The growing problem of antimicrobial resistance affects veterinarians on a daily basis. Antimicrobial stewardship and responsible prescribing are essential for a future with effective antimicrobials, as it is unlikely that new antimicrobials will become available for use in horses in the near future. Extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA) and Salmonella spp. are pathogens of significant concern but there are also other opportunistic pathogens such as Pseudomonas spp., α-haemolytic Streptococcus spp., Enterococcus spp. and Acinetobacter spp. which, due to their high intrinsic resistance, have limited treatment options in adult horses. It is essential that highest priority critically important antimicrobials such as ceftiofur, enrofloxacin, rifampicin and polymyxin B are used prudently in horses and ideally based on culture and antimicrobial susceptibility testing (AST). For example, the use of polymyxin B at a low anti-endotoxic dose rather than at a higher antimicrobial dose in horses for the treatment of systemic inflammatory response syndrome is a potential driver for resistance to colistin (polymyxin E), an antimicrobial used as a last resort in the treatment of multidrug resistant (MDR) Enterobacteriaceae infections in humans. Serum procalcitonin levels are used in humans to distinguish noninfectious inflammatory conditions from inflammation caused by bacteria and other infectious agents and are also used to guide cessation of antimicrobial treatment. Although no such studies have been performed in horses, this or other markers may prove to be helpful in guiding antimicrobial treatment decisions in the future. Optimising sampling techniques and good communication with the microbiology laboratory are essential for generating the accurate culture and AST results that underpin appropriate antimicrobial use. Additionally, there is clearly a need for national and international harmonisation of laboratory methods in order to improve the reliability and consistency of results reported by different laboratories.

中文翻译：

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通过在马身上负责任地使用抗菌药物来改善临床结果

日益严重的抗菌素耐药性问题每天都在影响着兽医。抗菌药物管理和负责任的处方对于未来使用有效的抗菌药物至关重要，因为在不久的将来新的抗菌药物不太可能用于马匹。产超广谱 β-内酰胺酶 (ESBL)肠杆菌科细菌、耐甲氧西林金黄色葡萄球菌(MRSA) 和沙门氏菌属。是重要的病原体，但也有其他机会性病原体，如假单胞菌属、α-溶血性链球菌属、肠球菌属。和不动杆菌spp. 由于其高内在抵抗力，成年马的治疗选择有限。至关重要的是，在马身上谨慎使用头孢噻呋、恩诺沙星、利福平和多粘菌素 B 等最重要的抗菌药物，最好基于培养和抗菌药敏试验 (AST)。例如，在马中使用低抗内毒素剂量而不是较高抗微生物剂量的多粘菌素 B 来治疗全身性炎症反应综合征是对粘菌素（多粘菌素 E）耐药的潜在驱动因素，粘菌素 E 是一种用作抗内毒素的抗菌剂。治疗多重耐药（MDR）肠杆菌科细菌的最后手段人类感染。人体血清降钙素原水平用于区分非感染性炎症状况与由细菌和其他感染性因子引起的炎症，也用于指导停止抗菌治疗。虽然没有在马身上进行过这样的研究，但这种或其他标志物可能被证明有助于指导未来的抗菌治疗决策。优化采样技术和与微生物实验室的良好沟通对于产生准确的培养和 AST 结果以支持适当的抗菌药物使用至关重要。此外，为了提高不同实验室报告结果的可靠性和一致性，显然需要国家和国际实验室方法的统一。