Using informatics and the electronic medical record to describe antimicrobial use in the clinical management of diarrhea cases at 12 companion animal practices.

Herman Tse,R Michele Anholt,Carl S Ribble,Margaret L Russell,Craig Stephen,John Berezowski

doi:10.1371/journal.pone.0103190

Herman Tse, R Michele Anholt + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0103190

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Abstract

Antimicrobial drugs may be used to treat diarrheal illness in companion animals. It is important to monitor antimicrobial use to better understand trends and patterns in antimicrobial resistance. There is no monitoring of antimicrobial use in companion animals in Canada. To explore how the use of electronic medical records could contribute to the ongoing, systematic collection of antimicrobial use data in companion animals, anonymized electronic medical records were extracted from 12 participating companion animal practices and warehoused at the University of Calgary. We used the pre-diagnostic, clinical features of diarrhea as the case definition in this study. Using text-mining technologies, cases of diarrhea were described by each of the following variables: diagnostic laboratory tests performed, the etiological diagnosis and antimicrobial therapies. The ability of the text miner to accurately describe the cases for each of the variables was evaluated. It could not reliably classify cases in terms of diagnostic tests or etiological diagnosis; a manual review of a random sample of 500 diarrhea cases determined that 88/500 (17.6%) of the target cases underwent diagnostic testing of which 36/88 (40.9%) had an etiological diagnosis. Text mining, compared to a human reviewer, could accurately identify cases that had been treated with antimicrobials with high sensitivity (92%, 95% confidence interval, 88.1%–95.4%) and specificity (85%, 95% confidence interval, 80.2%–89.1%). Overall, 7400/15,928 (46.5%) of pets presenting with diarrhea were treated with antimicrobials. Some temporal trends and patterns of the antimicrobial use are described. The results from this study suggest that informatics and the electronic medical records could be useful for monitoring trends in antimicrobial use.

Highlights

Diarrhea is a common clinical presentation in companion animals [1]
It was not possible to improve the performance of the text miner to classify cases by the diagnostic test performed or their etiological diagnosis, so the text miner was not used for these purposes
Diagnostic testing, diagnoses and antimicrobial use As the text miner did not accurately classify cases that had laboratory testing performed or a diagnosis made, the results presented are from the manual review of the sample of 500 diarrhea positive cases only

Summary

Introduction

Diarrhea is a common clinical presentation in companion animals [1]. The pathophysiology of diarrhea is complex, poorly understood and can involve a wide array of infectious and noninfectious etiologies [2,3]. Clinicians must weigh the cost of diagnostic procedures, the owner’s willingness to pay for them and the time spent waiting for a result against the likelihood that the results of a diagnostic test will affect their therapeutic recommendations. This cost-benefit analysis often results in diarrhea in pets being managed by empirical therapy with antihelmintics and antimicrobials [4]. Warnings against indiscriminate AMU in animals are increasing because the consequences of AMU include antimicrobial resistance (AMR) with decreased efficacy of important antimicrobials against significant animal and human pathogens [7,8] In their closely shared environment, pets may be a source of antimicrobial resistant enteric bacteria or resistance genes for their owners [9,10,11]

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