 2: 13:24

Yeah, you're still a great performer. Casey, we'll ask you a slightly different question what's the oldest or the most interesting thing in your desk drawer?

Speaker 3: 13:35

So I am a listener of the Vet and Avertex podcast and so I have been preparing for this question, trying to find something interesting or collect something interesting in my desk, and so I actually moved offices recently and so it's not even in my desk anymore because I sadly threw it out. But I had a souvenir from an interesting clinical case of a dog that had a recurrent ear hematoma and we had previously placed like a teak cannula drain in the hematoma and then had resolved for a while, and then the hematoma came back, and so I was teaching a student how to surgically repair this ear hematoma and lo and behold, there is the teak cannula inside the hematoma, between the ear cartilage, and the owner had thought it had fallen out and so what? It had actually fallen into the hematoma. So it was just kind of an interesting case of there was actually a foreign body in this ear hematoma and after we removed it the ear healed and the dog was much better.

Speaker 1: 14:36

You never know Veterinary medicine surprises me every day.

Speaker 3: 14:40

You never know. We did not expect that.

Speaker 1: 14:43

It's also a great answer. I love that question because we've never had the same thing twice and the answers are always super interesting and usually related to that person's specialty, which is even more fun. Yeah so yeah, and just thank you both again for being here today and for sharing your manuscripts with Javma. I think it's really really great information for our listeners and our readers.

Speaker 3: 15:04

Thank you so much for having us.

Speaker 4: 15:05

Yes thank you again. This is wonderful.

Speaker 1: 15:08

And to our listeners. You can read Casey and Amelia's manuscript in print Javma or on our journals website. I'm Sarah Wright with Lisa 40A. We want to thank each of you for joining us on this episode of the Veterinary Vertex Podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.