April 1, 2025 • 16 mins
Dr. Jennifer Granick takes us deep into her groundbreaking research on antibiotic prescribing patterns in companion animal practice, revealing both challenges and opportunities for improvement.
This conversation unveils the complex reality of veterinary prescribing. Perhaps most surprising is the finding that preventive antibiotic treatments typically last the same duration (10 days) as those targeting confirmed infections—a practice without scientific justification.
What makes this discussion particularly valuable is Dr. Granick's practical approach to creating change. Rather than overwhelming practitioners with an insurmountable challenge, she advocates starting small: "Pick one common condition, check prescribing guidelines, and make one small change." This accessible strategy empowers veterinarians to contribute meaningfully to antimicrobial stewardship without complete practice overhauls. Meanwhile, pet owners gain crucial perspective on when antibiotics truly help versus when they might cause harm.
As Dr. Granick's team explores innovative methods using electronic health records and AI to gather prescribing data while maintaining privacy, the future of veterinary antimicrobial stewardship looks promising. Her parting wisdom serves as both warning and hope: antibiotics are indeed life-saving, but only if they continue to work. Join us for this essential conversation at the intersection of companion animal medicine, public health, and our shared responsibility to preserve these precious medications for generations to come.
Open access JAVMA article: https://doi.org/10.2460/javma.24.11.0716
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Wellness Pet Foods (00:01):
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:31):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode we chat abouthow measurement of antibiotic
use in cats and dogs presentingto US primary care and Referral
Practices provides insights forantimicrobial stewardship.
With our guest Jennifer Granick.
Lisa Fortier (00:48):
Welcome listeners.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Thank you so much for takingtime to be with us here today.
Jennifer Granick (00:57):
Thanks for having me.
Sarah Wright (00:59):
All right, let's dive right in.
So, Jennifer.
Your JAVMA article discusseshow measurement of antibiotic
use in cats and dogs presentingto US primary care and referral
practices provides insights forantimicrobial stewardship.
Please share with our listenersthe background on this article.
Jennifer Granick (01:16):
Yeah, so I think most practicing vets have
experienced an increase inantimicrobial resistant or AMR
bacterial infections in theirpatients, and we know that AMR
is a global health concern inpeople and animals.
If you were paying attention tothe news, back in September
there was a high-level meetingabout AMR at the United Nations
(01:39):
General Assembly, so there's alot of attention focused on this
topic, not so much in companionanimals.
So that's one of the thingsthat I have wanted to address,
and there are certainly lots ofdifferent actions needed to
address AMR.
But the use of antimicrobials,including antibiotics, is a
(02:00):
really important risk factor forthe development of AMR and the
cool thing is it's under all ofour control.
If we're prescribers right,it's something that we can
directly impact, and a colleagueof mine who's a co-author on
this study, Dr Amanda Bedoin,always says you can't manage
what you don't measure.
So that was our goal was tomeasure antibiotic use in cats
(02:22):
and dogs.
Sarah Wright (02:24):
I like that phrase .
Actually, we actually I don'tknow if you know this, but we
have an antimicrobial-themedcollection of freely accessible
articles published in JAVMA andAJVR on our website.
So far, that's a resource forour readers.
Jennifer Granick (02:38):
Yeah, AVMA has a lot of really wonderful
prescribing resources.
Sarah Wright (02:43):
Definitely so.
What are some of the importanttake-home messages from this
JAVMA article?
Jennifer Granick (02:49):
So there's a few.
I think one of the big ones wasthat in this study we saw a lot
of use of metronidazole for thetreatment of diarrhea in dogs
and we have a lot of really goodevidence now that using
antibiotics can further disruptintestinal microbiome and we
know the microbiome has allthese wonderful positive impacts
(03:10):
on the whole body.
So there's sort of hiddeneffects of using an antibiotic
in that situation that I don'tthink we always think about when
we're prescribing for diarrhea.
There's also a handful ofstudies that show that even
though it makes us feel betterusing antibiotics in that
situation, it doesn't actuallyresolve diarrhea faster.
So I think one of the outcomesfor me from this study is that
(03:33):
this is an important area thatwe need to focus not only
education for veterinarians butreally importantly, client
education.
Clients are really used toreceiving an antibiotic when
their dog has diarrhea.
They don't have a lot oftolerance for diarrhea, but I
don't think they know all thatwe've learned about this disease
(03:56):
and how antibiotics affect it,not always for the better.
So that's one thing.
The other thing that we saw alot of was the use of
third-generation cephalosporins,so things like cefavescin and
cefpidoxime I think most peopleknow as, like Convenia and
Simplicef, in situations whenother first-line agents that
(04:17):
carry a lower risk of thedevelopment of AMR could have
been used, and I think we seethis most frequently in cats,
and cats are also prescribedmore fluoroquinolones than dogs.
So things like pradofloxacin,enrofloxacin, marbofloxacin and
those drugs also carry a biggerrisk for AMR.
So I think that's maybe anothertakeaway.
(04:38):
And lastly, we just didn't seea whole lot of use of bacterial
culture and susceptibility.
We know this is true, it'sexpensive, there are a lot of
barriers to it, but there areother diagnostics that are more
accessible and less expensive,like cytology, and in our study,
(05:00):
only a third of the situationsin which antibiotics were
prescribed to treat infectionwere actually confirmed
infection and 11% there wasactually no evidence of
infection.
So I think that kind of gets tothe.
Sometimes we're prescribingantibiotics and we don't really
know what's going on, because wewant to do something.
But this is an area I thinkthat we really need to focus a
(05:21):
lot on in vet med this sort oflike fear-based prescribing or
just-in-case prescribing,especially as we learn about the
impacts of antibiotic use whenwe don't need to be using it.
Lisa Fortier (05:34):
Yeah, Jennifer, you might know I'm an equine
specialist, though for us it'sthe same.
But it's trimethoprim, sulfa,sulfamethodoxazone.
Like every scratch, every cough, everything starts shaking out
the white pills.
Jennifer Granick (05:48):
Yeah, yeah, I think I mean there's a lot of
similarities.
I would say like I wish we usedmore TMS in companion animals,
because at least it's a firsttier drug.
I mean, a lot of times we'reusing kind of higher tier drugs,
maybe a riskier drugs in termsof AMR, when we don't need them
in small animals.
But yeah, it's a.
You know, it's an issue inhuman health care too.
(06:08):
You know, I think sometimes wejust feel like we need to do
something and historically we'vethought that providing an
antibiotic is less risky thannot and I think we really need
to investigate kind of outcomesbased studies to see if that
really holds up.
Lisa Fortier (06:24):
Yeah, on the flip side, you could think of a
spectrum of care and likehelping veterinarians not make
clients feel guilty for notdishing out 100 or 200 or
whatever they need for a 10-daycourse of antimicrobials.
Jennifer Granick (06:37):
Yeah, yeah for sure, antibiotics are not
inexpensive, especially thosehigher tier drugs.
Lisa Fortier (06:45):
Sure what sparked your interest in antimicrobial
stewardship.
Jennifer Granick (06:49):
Um, my interest really sparked because
I saw a change just in mypractice lifetime of you know,
when I first started practicingantimicrobial resistant
infections were really rare, youknow, it was just.
It was almost like exciting whenyou saw it because it was so
uncommon and um, and it got tothe point where I was seeing
(07:11):
these like weekly and you knownow it's daily, I would say.
So that was alarming to me.
You know I work in a referralpopulation setting so I'm
certainly seeing more than maybein primary care settings, but I
definitely saw a trend, So Ifelt compelled to do something,
(07:38):
figure out what's going on anddo more and kind of at that same
time, here in Minnesota ourDepartment of Health started a
One Health AntibioticStewardship Collaboration which
is across professional groupsincluding, like pharmacists and
physicians and dentists andveterinarians and, you know,
food commodity groups too, and Ilearned a lot from that group
(07:59):
about what was being done on thehuman health care side in terms
of antimicrobial stewardship.
So, I think I really gotexcited that maybe those things
were translational to us.
Lisa Fortier (08:10):
Fantastic.
I love this, the idea of thatgroup.
Earlier, Sarah asked you whatare some of the big take-home
messages, but whenever we dosomething like this, we're
always surprised.
What were some things thatsurprised you in this article?
Jennifer Granick (08:23):
Okay, so the biggest thing that surprised me
was that the duration ofprescriptions for antibiotics
for treating infections themedian duration was like 10 days
.
So if you know you have aninfection, you're treating for
10 days, but it was also 10 daysfor prophylactic treatment.
So when we have no infectionand we're just trying to prevent
(08:44):
it, we're using antibiotics forthe same duration, which I
thought was wild and clearly anarea that needs some guidance,
because there's not a lot ofprescribing guidance.
Good news is that there's agroup working on that, so I
think we'll see some guidancewithin this next year, but that
was really shocking to me.
Sarah Wright (09:02):
You actually teed me up perfectly for my next
question, which is what are thenext steps for research in this
topic?
Jennifer Granick (09:08):
Oh, so I mean I think that you know we're
interested in looking at our ownprescribing in our hospitals,
see if we can make some impactsthere.
I think studies like thisprovide some baseline data.
So repeating studies,especially if there are new
things that come out like newguidance, can tell us whether
there's uptake of those thingsover time.
(09:30):
But another area that we'refocused on is new, different
methods for collecting this data.
So we had a group of amazingvolunteers at all the practices
that participated in this studyand they manually, you know
gathered data and put it intoour online data capture system,
(09:52):
and we couldn't have done thisstudy without that.
But it's a lot of work and soit makes it hard to scale up.
So what we're working on isgathering prescribing data
directly from electronic healthrecords at a large scale, so
that there is really no efforton the practice level and solve
work that we need to do.
So that's what we're working onright now.
Sarah Wright (10:16):
Do you think AI could help with that at all?
Jennifer Granick (10:18):
Yeah, absolutely.
What we found with working withelectronic health records is
that you know there are thingscalled standard fields, where
you know there's a limitednumber of selections from a
drop-down menu.
They're not utilized a lot.
We don't have standard codingfor diagnoses or for billing in
(10:40):
vet med like they do in humanhealth care, so most of that
rich information that we'reinterested in is in what we call
free text fields, so it's whereyou just type whatever you want
so in your soap notes, yourdoctor's notes and we really
need AI to get that informationout, and we've done some
experimenting with that already.
(11:01):
The one thing that we areconstantly thinking about when
we use a methodology like thatis that we need to do it in a
way that keeps data private.
So that's what we're working onright now and, yeah, AI, I
think, is I think we're going tosee amazing impacts of AI, but
(11:23):
I think we need to do itcarefully.
Sarah Wright (11:23):
And speaking of AI , just putting in a plug here we
have our AJVR ArtificialIntelligence Supplemental Issue
coming out in March of this year, so very exciting for that.
So be on the lookout.
Jennifer Granick (11:33):
I'm looking forward to that.
That's cool.
Sarah Wright (11:35):
Yeah, yeah, no, it should be awesome.
And for those of you justjoining us, we're discussing how
the measurement of antibioticuse in cats and dogs, presenting
to you as primary care andreferral practices, provides
insights for antimicrobialstewardship.
With our guest Jennifer.
Lisa Fortier (11:49):
Jennifer, how does your training in previous work
prepare you to write thisarticle?
Jennifer Granick (11:53):
Well, I think that's just as a group are
really well trained in onehealth.
So I think for me, just myveterinary training made it
pretty natural to look formethodology for data collection
used on the human health careside and see how it could be
adapted for vet med.
And then we've done a number ofthese what we call point
(12:18):
prevalence surveys, to collectthis data.
So we tried it out in our ownteaching hospital.
We did it every month for ayear and got some really cool
insights into what we were doingand how we could, you know,
change our practices.
And then we expanded that nextto practices in Minnesota, north
Dakota and then in academicteaching hospitals across the US
.
So this was the biggest studythat we had done at that point,
(12:44):
but we had a lot of practice.
We refined our methods.
So that just makes perfect, Iguess.
Well, it makes better.
I don't know what perfectionreally looks like yet.
Sarah Wright (12:55):
I was a literally just about to say that.
Lisa Fortier (12:57):
I'm from North Dakota.
Jennifer, I don't hear too muchMinnesota in your accent.
Jennifer Granick (13:01):
Oh, no, I was born in Philly, yeah, but I'm a
Midwesterner at heart, so Iwould never go back.
I've been here, I think, longerthan I ever lived on the East
Coast.
Lisa Fortier (13:13):
Very good.
Sarah Wright (13:14):
Midwest is best, I have to say.
So, Jennifer, this next set ofquestions is going to be really
important for our listeners.
We're going to try to boil allthis great information that you
shared with us today down tolike one important point.
So what is one piece ofinformation the veterinarian
should know about antimicrobialstewardship in small animal
primary care and referralpractices?
Jennifer Granick (13:36):
Yeah.
So, I think this idea ofantimicrobial stewardship kind
of feels like this big idea andmaybe not something that is
accessible.
But honestly, improvingprescribing which is one of the
goals of antimicrobialstewardship can start with like
one little action.
So I think that's an importantthing to remember.
(13:56):
So, pick, you know, picking acommon condition, checking out
prescribing guidelines andmaking one small change like
treating lower urinary tractinfections for three days
instead of 10, can make a reallybig impact.
And once you have that underyour belt, you can look to the
next thing.
But I think just taking smallsteps towards improving
prescribing is the biggesttake-home message.
Sarah Wright (14:28):
Speaking of UCIs, we actually had a really cool
article published in asubsequent podcast episode where
we interviewed the authorsabout in-house urine cultures to
see how feasible that was andhow practical.
So definitely some cool stuff,a spectrum of care happening in
the antimicrobial stewardshipworld.
So, on the other side of therelationship, what's one thing
clients should know about thistopic?
Jennifer Granick (14:45):
I think clients know antibiotics are
life-saving, but what they needto know is that's only true if
they still work, and I think weprobably don't talk about some
of these undesirable sideeffects.
So in clients, you know, what Iwould encourage for clients is
to advocate for usingantibiotics, but only when
they're needed.
Lisa Fortier (15:06):
Yeah, very well said.
Thanks again, Jennifer.
I learned a ton and it's alwaysgood food for thought.
I love your idea of startingsmall.
Just pick one thing becauseyou're right, it sounds very
esoteric, academic to thinkabout, and the word stewardship,
yeah.
So, thank you for distilling itdown for me and hopefully a lot
of our listeners.
As we close, we'd like to ask afun fact and for you, we'd like
(15:32):
to know what is Jennifer'sfavorite animal fact?
Jennifer Granick (15:37):
Well, I love octopuses or octopi I'm not sure
what the correct plural is butthey have three hearts.
But what I didn't know is thatthey have nine brains.
They have a central brain and abrain for each arm.
I think that is amazing.
So that's my fun animal fact.
Sarah Wright (15:55):
So, I think what Lisa and I have learned because
he was laughing, so she knows isthat the octopus fascinates
veterinarians.
I'm not kidding, Jennifer.
I think almost everyone hasanswered this question with a
fact about octopus.
Lisa Fortier (16:22):
But different facts.
The ophthalmologist answeredabout that.
They have a little perforationin their anterior chamber.
Somebody else said the threehearts, you added nine brains.
The octopus is fascinating.
Jennifer Granick (16:27):
Yeah, it really is.
I'm a sucker for those naturedocumentaries that focus on
octopuses.
They're so cool.
Sarah Wright (16:30):
Double pods are cool.
Well, thank you again, Jennifer, for being here today, for
sharing your manuscript withJAVMA and just for sharing the
information, too, with ourlisteners on our podcast.
Jennifer Granick (16:39):
Yeah, thanks a lot for having me.
Sarah Wright (16:41):
It was fun to share a little bit more about
the study and to our listeners,you can read Jennifer's article
in JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
Mealtime is more than a bowl of food.
It's the foundation for a longand healthy life.
At Wellness, dry recipes arecrafted with the highest quality
natural ingredients for a tastethat pets love and
scientifically proven throughAFCO feeding trials to ensure
that every complete and balancedmeal supports the five signs of
wellbeing.
With Wellness Pet Foods, petparents can share a life of
(00:25):
well-being together with theirpet.
Sarah Wright (00:31):
This is Veterinary Vertex, a podcast of the AVMA
Journals.
In this episode we chat abouthow measurement of antibiotic
use in cats and dogs presentingto US primary care and Referral
Practices provides insights forantimicrobial stewardship.
With our guest Jennifer Granick.
Lisa Fortier (00:48):
Welcome listeners.
I'm Editor-in-Chief LisaFortier, and I'm joined by
Associate Editor Sarah Wright.
Thank you so much for takingtime to be with us here today.
Jennifer Granick (00:57):
Thanks for having me.
Sarah Wright (00:59):
All right, let's dive right in.
So, Jennifer.
Your JAVMA article discusseshow measurement of antibiotic
use in cats and dogs presentingto US primary care and referral
practices provides insights forantimicrobial stewardship.
Please share with our listenersthe background on this article.
Jennifer Granick (01:16):
Yeah, so I think most practicing vets have
experienced an increase inantimicrobial resistant or AMR
bacterial infections in theirpatients, and we know that AMR
is a global health concern inpeople and animals.
If you were paying attention tothe news, back in September
there was a high-level meetingabout AMR at the United Nations
(01:39):
General Assembly, so there's alot of attention focused on this
topic, not so much in companionanimals.
So that's one of the thingsthat I have wanted to address,
and there are certainly lots ofdifferent actions needed to
address AMR.
But the use of antimicrobials,including antibiotics, is a
(02:00):
really important risk factor forthe development of AMR and the
cool thing is it's under all ofour control.
If we're prescribers right,it's something that we can
directly impact, and a colleagueof mine who's a co-author on
this study, Dr Amanda Bedoin,always says you can't manage
what you don't measure.
So that was our goal was tomeasure antibiotic use in cats
(02:22):
and dogs.
Sarah Wright (02:24):
I like that phrase .
Actually, we actually I don'tknow if you know this, but we
have an antimicrobial-themedcollection of freely accessible
articles published in JAVMA andAJVR on our website.
So far, that's a resource forour readers.
Jennifer Granick (02:38):
Yeah, AVMA has a lot of really wonderful
prescribing resources.
Sarah Wright (02:43):
Definitely so.
What are some of the importanttake-home messages from this
JAVMA article?
Jennifer Granick (02:49):
So there's a few.
I think one of the big ones wasthat in this study we saw a lot
of use of metronidazole for thetreatment of diarrhea in dogs
and we have a lot of really goodevidence now that using
antibiotics can further disruptintestinal microbiome and we
know the microbiome has allthese wonderful positive impacts
(03:10):
on the whole body.
So there's sort of hiddeneffects of using an antibiotic
in that situation that I don'tthink we always think about when
we're prescribing for diarrhea.
There's also a handful ofstudies that show that even
though it makes us feel betterusing antibiotics in that
situation, it doesn't actuallyresolve diarrhea faster.
So I think one of the outcomesfor me from this study is that
(03:33):
this is an important area thatwe need to focus not only
education for veterinarians butreally importantly, client
education.
Clients are really used toreceiving an antibiotic when
their dog has diarrhea.
They don't have a lot oftolerance for diarrhea, but I
don't think they know all thatwe've learned about this disease
(03:56):
and how antibiotics affect it,not always for the better.
So that's one thing.
The other thing that we saw alot of was the use of
third-generation cephalosporins,so things like cefavescin and
cefpidoxime I think most peopleknow as, like Convenia and
Simplicef, in situations whenother first-line agents that
(04:17):
carry a lower risk of thedevelopment of AMR could have
been used, and I think we seethis most frequently in cats,
and cats are also prescribedmore fluoroquinolones than dogs.
So things like pradofloxacin,enrofloxacin, marbofloxacin and
those drugs also carry a biggerrisk for AMR.
So I think that's maybe anothertakeaway.
(04:38):
And lastly, we just didn't seea whole lot of use of bacterial
culture and susceptibility.
We know this is true, it'sexpensive, there are a lot of
barriers to it, but there areother diagnostics that are more
accessible and less expensive,like cytology, and in our study,
(05:00):
only a third of the situationsin which antibiotics were
prescribed to treat infectionwere actually confirmed
infection and 11% there wasactually no evidence of
infection.
So I think that kind of gets tothe.
Sometimes we're prescribingantibiotics and we don't really
know what's going on, because wewant to do something.
But this is an area I thinkthat we really need to focus a
(05:21):
lot on in vet med this sort oflike fear-based prescribing or
just-in-case prescribing,especially as we learn about the
impacts of antibiotic use whenwe don't need to be using it.
Lisa Fortier (05:34):
Yeah, Jennifer, you might know I'm an equine
specialist, though for us it'sthe same.
But it's trimethoprim, sulfa,sulfamethodoxazone.
Like every scratch, every cough, everything starts shaking out
the white pills.
Jennifer Granick (05:48):
Yeah, yeah, I think I mean there's a lot of
similarities.
I would say like I wish we usedmore TMS in companion animals,
because at least it's a firsttier drug.
I mean, a lot of times we'reusing kind of higher tier drugs,
maybe a riskier drugs in termsof AMR, when we don't need them
in small animals.
But yeah, it's a.
You know, it's an issue inhuman health care too.
(06:08):
You know, I think sometimes wejust feel like we need to do
something and historically we'vethought that providing an
antibiotic is less risky thannot and I think we really need
to investigate kind of outcomesbased studies to see if that
really holds up.
Lisa Fortier (06:24):
Yeah, on the flip side, you could think of a
spectrum of care and likehelping veterinarians not make
clients feel guilty for notdishing out 100 or 200 or
whatever they need for a 10-daycourse of antimicrobials.
Jennifer Granick (06:37):
Yeah, yeah for sure, antibiotics are not
inexpensive, especially thosehigher tier drugs.
Lisa Fortier (06:45):
Sure what sparked your interest in antimicrobial
stewardship.
Jennifer Granick (06:49):
Um, my interest really sparked because
I saw a change just in mypractice lifetime of you know,
when I first started practicingantimicrobial resistant
infections were really rare, youknow, it was just.
It was almost like exciting whenyou saw it because it was so
uncommon and um, and it got tothe point where I was seeing
(07:11):
these like weekly and you knownow it's daily, I would say.
So that was alarming to me.
You know I work in a referralpopulation setting so I'm
certainly seeing more than maybein primary care settings, but I
definitely saw a trend, So Ifelt compelled to do something,
(07:38):
figure out what's going on anddo more and kind of at that same
time, here in Minnesota ourDepartment of Health started a
One Health AntibioticStewardship Collaboration which
is across professional groupsincluding, like pharmacists and
physicians and dentists andveterinarians and, you know,
food commodity groups too, and Ilearned a lot from that group
(07:59):
about what was being done on thehuman health care side in terms
of antimicrobial stewardship.
So, I think I really gotexcited that maybe those things
were translational to us.
Lisa Fortier (08:10):
Fantastic.
I love this, the idea of thatgroup.
Earlier, Sarah asked you whatare some of the big take-home
messages, but whenever we dosomething like this, we're
always surprised.
What were some things thatsurprised you in this article?
Jennifer Granick (08:23):
Okay, so the biggest thing that surprised me
was that the duration ofprescriptions for antibiotics
for treating infections themedian duration was like 10 days
.
So if you know you have aninfection, you're treating for
10 days, but it was also 10 daysfor prophylactic treatment.
So when we have no infectionand we're just trying to prevent
(08:44):
it, we're using antibiotics forthe same duration, which I
thought was wild and clearly anarea that needs some guidance,
because there's not a lot ofprescribing guidance.
Good news is that there's agroup working on that, so I
think we'll see some guidancewithin this next year, but that
was really shocking to me.
Sarah Wright (09:02):
You actually teed me up perfectly for my next
question, which is what are thenext steps for research in this
topic?
Jennifer Granick (09:08):
Oh, so I mean I think that you know we're
interested in looking at our ownprescribing in our hospitals,
see if we can make some impactsthere.
I think studies like thisprovide some baseline data.
So repeating studies,especially if there are new
things that come out like newguidance, can tell us whether
there's uptake of those thingsover time.
(09:30):
But another area that we'refocused on is new, different
methods for collecting this data.
So we had a group of amazingvolunteers at all the practices
that participated in this studyand they manually, you know
gathered data and put it intoour online data capture system,
(09:52):
and we couldn't have done thisstudy without that.
But it's a lot of work and soit makes it hard to scale up.
So what we're working on isgathering prescribing data
directly from electronic healthrecords at a large scale, so
that there is really no efforton the practice level and solve
work that we need to do.
So that's what we're working onright now.
Sarah Wright (10:16):
Do you think AI could help with that at all?
Jennifer Granick (10:18):
Yeah, absolutely.
What we found with working withelectronic health records is
that you know there are thingscalled standard fields, where
you know there's a limitednumber of selections from a
drop-down menu.
They're not utilized a lot.
We don't have standard codingfor diagnoses or for billing in
(10:40):
vet med like they do in humanhealth care, so most of that
rich information that we'reinterested in is in what we call
free text fields, so it's whereyou just type whatever you want
so in your soap notes, yourdoctor's notes and we really
need AI to get that informationout, and we've done some
experimenting with that already.
(11:01):
The one thing that we areconstantly thinking about when
we use a methodology like thatis that we need to do it in a
way that keeps data private.
So that's what we're working onright now and, yeah, AI, I
think, is I think we're going tosee amazing impacts of AI, but
(11:23):
I think we need to do itcarefully.
Sarah Wright (11:23):
And speaking of AI , just putting in a plug here we
have our AJVR ArtificialIntelligence Supplemental Issue
coming out in March of this year, so very exciting for that.
So be on the lookout.
Jennifer Granick (11:33):
I'm looking forward to that.
That's cool.
Sarah Wright (11:35):
Yeah, yeah, no, it should be awesome.
And for those of you justjoining us, we're discussing how
the measurement of antibioticuse in cats and dogs, presenting
to you as primary care andreferral practices, provides
insights for antimicrobialstewardship.
With our guest Jennifer.
Lisa Fortier (11:49):
Jennifer, how does your training in previous work
prepare you to write thisarticle?
Jennifer Granick (11:53):
Well, I think that's just as a group are
really well trained in onehealth.
So I think for me, just myveterinary training made it
pretty natural to look formethodology for data collection
used on the human health careside and see how it could be
adapted for vet med.
And then we've done a number ofthese what we call point
(12:18):
prevalence surveys, to collectthis data.
So we tried it out in our ownteaching hospital.
We did it every month for ayear and got some really cool
insights into what we were doingand how we could, you know,
change our practices.
And then we expanded that nextto practices in Minnesota, north
Dakota and then in academicteaching hospitals across the US
.
So this was the biggest studythat we had done at that point,
(12:44):
but we had a lot of practice.
We refined our methods.
So that just makes perfect, Iguess.
Well, it makes better.
I don't know what perfectionreally looks like yet.
Sarah Wright (12:55):
I was a literally just about to say that.
Lisa Fortier (12:57):
I'm from North Dakota.
Jennifer, I don't hear too muchMinnesota in your accent.
Jennifer Granick (13:01):
Oh, no, I was born in Philly, yeah, but I'm a
Midwesterner at heart, so Iwould never go back.
I've been here, I think, longerthan I ever lived on the East
Coast.
Lisa Fortier (13:13):
Very good.
Sarah Wright (13:14):
Midwest is best, I have to say.
So, Jennifer, this next set ofquestions is going to be really
important for our listeners.
We're going to try to boil allthis great information that you
shared with us today down tolike one important point.
So what is one piece ofinformation the veterinarian
should know about antimicrobialstewardship in small animal
primary care and referralpractices?
Jennifer Granick (13:36):
Yeah.
So, I think this idea ofantimicrobial stewardship kind
of feels like this big idea andmaybe not something that is
accessible.
But honestly, improvingprescribing which is one of the
goals of antimicrobialstewardship can start with like
one little action.
So I think that's an importantthing to remember.
(13:56):
So, pick, you know, picking acommon condition, checking out
prescribing guidelines andmaking one small change like
treating lower urinary tractinfections for three days
instead of 10, can make a reallybig impact.
And once you have that underyour belt, you can look to the
next thing.
But I think just taking smallsteps towards improving
prescribing is the biggesttake-home message.
Sarah Wright (14:28):
Speaking of UCIs, we actually had a really cool
article published in asubsequent podcast episode where
we interviewed the authorsabout in-house urine cultures to
see how feasible that was andhow practical.
So definitely some cool stuff,a spectrum of care happening in
the antimicrobial stewardshipworld.
So, on the other side of therelationship, what's one thing
clients should know about thistopic?
Jennifer Granick (14:45):
I think clients know antibiotics are
life-saving, but what they needto know is that's only true if
they still work, and I think weprobably don't talk about some
of these undesirable sideeffects.
So in clients, you know, what Iwould encourage for clients is
to advocate for usingantibiotics, but only when
they're needed.
Lisa Fortier (15:06):
Yeah, very well said.
Thanks again, Jennifer.
I learned a ton and it's alwaysgood food for thought.
I love your idea of startingsmall.
Just pick one thing becauseyou're right, it sounds very
esoteric, academic to thinkabout, and the word stewardship,
yeah.
So, thank you for distilling itdown for me and hopefully a lot
of our listeners.
As we close, we'd like to ask afun fact and for you, we'd like
(15:32):
to know what is Jennifer'sfavorite animal fact?
Jennifer Granick (15:37):
Well, I love octopuses or octopi I'm not sure
what the correct plural is butthey have three hearts.
But what I didn't know is thatthey have nine brains.
They have a central brain and abrain for each arm.
I think that is amazing.
So that's my fun animal fact.
Sarah Wright (15:55):
So, I think what Lisa and I have learned because
he was laughing, so she knows isthat the octopus fascinates
veterinarians.
I'm not kidding, Jennifer.
I think almost everyone hasanswered this question with a
fact about octopus.
Lisa Fortier (16:22):
But different facts.
The ophthalmologist answeredabout that.
They have a little perforationin their anterior chamber.
Somebody else said the threehearts, you added nine brains.
The octopus is fascinating.
Jennifer Granick (16:27):
Yeah, it really is.
I'm a sucker for those naturedocumentaries that focus on
octopuses.
They're so cool.
Sarah Wright (16:30):
Double pods are cool.
Well, thank you again, Jennifer, for being here today, for
sharing your manuscript withJAVMA and just for sharing the
information, too, with ourlisteners on our podcast.
Jennifer Granick (16:39):
Yeah, thanks a lot for having me.
Sarah Wright (16:41):
It was fun to share a little bit more about
the study and to our listeners,you can read Jennifer's article
in JAVMA.
I'm Sarah Wright with LisaFortier.
Be on the lookout for nextweek's episode and don't forget
to leave us a rating and reviewon Apple Podcasts or whatever
platform you listen to.
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