Jeffrey Scott Weese

Background: Apramycin is an aminoglycoside that is used in animals but has not been authorized for use in humans. However, interest has been raised about repurposing it for use in humans because of its activity against Gram negative pathogens. Objective: To systematically review and analyze data pertaining to apramycin resistance in bacteria isolated from humans and to identify knowledge gaps, to inform work evaluating the potential for re-purposing of apramycin for clinical use in humans. Methods: A systematic review and meta-analysis was performed. Results: The review identified 34 studies of apramycin susceptibility in humans. Pooled estimates for apramycin resistance were 6% (95% CI 1-12%) for E. coli, 1% (0-3%) for Acinetobacter spp, 3% (0-17%) for Enterobacter spp, 7% (2-15%) for Klebsiella spp, 4% (0-13%) for Pseudomonas and 0% (0-0%) for Salmonella spp. Conclusion: Despite nearly 50 years of apramycin use in animals, apramycin resistance was identified in bacteria of human origin but was rare, supporting the potential value of re-purposing this drug for use in humans and suggesting that there is limited spillover of resistance from veterinary and agricultural use of apramycin.

Canine Lyme borreliosis is commonly treated with a 28-day course of doxycycline, a regimen based on historical precedent rather than evidence. Most dogs exposed to Borrelia burgdorferi remain clinically normal despite seroconversion; of those that do develop clinical Lyme disease, the most common presentation is acute or recurrent shifting-leg lameness consistent with Lyme arthropathy. This Viewpoint proposes there is clinical equipoise to evaluate shorter durations of 10 days of doxycycline in dogs with uncomplicated Lyme arthropathy and outlines a prospective parallel-group randomized controlled trial to reassess treatment duration. Determining whether a shorter treatment course is clinically effective also has important implications for antimicrobial stewardship by minimizing unnecessary antimicrobial exposure and selection pressures for antimicrobial resistance.

Background. Antimicrobial resistance (AMR) poses a significant global health challenge, threatening the effectiveness of life-saving antimicrobial therapies, and requires a multifaceted approach for its mitigation. Methods. This article explores the One Health (OH) framework as a comprehensive strategy that integrates human, animal, and environmental health to combat AMR. Key aspects of antimicrobial stewardship across various sectors are analyzed, including hospital-based interventions, community initiatives, and veterinary practices. Environmental contributors, including antibiotic water and soil contamination, are addressed through mitigation strategies, such as advanced waste management technologies and sustainable agricultural practices. Wildlife's role in transmitting resistance is discussed, emphasizing the need for conservation efforts and environmental monitoring. This paper also reviews global success stories and collaborative programs, in Africa, Europe, and North America, illustrating the importance of integrated surveillance and policy harmonization. Results. Challenges to implementing the OH strategy, including regulatory discrepancies, communication barriers, and cultural resistance, are acknowledged. However, opportunities for progress, such as global partnerships, interdisciplinary education, and innovation, offer hope for mitigating AMR. The role of technological innovations, such as artificial intelligence, advanced data analysis, and cutting-edge antibiotic research, is explored, alongside the importance of vaccines in preventing infections with resistant pathogens. Conclusions. By fostering collaboration, promoting sustainable practices, and leveraging advanced technologies, the OH framework provides a pathway to address AMR and safeguard public, animal, and environmental health for future generations.

Fungal cystitis in dogs and cats presents a diagnostic and therapeutic challenge, with implications for antifungal stewardship in veterinary medicine. Unlike bacterial cystitis, diagnostic pathways for fungal infection are less well-defined, and antifungal therapy is often empirical. This article discusses key considerations for the diagnosis and management of fungal urinary tract infections, including the interpretation of urine cytology, the potential role and limitations of fungal culture, and the value of species-level identification and antifungal susceptibility testing. Clinical, laboratory, and pharmacokinetic factors that influence treatment decisions are highlighted, alongside the effect of confounding host and iatrogenic risk factors. The article also explores current gaps in evidence, variability in laboratory capabilities, and opportunities for strengthening antifungal stewardship in veterinary practice. Rather than providing prescriptive recommendations, this work aims to raise awareness, facilitate informed decision-making, and guide future research and consensus-building efforts to improve outcomes for animals while contributing to broader antifungal stewardship initiatives.

Objectives: Feline injection‐site sarcoma is a rare but serious adverse event associated with vaccination in cats. Published estimates of feline injection‐site sarcoma incidence vary widely, contributing to uncertainty in clinical decision‐making and incidence communication. Materials and Methods: We conducted a systematic review and meta‐analysis to estimate the incidence of feline injection‐site sarcoma following vaccination in cats and to assess the certainty of the evidence. MEDLINE ( via Ovid), CAB Abstracts and Web of Science were searched from database inception through January 2026 using terms related to cats, vaccination, sarcomas and adverse vaccine events. Eligible studies reported quantitative estimates of feline injection‐site sarcoma incidence, including incidence, incidence rate or measures of association. Two reviewers independently screened studies, extracted data and assessed study quality using the Joanna Briggs Institute checklist for prevalence studies. Incidence estimates were calculated using random‐effects meta‐analysis. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation framework. Results: Eight studies met inclusion criteria, representing 14,059,036 vaccinations and 411 reported feline injection‐site sarcoma cases. Study‐level incidence estimates ranged from near zero to substantially higher values per vaccination. The incidence was 8.8 feline injection‐site sarcoma cases per 100,000 vaccinations (95% CI 0.8 to 100.6), equivalent to approximately 1 feline injection‐site sarcoma per 10,000 vaccinations. Between‐study heterogeneity was very high ( I ² = 99.61%), reflecting differences in study design, surveillance systems and reporting methods. Subgroup analyses comparing studies conducted before and after 2000 found no significant difference in feline injection‐site sarcoma incidence; although lower incidence estimates were observed in later studies, suggesting that the introduction of non‐adjuvanted vaccines may have reduced feline injection‐site sarcoma incidence. Overall certainty of evidence was rated as very low due to high risk of bias and imprecision. Clinical Significance: Feline injection‐site sarcoma remains a rare adverse event associated with vaccination in cats. Current evidence supports a low absolute incidence and reinforces the importance of routine feline vaccination while underscoring the need for improved surveillance and higher quality epidemiologic studies.

Objectives: To identify and describe available evidence pertaining to the local and systemic infectious complications in dogs and cats that have undergone dental procedures and the impact of peri‐procedural antimicrobial prophylaxis. Materials and Methods: A systematic review was performed based on Preferred Reporting Items for Systematic Reviews and MetaAnalysis guidelines. Results: No studies clearly reported the incidence of sepsis or infective endocarditis data associated with dental procedures. The pooled prevalence of post‐dental procedure bacteraemia was 47% (95% confidence interval 23% to 74%). Two studies investigated both dogs undergoing dental procedures and controls. Neither showed a clear association of dental procedures and bacteraemia. Bacteraemia was not associated with any clinical consequences based on these data, but data were very limited, with a very low level of certainty of evidence. No studies evaluated the impact of peri‐procedural antimicrobial on endocarditis, sepsis or other infectious complications. Two relevant studies that used bacteraemia as the outcome were identified. Both studies were deemed to have some concerns of bias. Certainty of evidence was deemed to be very low. No data were available to assess the impact of post‐procedural antimicrobials on infectious complications. Clinical Significance: The evidence base to assess the incidence and risks of infectious complications after dental procedures and impact of antimicrobial prophylaxis in dogs and cats is severely limited. This highlights a major research gap for a common patient population and hampers development of evidence‐based guidelines for peri‐procedural antimicrobial administration in dogs and cats.

Background: Evidence guiding the optimal antibiotic duration for bacterial pneumonia in dogs and cats is limited, and recommended courses often exceed those used in human medicine. This review evaluated whether shorter systemic antibiotic courses are as effective as longer courses for the treatment of bacterial pneumonia in these species. Methods: This review was registered with the Open Science Framework ( https://osf.io/c5n24 ). MEDLINE, EMBASE, CAB Abstracts, and Scopus were searched from inception to April 2025, and reference lists were hand-searched. Eligible studies were randomized controlled trials or observational studies comparing different antibiotic durations in dogs or cats with suspected or confirmed bacterial pneumonia. Outcomes included clinical, microbiological, or radiographic resolution. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias tool for randomized trials and ROBINS-I for observational studies. Random-effects meta-analysis was performed. Results: 3 studies involving 74 dogs met the inclusion criteria; no eligible studies of cats were found. Two studies were randomized controlled trials, and 1 study was observational. Comparisons evaluated shorter (10 to 14 days) versus longer (21 to 28 days) antibiotic courses. Pooled analysis showed no significant difference in treatment success between shorter and longer durations (OR, 1.13; 95% CI, 0.28 to 4.56). Certainty of evidence was very low due to risk of bias, indirectness, and imprecision. Clinical Relevance: Shorter antibiotic courses may be as effective as longer courses for the treatment of canine bacterial pneumonia, but current evidence is insufficient. No data are available for feline pneumonia, highlighting a critical evidence gap. Well-designed trials are needed to inform veterinary guidelines and antimicrobial stewardship.

Background Apramycin is an aminoglycoside that is used in animals but has not been authorized for use in humans. However, interest has been raised about repurposing it for us in humans because of its activity against Gram negative pathogens. Objective To systematically review and analyze data pertaining to apramycin resistance in bacteria isolated from humans and to identify knowledge gaps, to inform work evaluating the potential for re-purposing of apramycin for clinical use in humans. Methods A systematic review and meta-analysis was performed. Results The review identified 34 studies of apramycin susceptibility in humans. Pooled estimates for apramycin resistance were 6% (95% CI 1-12%) for E. coli, 1% (0-3%) for Acinetobacter spp, 2% (0-5%) for Enterobacter spp, 7% (2-15%) for Klebsiella spp, 4% (0-13%) for Pseudomonas and 0% (0-0%) for Salmonella spp. Conclusion Despite nearly 50 years of apramycin use in animals, apramycin resistance was identified in bacteria of human origin but was rare, supporting the potential value of re-purposing this drug for use in humans and suggesting that there is limited spillover of resistance from veterinary and agricultural use of apramycin.

Objectives: To develop consensus‐based definitions for infectious urinary tract disease in dogs and cats. Materials and Methods: A modified Delphi approach was used to develop consensus on standard terminology and definitions. Results: Four rounds of review were performed with two different expert and stakeholder audiences. The four rounds of review involved 19, 16, 90 and 52 participants, respectively. Consensus was reached for a collection of 29 terms and associated definitions, and one set of cut‐off values. Clinical Significance: Standardisation of terminology is a foundational component of clinical communication, surveillance and guideline development. Unclear or variable definitions have commonly been present in studies of urinary tract disease in dogs and cats, causing confusion and hampering evidence assessment. Development of a set of standardised terms and definitions based on broad stakeholder consensus should assist with diagnosis, communication, surveillance and clinical research, improving the evidence base pertaining to infectious urinary tract disease and fostering improved clinical guidance.