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Skip to 0 minutes and 7 seconds We are still thinking about MRSA and MRSP as a complicating pathogen for our dogs with pyoderma. But because the skin is actually an organ that we’ve got right under our hands and our eyes, there are quite a few opportunities for good antimicrobial stewardship. So the first thing is, is it actually a bacterial problem? You want to confirm that this is a pyoderma, rule out potential differential diagnosis. Here on the left, you can see a dog suffering from pemphigus foliaceus. So this dog needs steroids rather than antibiotics. And then, what is the primary cause of the lesion?

Skip to 0 minutes and 49 seconds Because pyoderma can literally complicate any break in the skin barrier, and we need to find out what the primary cause is in order to stop recurrences. And cytology from the surface or from lesional skin is really the way forward here. It is a tool that’s underused in practice at the moment, and this is one of the main things that I want to emphasise today. You can do it in-house. It’s quick, it’s cheap. All you need is some Diff-Quick stain, a sellotape, and some slides and a microscope.

Skip to 1 minute and 23 seconds And tape strip the lesion– for example, here, in the dog’s skin nasal fold– and it will tell you whether there are cocci in and amongst neutrophils, confirming pyoderma, or maybe Malassezia being involved, in which case antibiotics are not going to be crowned with success. And the second major opportunity for good antimicrobial stewardship is, we need to focus on topical therapy, because it has been shown that topical antibacterial therapy can actually be effective on its own. Chlorhexidine products come in all sorts of shapes and forms– foams, shampoos, sprays. And there is evidence now that they can be effective for superficial pyoderma and surface pyoderma on their own. And efficacy has also been shown if the infection involves multidrug-resistant MRSP.

Skip to 2 minutes and 21 seconds And obviously, there is always a worry– if we don’t give antibiotics, could things go wrong? And it’s then difficult to justify not using systemic antibiotics. But there is now a good consensus published by FECAVA in their online poster on responsible use of antimicrobials where actually conditions likely to respond to antiseptics or topical agents are listed in this little blue box. And they include surface and superficial pyoderma and various other dermatological conditions. But there will be cases when antimicrobials are indicated. And then we need to treat our animals suffering, for example, from deep pyoderma. And the general rules of responsible use of antimicrobials apply.

Skip to 3 minutes and 8 seconds But what is important for skin is that, always use them at the higher end of the recommended dose range because of the lower blood profusion of the skin. Guidelines are available for bacterial foliculitis, for deeper pyoderma as well, and specifically for methicillin-resistant staphylococcal infections. But what we have to consider also, if MRSP and MRSA are involved, is infection control. Staphylococci can survive for over 12 months on dry surfaces, and hand hygiene has been shown to be the single most effective control measure. We do know that MRSA in hospitals was mainly transmitted by hand contact. And actually, these infection control measures go back to Semmelweis, and Florence Nightingale, and Lister– the pictures on the top here.

Skip to 3 minutes and 58 seconds So there is no modern magic involved. It’s all down to actually compliance– doing it– rather than magical products. But there are some newer guidance or posters online to increase participation.

Skip to 4 minutes and 17 seconds And what is important with regard to prudent use of antimicrobials is we want to prevent those relapses, and we want to prevent wrong antibiotic use. This dog here, with quite extensive and severe deep pyoderma, needed an acaricide for its dermatomycosis, rather than an antibiotic for its multidrug-resistant staphylococcus. Then other primary causes to consider, that we seek often in the clinic are underlying allergies, endocrinopathies, occasionally neoplasia. And the key here is that we need to resolve the bacterial infection first, and then re-examine the dog and address the underlying problems. So in the case of itchiness remaining and erythema remaining, ecotoparasites and allergy workup would be indicated.

Skip to 5 minutes and 6 seconds And often, the topical use of glucocorticoids– or even oral prednisolone at the lowest necessary dose on alternate days– would be preferable for long-term control of these dogs, compared to repeated use of antimicrobials. So the top tips to take home– we need accurate diagnosis. Not every crust is a pyoderma. In-house cytology is currently under use, so try to make use of it more often. It’s incredibly helpful to confirm bacterial infection. The focus for treatment should be, nowadays, topical therapy for all these surface and superficial pyodermas. But for deep pyodermas, obviously, where systemic antimicrobial use is indicated, culture-based prescribing, following guidelines are vital. And then rigorous hygiene measures, as soon as you’ve got MRSA or MRSP are involved, and owner education.

Skip to 6 minutes and 6 seconds And to me, the most important thing in preventing inappropriate use of antimicrobials is actually focusing on the underlying causes and correcting those so that we can prevent this roller-coaster scenario of recurrent pyoderma. All right, thank you very much.

MRSP, MRSA and Pyoderma

We have not yet looked at solutions to the challenges involved in multiple drug resistance in companion animal practice. Step 1.13 introduced the barriers to achieving AMS in canine pyoderma with MRSA and MRSP. In this video, Anette Loeffler explores how AMS can be implemented in cases of canines with complicated pyodermas and MRSA or MRSP infections.

Establishing an accurate diagnosis using appropriate testing is vital. When MRSA and MRSP are involved, infection control and hand hygiene are also really important to prevent transmission and spread of infection.

Watch the video to gain a better understanding of how to deal with canine pyodermas and multiple drug resistance. It is a scenario that is becoming increasing prevalent due to the rise of antimicrobial resistance. In the comments section, discuss how you can use the ideas in the video in your own practice.

Please find a downloadable copy of the PowerPoint slides used in the video in the downloads section below.

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Antimicrobial Stewardship in Veterinary Practice


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