Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Veterinary Antimicrobial Resistance Research
Discover why antimicrobial resistance isn't just a challenge but a critical frontier in veterinary medicine with Kelli Maddock and Dr. Claire Burbick. This episode does a deep dive into the world of veterinary antimicrobial resistance research, where you'll gain an understanding of the importance of genotypic methods like PCR, the role of whole-genome sequencing in safeguarding animal health, and the intricate web of diagnostic challenges faced by veterinarians. You're not just listening to another scientific discussion; you're stepping into the epicenter of a critical battle to keep our animals healthy and our shared environment safe.
Meet Kelli and Claire, two trailblazers whose stories of transition from passionate learners to leaders in public health and veterinary microbiology will inspire and educate. Through their eyes, we'll explore the complex relationship between diagnostics and treatment strategies, the significance of the One Health approach, and the vital collaborations shaping the future of veterinary care. This conversation goes beyond the petri dish and the clinic—it's about the power of education, the promise of research, and the professionals who are at the very heart of managing the delicate balance of antimicrobial resistance. Join us for a thought-provoking session that will leave you informed and compelled to learn more about the unseen defenders of animal and public health.
JAVMA article: https://doi.org/10.2460/javma.23.12.0687
AJVR article: https://doi.org/10.2460/ajvr.23.12.0294
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You are listening to Veterinary Vertex, a podcast of the AVMA journals. In this episode we chat about veterinary antimicrobial resistance research with our guests Kelly Maddock and Claire Burbick.
Speaker 2:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier. I'm joined by Associate Editor Sarah Wright. Today we have Claire and Kelly joining us. Thank you both so much for taking time out of your busy work schedule to be with us here today.
Speaker 1:Thanks, for having us. Let's dive into the fascinating research being performed in veterinary antimicrobials. Kelly, your JAVMA and AJVR articles discuss veterinary antimicrobial resistance research. Please share with our listeners the background on these studies.
Speaker 3:Yeah, thank you. So for the JAVMA article, our main goal was to discuss the limitations or potential uses of antimicrobial resistance testing, or ART. As we pointed in this article, it is a genotypic method of testing, so that's using molecular. So technologies like PCR or polymerase chain reaction, whole genome sequencing, metagenomic sequencing, compared to our traditional gold standard methods such as culture and antimicrobial susceptibility testing or AST. So there's currently pressure we feel like in the veterinary setting for clinicians to start using more of the genotypic methods and there are a lot of limitations if we were to use those methods, potentially over-calling resistance. So we really use this article to set up a discussion of what is currently done or what is the gold standard and how that process works, and then move into the potential uses and limitations of that genotypic resistance and it's really just hoping to caution appropriate use of those technologies and then also considering the quality of the results that are coming from the laboratories, because not all labs are accredited or necessarily are held to the same stringent quality control procedures that other laboratories might be.
Speaker 3:And then for the AJVR article, we are really focusing on where we are at for antimicrobial susceptibility testing and where we need to go and really in veterinary laboratory medicine and particularly in microbiology, I feel like we are resource limited. We very much try to keep our testing as affordable as possible for our clients, which, of course, our veterinarians are the direct users. But ultimately it's the people in our states and our communities that are benefiting from these results and we have to keep those tests affordable for them. Of course, everyone knows you don't typically have health insurance for your pets and when you're looking at herd health there's a big expensive impact to those test results. So making sure that we have that right is important. So a lot of our needs are getting the test methods as good as we possibly can, which means manufacturer updates.
Speaker 4:Well, and I think in my mind too, especially in that we kind of laundry listed out all of the different areas that need pretty significant investment into it, from our device manufacturer, consumable manufacturers, to the interpretations that we're using to give that clinically relevant information to the veterinarian. So do we even know what works or doesn't? Do we have clinical outcome studies to say that this drug is really a good choice for this particular infection? So it really, in a way, I always feel a little bit ambivalent having these conversations because I feel like we do have so many needs and so many diverse areas across microbiology, the nuts and bolts of medicine, when we are starting to look at antimicrobials and how we're using them in vet med. And then we also have this unique veterinary situation of like we don't have one species, so we have to duplicate these efforts a lot, especially in the pharmacology world and in outcomes between really unique animal species, different bacteria that affect those animals. So it's a bit of a heavy lift and I think in my mind these paired articles are trying to give a little bit of a plea from the laboratory standpoint to say, hey, we really have a lot of gaps in our kind of day-to-day as far as providing information for actionable use by the veterinarian, which obviously is impacting the animal health, be it companion, be it food safety, animal production, livelihood, all of the things. And so I think it's something that the vets don't get an opportunity to think about because they obviously have their own concerns dealing with practice, dealing with all of that, and so we're trying to do a little bit of hand-waving and highlighting of some of the things that we would like to be able to provide for veterinarians in practice. So through the fact that this is a pretty significant one health issue in a lot of different ways.
Speaker 4:And so, you know, I think our voice sometimes has been quite small in this area, just because we are a very small profession in veterinary microbiology and even veterinary pharmacology, there's just very small groups that are focused in these areas, and so, you know, trying to get more information, to get you know some context around, you know the testing that's done, the limitations of the testing, something sound really fancy and amazing and that they're going to solve all the problems. But you know we really, as people working in diagnostic labs, you know we want to be able to help with the interpretation because no test is perfect, and so we really want, you know, veterinarians to be like okay, I know I can use this test for this situation. It's fantastic For this situation, it has these limits and so that I think I don't know, kelly, if you have, you know, kind of other thoughts on that. But I think it was really, as we evolve in technology, you know, for the molecular paper, as we see the needs that we have and kind of all of the scope of susceptibility, testing and use, you know, we're trying to really get the word out that we have.
Speaker 4:We have some work to do, you know, in this area and that we would. We hope. I mean, I think there's signs that there's some more things happening and more opportunities for us. But I think it's, you know, that was why I was really excited about you know, being a part of these papers is because you know this is a huge platform for us and that you know it's really hopefully we'll drive some interest from the veterinary community to try, and, you know, advocate for more work and more resources in these areas, because it's pretty inconsistent across the veterinary landscape, unfortunately.
Speaker 3:I think that covered it really nicely Definitely varied needs and those species really add interest. And something else I'd like to highlight we do touch a little bit on reporting practices and I think this is something that is becoming more of a bigger need to. We have the tendency to think more is better when we're getting antimicrobial susceptibility test results, and we suggest the need for more guided studies on antimicrobial use based on what we're putting on our reports, and I think it can really showcase the ability of laboratories to help us stewards but also help veterinarians make better, easier choices in the clinic and as far as choosing which antimicrobials are appropriate for their patient.
Speaker 4:Yeah, I just want to like do a little bit more hand waving about what Kelly just said, that you know, for us we do have a kind of a different relationship than is on the human side, which I think is highlighted a bit.
Speaker 4:So the micro labs, you know, are really an important part of stewardship and very much acknowledged within the human medical community as being a resource and easing the you know the way for clinicians to be able to pick drugs, and so that also is something I think we're really wanting to work on and to promote those relationships to see the diagnostic labs as helping, as triage and not just giving a laundry list of things to a vet and just say, you figure it out, that we actually do have the expertise, you know the specialists within these laboratories, to say, hey, you know.
Speaker 4:Alternatively, we could give you a short list of things that are very appropriate for this bug, drug, animal species combination, so that you don't have to go through and figure out you know things for all of your cases. So I think that that is our hope as stewardship partners is that we can, you know, really be seen as a huge resource and as being able to not have to give you a data dump and then you figure out what's going on, but just to say, hey, these are the top tier one choices, these are the you know, the second level down. If we see resistance in these first ones, we can communicate about, you know, significant resistance that we're detecting and saying, hey, this might be an infection control concern. Let's educate around some of these resistance mechanisms and so really to be able to work in partnership more with our you know veterinarians and make their lives a little bit easier. I think that's what we're kind of hoping to do.
Speaker 1:Clinical veterinarians definitely appreciate that. So thank you for being a resource and also for contributing these articles to JAPM. On AJBR Kelly. What were some of the pivotal findings from the JAVMA study?
Speaker 3:I think the biggest finding really was actually the lack of information we have on using these technologies in veterinary medicine. Even in human medicine, it's actually really hard to find good outcome studies based on molecular testing. Something that's important to note is molecular testing is pretty much used to detect one resistance mechanism that would help with infection control or could help with an immediate action on a patient that is very ill, such as in the case of sepsis, compared to just doing metagenomic sequencing, because we have the technology that is such a highly controlled process that even my litmus test is, if Mayo Medical Laboratories isn't routinely doing it, I maybe shouldn't. That's one of the bigger findings is that it's still in its infancy in human medicine, and so we have to be careful and look at our human counterparts and how we are choosing to use it and that it's being used correctly, because we could actually do the opposite of what we're hoping, which is to drive more antimicrobial resistance, and we obviously don't want that.
Speaker 2:Yeah, what I like about your guys' paired manuscripts is not only identifying how far we have to go, but really identifying some solutions as well. Like be part of the solution. So well done, claire. You clearly have a passion for this subject and antimicrobial resistance. What sparked your research interest in this topic?
Speaker 4:You know it's funny it's basically what Kelly just said is I went into microbiology being like, oh, I really like infectious disease, it's super fascinating, I love diagnostic medicine Amazing. And then I was like, okay, and part of this as a section head for bacteriology is doing susceptibility testing. And I was like we do it, great, we do all these magical things, we follow all this stuff. And then I started learning more and seeing more and realizing that the struggles that I was having in the laboratory of like what does this data mean? Why do I not have interpretations for drugs in different animal species that I really need, where are we actually at? And I think it was really bumping up against the lack of information.
Speaker 4:Lack of information and sort of this assumption that everything is working perfectly and that we have all the things done and realizing that we don't. That's kind of been my driver. And then my interest in kind of public health one health, you know has kind of always been an underlying, you know, motivator for me. And so once I kind of realized, you know, hey, we have some significant challenges in antimicrobial testing, susceptibility testing, research just in resistance and veterinary medicine in general, but yet we have this very large pressure about one health, human health, being responsible, and yet we don't have the tools and the funding to really support us doing that. And so that's where I, you know, for, for better or worse, I think both Kelly and myself can feel quite overwhelmed with what we're doing, is that, you know, we really feel like there's a big ethical imperative for us to stand up and try and do some hand waving and and pushing forward and trying to educate around you know, these, these issues and challenges that we have.
Speaker 4:And so it really came from a place of like oh, why does my instrument not interpret, you know, fluoroquinolones for cats, which literally was the thing that started this whole, like what just happened here, and then realizing, oh, it's because now this body site is not being interpreted for this drug in this animal species, because of whatever random reason that I can't quite figure out, you know has turned into this.
Speaker 4:You know, kind of trying to, to be more involved in seeing, you know how far we can, we can get you know, and then hopefully finding partners like Kelly who are like oh, I will also want to to do this thing with you, and you know, and I think we're building up sort of a community there, and you know, I think I'd be interested to hear what Kelly says too about this. But you know, I think that's it's really just almost like an accident, like this one thing happened one day and then, you know, went down the rabbit hole of trying to figure out what actually is going on, you know kind of into the weeds and so, for better or worse, that that's kind of how it happened. But you know, really, I think public health has been a big focus for me and that's kind of. That's kind of where, you know, I think I've ultimately ended up in this crazy position of trying to do this work.
Speaker 2:Kelly, what's your story? Do you have the cat fluoroquinolone story too? Or what inspired you to become so passionate and contribute to antimicrobial resistance?
Speaker 3:Definitely not the cat floor quintalone story, but very similar in basically spiraling down a rabbit hole. But my background is in human medical laboratory science, so one health is just built into, I guess, my DNA at this point, and so I approach laboratory medicine the same way. It's the best way to get the right results with the right sample and then so just digging into those topics. Antimicrobial resistance research, I think actually probably stemmed a lot from Claire. I'm in vet medicine because I happened to meet her at a meeting. I might have been an accountant or gone back to school for something very not science-y had I not found veterinary medicine. I think I was getting burnt out in a hospital.
Speaker 3:But the more you learn, the more you realize you don't know. And then you find those areas of interest that just drag you into the weeds and you find more and there's always something that can be done. There's so much low hanging fruit. I feel like that can be researched and then used to improve our practices and overall help the client and that one health. Of course not wanting to spread antimicrobial resistance between human and animals, but also knowing that there is a person with that animal and an emotional bond to them and if they're dealing with that infection and it's just this awful thing. It seems like every situation where you see those really nasty infections, the person is also immunocompromised, so there's just so many pieces to it that add to that personal element, even though we don't see the patient as a laboratory, and you're always thinking of, oh, this poor dog based on the case history and then just imagining what they're going through. So it's hard to be disconnected and it's a very important and emotional thing, even disconnected in the laboratory Always very interesting.
Speaker 2:So we try to do in these currents and one health manuscripts is not just talk about translation from human to animals, but obviously antimicrobial resistance includes the environment as well.
Speaker 1:Kelly. What are some pivotal findings from the AJBR article?
Speaker 3:From the AJBR article. I guess the most important findings again would just be that we have many areas that we can tackle and there's some very important areas that deserve funding and consideration for research, and that there's a lot that would be funded. That would involve collaboration between clinics or hospitals and veterinary diagnostic laboratories. That would, I think, result in a lot of just impactful research that would actually change the way that we do it and it would actually change the way we currently practice and it would make it better for the laboratories and for the clinician using that information. So I think that would be important takeaways there. Also, it might not be super apparent, but there's a bit of a plea for help from manufacturers and anyone that can help us out that would be willing to partner, because I think that's also really important.
Speaker 1:So I just wanted to highlight my veterinary diagnostic laboratory rotation. It was really cool and eye openings to be on the other side of those reports. I really appreciate it and I just really gained a deeper appreciation, too, for the veterinary microbiologists that are out there that are doing the work and helping us provide the best care that we can for our patients. So eye-opening experience for sure, and for our listeners just joining us. We're discussing veterinary antimicrobial resistance research with Kelly and Claire. We're going to move into a bit more of a personal note for our episode. Kelly, how did your advanced training prepare you to write these manuscripts?
Speaker 3:So my background again is in medical laboratory science. That's a very highly trained profession in the human medical laboratory. In the last few weeks we've been working on a lot of different scenes. We're trying to understand what's going on in the disease process but also how our test results interpret and are used for diagnosis and management of disease. And so we learned the whole clinical process, not just microbiology. But I was in love with microbiology before I started my internship and it's been that way forever. So I'm doing my research in medical laboratory science. So again, just that advanced passion for the profession and promoting best laboratory practices. I'm really in the process of getting my doctorate in public health. So you get that one health, and again it's that laboratory side and how the laboratory contributes to public health and how we can improve change.
Speaker 1:Congratulations. That's really exciting.
Speaker 3:Thank you.
Speaker 1:Claire, how did your advanced training prepare you to write this article?
Speaker 4:I feel like I was really well one. I mean, going through vet school gave me that broad-based knowledge medicine, disease, all of the things that I feel like I've forgotten. I learned so much and I've forgotten so much. It still gives me very sad PTSD feeling. So I was really fortunate enough to just happen upon this thing called clinical microbiology residency. I in vet school was 100% unaware that this was something that you could do, and I was able to get into a program at Washington State University so I could actually train as a veterinarian in a diagnostic laboratory and be able to understand all of the ins and outs of testing, test interpretation sampling. So the black box that is the diagnostic lab was now open to me and I was being actually trained within that environment. So I felt like I really had a really strong start and support for understanding how clinical microbiology works. It was also combined with a PhD, so I had that kind of hypothesis driven research exposure as well, and so I think that paired really nicely together as a way to train through diagnostics, testing, interpretation, hypotheses, all of the evidence that you need to be able to push things forward.
Speaker 4:And then I think honestly, I just learned day to day and I think that's part of being in medicine is it's lifelong learning. Every day I'm like I feel like an idiot half the time because I'm like I feel like I just learned this very basic thing, even though it probably isn't super basic, but it's a very humbling, a very daily learning, very engaging. I feel like I'm never bored. Usually the opposite is just so many cool, amazing things and people, so kind of the combination of being set up for success through these actual training programs and then just that every day is something new, something incredible, being around the smartest people in the room. It's been an amazing journey so far and I think it just continues to kind of amaze me how much we learn literally every day. And then we have new technology coming and you're just like wow, it's just unbelievable.
Speaker 1:As Lisa likes to say, every day is a school day. She found you. I was going to say that too. It's like our motto for the journals. So now, going back to your articles, this next question is really important for our listeners and, if you can, I'd like you to boil it down to just one piece, claire. What is one piece of information the veterinarian should know before discussing antimicrobial resistance with the clients?
Speaker 4:So this is maybe not exactly like I think. So One of the things, my one thing from these articles is that, because it is an incredibly complex area, I want veterinarians to feel empowered to work, to call us to discuss questions they have, if they, because these kind of highlight the complexity of working in this area, that they feel like they have a resource and partner. Because, even talking with their clients about, is this resistant bacteria in my animal going to impact other animals in my household I have an immunocompromised person that's going to visit us. Do I need to deal with that? What are the treatment implications? Because sometimes that can be a very difficult conversation. If they're expensive drugs, hard to use drugs, they can't get the drugs in the animal. You know that they really have a partner in their vet diagnostic labs and their clinical microbiologists, because it is a really challenging and is a rapidly evolving world, and so I don't want veterinarians to feel like they have to figure it out themselves.
Speaker 4:I feel like sometimes we train veterinarians to figure it out themselves, but really to utilize the resources that are here. You know, within the diagnostic medicine community, to say, hey, I've never heard of this bacteria. I'm, you know, unfamiliar with this type of resistance. We're seeing resistance now develop in, you know, our vet patients that people have probably never heard of and not been taught to because we never thought we would be facing them, and so there's just a lot that veterinarians have to you know to deal with on a regular basis. And so I would say, you know, we want you know to work with in partnership as a resource, and you know, obviously I'm speaking like, well, the vet diagnostics would, like you know, love to be able to do this, but but I really feel like you know, within our discussion in the vet diagnostic labs, we really feel like we want to provide, you know, that resource, because medicine is very complicated. There's so much to keep you know, to keep track of.
Speaker 4:I was listening to a podcast where you know it was a physician from Harvard and he said you know, our biggest challenge in medicine is complexity. You have to, as a physician, know how to use 19,000 drugs right. How do we train to that? How do clinicians deal with that level? You know of information and so you know I think with these papers, there are people like us working in this area that can then translate this information to veterinarians in a way that's not overly complicated. Hopefully you know that provides that, so that would be. My hope and desire from these papers is that they want to come to us with questions about testing, sampling, interpretation, using drugs for what spectrum of things? Because we do have some small critical mass of knowledge in that area.
Speaker 1:Yeah, I think it's veterinarians who are very self-sufficient people and it takes skill to actually say, hey, I could use some help, can you help me? So thank you. And now, on the other side of the relationship, kelly, what's the one thing clients should consider around antimicrobial resistance?
Speaker 3:Yes, and so this is something too, that the AJBR article includes a little figure and at the center of it is a human. But that human representing the veterinarian, the laboratory and the owner. And just for clients to then understand that they are also part of this stewardship in the antimicrobial resistance. So following the recommendations of your veterinarian, that's very important. It might not be fun to clean your dog's ears every day, but that might prevent you from having to spend all sorts of money on antimicrobials and it's all about that infection prevention before you're getting to the point of treatment. So following the recommendations and guidelines of your veterinarian can really help you out in the long run. And again, that's also helping to minimize some of that resistance. And then also understanding that demanding an antimicrobial from your veterinarian is probably putting undue pressure on them and it's not helping you or your animal and it probably will end up costing you more money. So just understanding that that extra pressure isn't going to help your situation.
Speaker 2:Really good points. As we wind on even a little bit further, Kelly, we'll stay on you for a second. What is the first concert you attended?
Speaker 3:So actually a little indie rock band from Canada called the Weaker Thames. I know that one of their songs is at the end of 2005's the Wedding Crashers, but they're a really great band and, of course, being in North Dakota, one of the biggest cities we could go to was up in Canada, near where I was that, so that was my first big concert.
Speaker 2:Yeah, Kelly and I are mutual North Dakotans. Claire, how about you? What was your first concert?
Speaker 4:So my first concert I was actually quite small, it was Stevie Wonder and so I actually grew up in Pullman, washington, which is where I am now, which is where Washington State University is, and and he came to Pullman of all places, like we are not a large urban area, we are not close to a large urban area in any sense of the word, and he came to this like very tiny town because it's much smaller back then. I won't tell you how long ago that was, but but yeah, it was Stevie Wonder in Pullman Washington, which is like absolutely ridiculous, and I do. I remember it very well. I do not because I was very small. I think I probably was like I just want to go home and go to bed, but but yeah, I still feel a little bit proud about that.
Speaker 1:Yeah, I love that question. It's fun getting to know more about our authors, and everyone has such good answers too. I don't know if we've had the same answer twice. So thank you both, and just thank you again, kelly and clear, for being here today and for also contributing your Java and AJBR currents and one health articles to our journals.
Speaker 3:Thank you so much for having us.
Speaker 1:This is yeah, thank you, and to our listeners. You can read Kelly and Claire's articles in print, java or using your favorite search engine. I'm Sarah Wright, with Lisa 40 a. 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.
