When multiple studies report the same results, it gets more and more convincing that the findings are true. This is becoming the case with antibiotic use as a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) infections in dogs. Late last year, I wrote about a study of ours that identified prior antibiotic use as a risk factor in dogs for infections caused by MRSA versus those caused by methicillin-susceptible S. aureus. Recently, a similar study was published, with some similar results. This study (Magalhaes et al, Vet Res, 2010) compared dogs and cats and with MRSA infections to a group of dogs and cats with susceptible infections. They found that MRSA infections were associated with:

• the number of antimicrobial courses
• the number of days admitted to veterinary clinics
• having had surgical implants

Additionally, animals with MRSA infections more often had had contact with people that had been in hospital, but the difference was not statistically significant.

That’s two studies that identified antibiotic use as a risk factor for MRSA infection. It makes sense biologically, and it’s likely that antibiotic use is an important driving force for MRSA infection in pets (like it is in people).

How do we reduce the likelihood of MRSA infections? It’s pretty clear that reducing antibiotic use is a key factor. Antibiotics are important drugs and are certainly needed in many situations, but they’re also prone to overuse and misuse. Here are some things that can (and need to) be done:

• Only use antibiotics when necessary. Antibiotics are often used without evidence of a bacterial infection and in situations where bacterial infections are uncommon (e.g. urinary tract disease in cats, viral upper respiratory tract infections).
• Use logical and prudent peri-operative antibiotic regimens. Only use antibiotics for surgeries when there are actually needed, and only for as short a period of time as possible.
• Ensure that proper doses are given (and actually get into the animal). Unfortunately, underdosing (and overdosing) of antibiotics are not uncommon.
• Promote more research regarding effective antibiotic treatment regimens. We often use much longer courses of antibiotics in pets compared to people, in part because we have no research data telliing us whether we can use shorter treatment courses.

Another thing to consider is the fact that these studies looked at factors for methicillin-resistant versus methicillin-susceptible infections. Therefore, a dog had to have an infection to be included. While certain things are risk factors for MRSA versus susceptible infections, there are other factors that increase the chance of any infection, and reducing these will also help reduce the risk of MRSA (and other) infections (i.e. if your dog doesn’t get an infection in the first place, it won’t have an MRSA infection).  One very important factor is proper management of underlying skin diseases, such as controlling atopy, flea allergy dermatitis and food allergy. Proper wound care, good veterinary clinic infection control practices and myriad other factors probably also affect the risk of infection in general. Further, good general preventive medicine practices, including overall healthcare and proper nutrition, play a role by decreasing the pet’s susceptibility to infections.

Fighting antimicrobial resistance isn’t easy or clear cut. There is unlikely a single measures that will turn out to be the "magic bullet." To limit the impact of resistant bacteria, we need to take a multifaceted approach, and we need a lot more information to figure out what specific measures should be emphasized.