Antimicrobial prophylaxis in canine surgery

In 1961, Burke showed that antibiotics affect primary wound infections favourably only if they are administered before or shortly after bacterial contamination. The effect is optimal if there is already an effective tissue concentration at the time of contamination. During surgery the animal's resistance is strongly reduced, and consequently an infection may be caused by an inoculum present in a rather low concentration, at least lower than in normal circumstances. This reduced resistance lasts until only a few hours after operation. Prophylactic use of antibiotics therefore needs to be continued only for a short time after the final stage of the operation. A great number of clinical trials in human surgery have shown that short term peri-operative prophylactic use of antibiotics causes a reduction in the incidence of post-operative septic complications, in certain categories of operations and in selected groups of patients. Until properly designed, prospective, randomized and controlled clinical trials have been done in small animal clinics, it seems sensible to apply the abundant results from research with experimental animals and from clinical trials in human medicine to small animal surgery. Prophylactic use of antibiotics is indicated if the infection risks or dangers of possible complications are greater than the disadvantages of regular use of antibiotics. The risk factors in the development of wound infections and the choice of antibiotics are discussed.     

Wound contamination and antimicrobial susceptibility of bacteria cultured during total ear canal ablation and lateral bulla osteotomy in dogs.

OBJECTIVE: To detect contamination of wound sites from surgical handling of excised tissues during total ear canal ablation and lateral bulla osteotomy in dogs, and to compare susceptibility of bacterial isolates to cefazolin with susceptibility to other antimicrobial agents. DESIGN: Prospective clinical study. ANIMALS: 13 dogs. PROCEDURE: Dogs were treated surgically for otitis externa and media via total ear canal ablation and lateral bulla osteotomy. Specimens for aerobic bacterial culture were obtained from SC tissue immediately following skin incision, tissues excised from the osseous bulla (after transection of the horizontal ear canal and lateral bulla osteotomy), and from SC tissue prior to skin closure. Antimicrobial susceptibility of bacterial isolates to various antibiotics was determined by use of a broth dilution assay. RESULTS: There was a significant association between isolation of Streptococcus canis and Escherichia coli from specimens from the osseous bulla and specimens from the SC tissues prior to skin closure, indicating contamination of the SC tissues during surgery. Seventy percent of bacterial isolates were susceptible to cefazolin. CLINICAL IMPLICATIONS: Measures to limit bacterial contamination resulting from tissue handling during total ear canal ablation and lateral bulla osteotomy are necessary. Bacteriologic culture of tissue of the osseous bulla and determination of antimicrobial susceptibility are recommended. Administration of cefazolin alone may not be efficacious for antimicrobial prophylaxis.     

Antimicrobial use in the surgical patient.

Antimicrobials are often used in the surgical patient in an effort to prevent infection (prophylactic) or to treat established infection (therapeutic). To be effective, prophylactic antimicrobials at appropriate concentrations must be present in tissues at the surgical site at the time of contamination to prevent bacterial growth and subsequent infection. Therapeutic antimicrobials are used to treat established localized or systemic infection. Selection of antimicrobial agents for prophylactic or therapeutic use should be based on knowledge of expected flora, ability of the antimicrobial to reach the target tissue at appropriate concentrations, bacterial resistance patterns, drug pharmacokinetics, and culture and susceptibility testing results (therapeutic use). Failure of antimicrobial therapy to prevent or treat infection in the surgical patient may result from poor antimicrobial selection, inappropriate dosage or frequency, or inappropriate duration of therapy.     

The importance of the nonlactating period in the epidemiology of intramammary infection and strategies for prevention.

The dry period is a high risk period for the acquisition of new environmental IMIs, with over 60% of new IMIs occurring at this time. It also offers an ideal opportunity to improve udder health, through the judicious use of antibiotics to treat high SCC cows.The prophylactic use of antibiotics in food producing animals is increasingly being called into question; DCT is the primary example of such antibiotic use in the dairy cow. A holistic approach to management of the dry cow is a vital part of mastitis control, and should encompass environmental and nutritional management as well as the blanket use of therapeutic and prophylactic medicinal products. In high SCC cows, it is important to select cows appropriate for treatment (as opposed to culling), and there is a good clinical justification for the use of antibiotics to treat existing IMIs. In low SCC cows, teat sealants provide a viable alternative to antibiotic DCT, and careful consideration should be given to their use.     

Bacterial contamination of suction tips used during surgical procedures performed on dogs and cats

OBJECTIVE: To determine prevalence of bacterial contamination of surgical suction tips. SAMPLE POPULATION: Surgical tips used during 44 surgical procedures performed on 42 dogs and 2 cats. PROCEDURE: Surgical procedures were classified into 1 of 3 categories according to degree of bacterial contamination of the surgical site (clean, clean-contaminated, contaminated). Two sets of suction apparatuses were used for test and control suction tips. Test tips were used normally to suction blood and fluid, whereas control tips were placed on the surgical drapes but not in the surgical wound. Suction tips were collected aseptically and placed into thioglycolate broth tubes for qualitative aerobic and anaerobic bacterial culture at the end of each procedure. RESULTS: Test and control suction tips were contaminated with bacteria during 30 of 44 (68%) procedures. Staphylococcus spp were the predominant bacteria in tips used during clean and clean-contaminated surgeries. When surgery was performed on clean-contaminated or contaminated wounds, prevalence of isolation of other bacteria such as Pseudomonas spp, Streptococcus spp, and Escherichia coli from both test and control suction tips was higher than for clean wounds. Mean time of procedures during which both test and control suction tips became contaminated was not significantly different from time of procedures during which neither tip became contaminated. CONCLUSION AND CLINICAL RELEVANCE: Surgical suction tips often become contaminated during standard veterinary surgical procedures. The risk of wound infection after surgery may be influenced by bacterial contamination of surgical suction tips.     

Efficacy of Adhesive Incise Drapes in Preventing Bacterial Contamination of Clean Canine Surgical Wounds

Objective— To investigate the efficacy of adhesive incise drapes in reducing bacterial contamination of clean canine surgical wounds.
Study Design— Randomized clinical trial.
Animals— Dogs (n=100) having elective ovariohysterectomy or stifle surgery.
Methods— Dogs were randomly assigned to 1 of 2 groups: drape or no drape. Swabs obtained from the inner edge of the surgical wound at the beginning (swab 1) and end (swab 2) of surgery were submitted for microbial culture. Number of colony forming units was counted for all positive cultures and change in bacterial counts between swabs 1 and 2 was calculated. Percentage adhesive drape adherence at the end of surgery was calculated from a digital photograph of the surgical site. Duration of surgery/anesthesia and the anesthetic induction agent used were recorded.
Results— There was a significant increase in bacterial counts between swabs 1 and 2 ( P =.001). Wound contamination was 14% (6 drape; 8 no drape; P =0.78) with Staphylococcus spp. most commonly isolated. Median percentage drape adherence at the end of surgery was 89.3% (0–100%). Duration of anesthesia was significantly related to wound contamination ( P =.013), but duration of surgery and anesthesia induction agent were not.
Conclusions— Adhesive incise drapes did not reduce wound contamination of clean canine surgical wounds.
Clinical Relevance— Use of adhesive incise drapes in clean surgical procedures is of questionable benefit in dogs.     

Evaluation of the efficacy of a peroxygen disinfectant-filled footmat for reduction of bacterial load on footwear in a large animal hospital setting

OBJECTIVE-To compare the efficacy of a peroxygenbased disinfectant used in footbaths with the efficacy of the same disinfectant used in footmats for reducing bacterial contamination of footwear in a large animal hospital. DESIGN-Prospective study. SAMPLE POPULATION-Bacteria recovered from the soles of rubber boots after experimental microbial contamination and exposure to disinfectant solutions or water (water-treated control boots) or no treatment (untreated control boots). PROCEDURES-Investigators contaminated boots by walking through soiled animal bedding. Swab samples were collected from the sole of 1 untreated boot (right or left); the other boot was treated as investigators stepped through a disinfectant-filled footbath, a disinfectant-filled footmat, or water-filled footmat. Samples were collected 10 minutes after each treatment. Differences in numbers of bacteria recovered from treated and untreated boots were analyzed. RESULTS-Mean bacterial counts from peroxygentreated boots were 1.3 to 1.4 log(10) lower (95.4% to 99.8%) than the counts from untreated boots. Results were similar for footmat- and footbath-treated boots. In contrast, there were no statistically detectable differences in mean bacterial counts in samples collected from water-treated or untreated boots. CONCLUSIONS AND CLINICAL RELEVANCE-Results suggest that footmats and footbaths containing peroxygenbased disinfectant are effective in reducing bacterial contamination on the soles of boots when used in conditions representative of large animal hospitals. Similar results were achieved with use of either footmats or footbaths. The use of footbaths and footmats containing effective disinfectants may help decrease the risk for spread of nosocomial infection but should not be expected to sterilize footwear.     

Meta-analysis of field trials of antimicrobial mass medication for prophylaxis of bovine respiratory disease in feedlot cattle

One hundred and seven field trials of prophylactic mass medication for bovine respiratory disease (BRD) in feedlot cattle were reviewed. Meta-analysis is the formal quantitative statistical review process that was used to synthesize the data from randomized field trials and draw conclusions concerning the efficacy of prophylactic mass medication in feedlot calves.

The results of the meta-analysis indicated that prophylactic parenteral mass medication of calves with long-acting oxytetracycline or tilmicosin on arrival at the feedlot would reduce BRD morbidity rates (p < 0.001). There were, however, unreliable data on the effects of mass medication on mortality rates and performance, insufficient data on the most effective treatment regimes, and no valid data on the efficacy of feed and water medication for prophylaxis of BRD.

This review highlights the gaps in our knowledge and points out the need for additional well-designed randomized controlled field trials of adequate size to assess the efficacy and socioeconomic impact of prophylactic mass medication for BRD in feedlot cattle.

     

Epidemiologic evaluation of postoperative wound infection in clean-contaminated wounds: A retrospective study of 239 dogs and cats

OBJECTIVE: To evaluate risk factors for development of postoperative wound infections in clean-contaminated wounds. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: Two hundred thirty-nine dogs and cats that had clean-contaminated surgical procedures. METHODS: Records of animals that had a clean-contaminated surgical procedure and were prospectively monitored for development of postoperative wound infection were reviewed. Prospective data included signalment, nutritional status, body weight, duration of surgery, surgical procedures, wound classification, surgical site clip time before surgery, hypotension during surgery, the presence of an active distant infection, endocrinopathy, administration of an immunosuppressive agent, administration of antibiotics, and the type of antibiotic used. Additional retrieved data included total anesthesia time, temperature variables, blood loss, and suture material used. RESULTS: Intact males (P =.008) and animals with concurrent endocrinopathy (P =.008) were at a higher risk of development of postoperative wound infection. Total surgery time (P =.02) and total anesthesia time (P =.04) were longer in animals that developed postoperative wound infection. No other factors were statistically significant. CONCLUSIONS: Intact males and animals with a concurrent endocrinopathy were at higher risk of postoperative wound infection after clean-contaminated surgical procedures. CLINICAL RELEVANCE: Time under anesthesia and duration of surgery should be minimized to reduce the risk of wound infection in clean-contaminated surgical procedures.     

Swine diseases transmissible with artificial insemination

The transport of fresh and frozen semen to be used for artificial insemination creates a mode of disease transmission between farms. Normally, semen contains a number of nonpathogenic bacterial contaminants; however, excessive bacterial contamination can result in infertile matings. Contamination with a known pathogen, eg, Brucella suis, could initiate a serious outbreak of disease in a recipient herd. Methods to minimize bacterial contamination of semen include sanitary collecting and processing of semen, isolation of boards from certain pathogens, and the addition of appropriate broad spectrum or combination antibiotics to the semen. Mycoplasmas also have been isolated from semen, although transmission by this route is unlikely. The addition of an appropriate antimycoplasmal antibiotic to semen may be warranted in some situations. Numerous viruses have been detected in semen. Their exclusion from semen is especially critical because of their ability to survive in frozen semen. These viruses include pseudorabies virus, porcine parvovirus, enterovirus, adenovirus, vesicular disease virus, and African swine fever virus. The likelihood of disease transmission is greater with the introduction of a boar into a herd than through the use of fresh or frozen semen. We believe that artificial insemination allows for the introduction of new genetics into a breeding program, with minimal risk of disease transmission.     

Fractures of the mandible and maxilla.

External fixation is an effective method for stabilization of many mandibular fractures. Thorough physical examination and patient stabilization should be instituted before attending to the fractures and associated soft tissue trauma. Normal occlusion rather than perfect reduction is the goal of oral fracture repair. Loose teeth or teeth in the fracture should be removed, as should any avascular bone fragments. Soft tissue wounds should be treated as for any contaminated wound. Mucosal wounds are allowed to heal by second intention. Although prophylactic perioperative antibiotics are indicated, they are usually not needed postoperatively. The three basic types of external fixators described include the Kirschner-Ehmer splint, pins or screws and acrylic, and the biphase splint. All three types are relatively easy to apply, and the principles of their application are similar. A minimum of two pins or screws are placed percutaneously in each fragment, avoiding the mandibular canal. The Kirschner-Ehmer splint is more easily adjustable than the biphase splint or the pin-acrylic splint, which use acrylic connecting bars. The advantages of fixators that use acrylic bars are that the pins or screws need not all be in the same plane and that they are more lightweight than the Kirschner-Ehmer splint. The disadvantages of the biphase splint are its increased expense and its use being limited to larger dogs. External fixators are well tolerated by the animals, and postoperative care is minimal. Mandibular fractures are usually healed in 3 to 5 weeks, and the fixators can be removed with the animal under sedation.     

Nosocomial infections.

Nosocomial infections and antimicrobial resistance are topics that have been intensely studied in human medicine because of their significant impact on human health. In recent years, concerns have been raised that the use of antibiotics in veterinary medicine, animal husbandry, and agriculture may be contributing to the development of resistance in common bacterial species affecting human beings. Although there is inadequate proof at this time that the resistance is transmitted from animals to people, if antibiotics continue to be used indiscriminately in veterinary medicine, veterinarians may find themselves facing regulations restricting the use of some antibiotics. Nosocomial infections have been reported in veterinary medicine and are likely to increase in prevalence with the increase in intensive care practices in many hospitals. Prolonged hospitalization and the use of invasive devices and procedures increase the risk of nosocomial disease. As in human medicine, organisms isolated in the nosocomial infections reported in veterinary patients have an increasingly broad spectrum of antimicrobial resistance. Despite these findings, the use of empiric and prophylactic antibiotic therapy is still widespread in veterinary medicine. Nosocomial infections and antimicrobial resistance may have a serious impact on the future of [table: see text] veterinary medicine, because the cost and ability to treat our patients may be affected by the loss of access to or effectiveness of antimicrobial drugs. Despite the millions of dollars spent on research to reduce the incidence of nosocomial infections in human patients, the strategies that have consistently proven successful are simple and inexpensive to implement. The most important factor in preventing nosocomial infections is improving the hygiene practices of health care providers. Hand-washing or the use of disposable gloves can dramatically reduce the transmission of bacteria between patients. Aseptic technique should be used in the placement and management of all invasive devices. All staff members should be educated on the risks and symptoms associated with nosocomial infections so that cases can be detected early and treated appropriately. We in the veterinary profession have the opportunity to learn from the experiences of the human medical profession and can take steps to prevent the escalation of nosocomial infections and their impact on our profession.     

The prevalence of subclinical gastroduodenal ulceration in Dachshunds with intervertebral disc prolapse

Endoscopy was used to determine the prevalence of subclinical gastroduodenal ulceration in 30 Dachshunds undergoing decompressive surgery for acute intervertebral disc prolapse. The endoscopy was performed on the day of admission and on the 3rd or 4th day after surgery. Three regions of the stomach (cardia, corpus and pylorus) and the proximal duodenum were visually inspected and biopsy samples were taken for histopathology. The combination of visual and microscopic changes were then used to determine the prevalence of subclinical gastroduodenal ulceration in this population. An overall prevalence of 76% was calculated from these findings. Ulcerogenic medication administered prior to admission did not appear to influence the prevalence. This result identifies a need for veterinarians to be aware of this potentially severe complication and warrants the use of prophylactic anti-ulcer medication in spinal surgery patients.     

Modeling the relationship between food animal health and human foodborne illness

To achieve further reductions in foodborne illness levels in humans, effective pre-harvest interventions are needed. The health status of food animals that are destined to enter the human food supply chain may be an important, although often overlooked, factor in predicting the risk of human foodborne infections. The health status of food animals can potentially influence foodborne pathogen levels in three ways. First, diseased animals may shed higher levels of foodborne pathogens. Second, animals that require further handling in the processing plant to remove affected parts may lead to increased microbial contamination and cross-contamination. Finally, certain animal illnesses may lead to a higher probability of mistakes in the processing plant, such as gastrointestinal ruptures, which would lead to increased microbial contamination and cross-contamination. Consequently, interventions that reduce the incidence of food animal illnesses might also help reduce bacterial contamination on meat, thereby reducing human illness. Some of these interventions, however, might also present a risk to human health. For example, the use of antibiotics in food animals can reduce rates of animal illness but can also select for antibiotic-resistant bacteria which can threaten human treatment options. In this study, we present a mathematical model to evaluate human health risks from foodborne pathogens associated with changes in animal illness. The model is designed so that potential human health risks and benefits from interventions such as the continued use of antibiotics in animal agriculture can be evaluated simultaneously. We applied the model to a hypothetical example of Campylobacter from chicken. In general, the model suggests that very minor perturbations in microbial loads on meat products could have relatively large impacts on human health, and consequently, small improvements in food animal health might result in significant reductions in human illness.     

Antibiotic prophylaxis in veterinary cancer chemotherapy: A review and recommendations

Bacterial infection following cancer chemotherapy‐induced neutropenia is a serious cause of morbidity and mortality in human and veterinary patients. Antimicrobial prophylaxis is controversial in the human oncology field, as any decreased incidence in bacterial infections is countered by patient adverse effects and increased antimicrobial resistance. Comprehensive guidelines exist to aid human oncologists in prescribing antimicrobial prophylaxis but similar recommendations are not available in veterinary literature. As the veterinarian's role in antimicrobial stewardship is increasingly emphasized, it is vital that veterinary oncologists implement appropriate antimicrobial use. By considering the available human and veterinary literature we present an overview of current clinical practices and are able to suggest recommendations for prophylactic antimicrobial use in veterinary cancer chemotherapy patients.     

Evaluation of the efficacy of disinfectant footbaths as used in veterinary hospitals

OBJECTIVE: To evaluate efficacy of 2 disinfectants as used in footbaths in veterinary hospitals for reducing bacterial contamination of footwear. DESIGN: Prospective study. SAMPLE POPULATION: Bacteria collected from the soles of rubber boots after experimental contamination and exposure to disinfectant solutions or control conditions. PROCEDURES: Investigators contaminated boots by walking through soiled straw animal bedding. Swab samples were collected from the sole of 1 boot (right or left) without treatment. The other boot was briefly immersed in a disinfectant solution (either a quaternary ammonium compound [QAC] or a peroxygen compound) or water, and samples were collected after 7 minutes. Differences associated with the experimental treatments were analyzed statistically. Veterinary teaching hospitals (VTHs) in the United States and Canada were contacted to obtain information about the use of footbaths. RESULTS: Mean bacterial concentrations from peroxygen-treated boots were 67% to 78% lower, compared with samples taken from untreated boots. In contrast, there were no statistically detectable differences in mean bacterial concentrations in samples taken from QAC- or water-treated boots, compared with control boots. Disinfectant footbaths were reportedly used in 30 of 31 VTHs. CONCLUSIONS AND CLINICAL RELEVANCE: Disinfectant solution containing peroxygen applied in a footbath reduced bacterial concentrations on rubber boots under conditions representative of those found in VTHs. Footbaths are commonly used as a method to control infectious diseases in veterinary hospitals. Disinfectant footbaths should not be expected to sterilize footwear, but they may help in reducing the risk for nosocomial infection when used with effective disinfectants.     

Mupirocin, fusidic acid and bacitracin: activity, action and clinical uses of three topical antibiotics

Antibiotics applied to the skin must be formulated in a base that is nonirritant and nontoxic. They may have a narrow or fairly wide spectrum of activity but should produce no local reaction or sensitization; the commensal flora should not be affected unduly. Three antibiotics that have been used topically in humans and animals are fusidic acid, mupirocin and bacitracin, all of which have a narrow antibacterial spectrum. When applied to intact skin, fusidic acid penetrates more rapidly than other antibiotics. Clinically, the frequency of staphylococcal resistance to it and to mupirocin has remained low. Fusidic acid and mupirocin have been recommended for the treatment of acute staphylococcal skin lesions. However, the use of topical antibiotics for the treatment of chronic or recurring dermatitis and surgical or infected wounds may be inappropriate because of possible development of resistance and sensitization. Topical use of bacitracin may produce treatment failure and sensitization.     

Bacterial isolates and antimicrobial susceptibilities in equine bacterial ulcerative keratitis (1993--2004)

REASONS FOR PERFORMING STUDY: Bacterial ulcerative keratitis is a common and often vision-threatening problem in horses. Emerging bacterial resistance to commonly used topical antibiotics has been demonstrated. Previous antibiotic use may alter the antimicrobial susceptibility of bacterial isolates. OBJECTIVES: To document aerobic bacterial isolates and associated bacterial susceptibilities from horses with ulcerative keratitis treated at the University of Tennessee between January 1993 and May 2004 and determine whether prior antibiotic therapy affected antimicrobial susceptibility of the isolates. METHODS: Medical records from horses with ulcerative keratitis and positive aerobic bacterial cultures and antimicrobial susceptibility were evaluated. Clinical history regarding antibiotic therapy prior to culture was documented. RESULTS: Fifty-one aerobic bacterial isolates from 43 horses were identified. Streptococcus equi subspecies zooepidemicus was the most commonly isolated organism, accounting for 33.3% of all isolates, followed by Pseudomonas aeruginosa (11.8%), Staphylococcus spp. (11.8%) and Gram-negative nonfermenting rods (7.8 %). No resistance was noted amongst S. equi ssp. zooepidemicus to cephalothin, chloramphenicol or ciprofloxacin. Only 64 % of S. equi ssp. zooepidemicus isolates were sensitive to bacitracin. No resistance was noted among P. aeruginosa to gentamicin, tobramycin or ciprofloxacin. Antibiotic therapy with neomycin-polymixin B-bacitracin prior to presentation and culture was documented in 11/17 horses in which S. equi ssp. zooepidemicus was isolated and in 4/6 horses in which P. aeruginosa was isolated. Three horses received topical corticosteroids prior to culture, of which 2 had polymicrobial infections. CONCLUSIONS: S. equi ssp. zooepidemicus and P. aeruginosa were the most frequently isolated bacterial organisms in equine ulcerative keratitis. No significant trends in aminoglycoside or fluoroquinolone resistance were noted among these organisms. However, the resistance of S. equi ssp. zooepidemicus to bacitracin with common use of this antibiotic suggests that previous antibiotic therapy probably affects antimicrobial resistance. POTENTIAL RELEVANCE: Therapy prior to culture may play an important role in antimicrobial susceptibility of corneal bacterial isolates. Corticosteroid use may increase the risk of polymicrobial infections of corneal ulcers, leading to a worse prognosis. Although significant fluoroquinolone resistance has not been documented in the veterinary literature, these antimicrobials should be reserved for known infected corneal ulcers and not used for prophylaxis. Empirical antibiotic therapy should not only be guided by clinical signs, but also take into consideration previous antimicrobial and corticosteroid therapy.     

Stakeholder position paper: dairy producer

Bacterial antimicrobial resistance is a problem common to both animal and public health. An important public policy issue is to develop and implement prudent use practices where antimicrobials are used. As policy develops, there are questions regarding the use of antimicrobials in animal agriculture and whether these uses constitute prudent use. A series of papers assessing the risk to the public health from agricultural use of antimicrobials have consistently concluded that risk estimation is hampered by the lack of data that describe the amount, types, and uses of antimicrobials in animal agriculture. The absence of information has spurred efforts to develop a framework to collect these data. However, the reasons and benefit of collecting these data should be carefully defined. The dairy industry, contrasted to other major animal commodities, is not focused on meat production but on milk production. Milk production is constrained by disease and antimicrobial treatment is a common management tool, but unlike many other animal agricultural systems where the value and safety of the product is measured in the future; the value of milk is zero when an antimicrobial is used in a lactating cow and milk must be discarded because of residues. While there are exceptions, e.g. non-lactating cow therapy, this difference results in antimicrobials being used sporadically and directed at therapy rather than prophylactic uses. In the dairy industry, antimicrobial use data and its consequences may exist in sufficient detail or could be estimated from existing datasets without the expense of additional surveys. Finally, the main food product milk is mainly pasteurized and all shipments of milk from the farm to the processing plant are tested for the presence of antimicrobials. This makes the likelihood of farm-origin antimicrobials or bacteria appearing in finished product very low. This suggests that the use and quantity of antimicrobials in the dairy system has little impact on public health. This does not imply that the dairy industry does not have a significant role in developing guidelines for appropriate and careful application of antimicrobials, but the effort and cost to collect additional data should be used to fund efforts that improve our diagnostic and managerial skills. These data would change the use of antimicrobials by decreasing the rates of disease and ultimately decreasing prophylactic, metaphylactic and therapeutic use of antimicrobial. These studies and outcome are as important to the dairy industry as to public health.