Antibiotic Use in European Pig Production: Less Is More.

The goal of this study is to describe the current use of antibiotics in the European pig industry based on an extensive literature review. To achieve this, an overview of results from national (n = 15) and multi-country (n = 2) cross-sectional and longitudinal (n = 2) surveys, which describe antimicrobial use in pigs, is presented. Results are further linked to the outcome of the European Surveillance of Veterinary Antimicrobial Consumption (ESVAC) project. Overall, it was found that weaned piglets received the most antibiotics, followed by suckling piglets resulting in over 80% of the treatments being administered to animals before 10 weeks of age. Furthermore, it was observed that antibiotic use (ABU) was significantly associated across age categories, indicating that farms with a high use in piglets also used more antibiotics in their finishers. This may, among other things, be explained by farmers' habits and behavior. However, above all, the studies showed surprisingly large differences in ABU between the countries. These differences may be related to the differences in disease prevalence and/or differences in the level of biosecurity. However, they may also reflect variations in rules and regulations between countries and/or a difference in attitude towards ABU of farmers and veterinarians that are not necessarily linked to the true animal health situation. Furthermore, it was observed that already a substantial proportion of the European pig production is able to successfully raise pigs without any group treatments, indicating that it is possible to rear pigs without systematic use of antibiotics. Based on the ESVAC data, a decline of 43.2% was observed in sales of antibiotics for animals in Europe between 2011 and 2020. To enable efficient antimicrobial quantification and stewardship, 15 European countries have already established systems for herd level monitoring ABU in pigs.

Determining the Characteristics of Farms That Raise Pigs without Antibiotics.

Reduced and responsible antimicrobial use leads to a lower risk of developing antimicrobial resistance. Raised Without Antibiotics (RWA) is a certification label that is recognized in only a few countries, and it is often unclear what the specific criteria and characteristics of RWA farms are. The objectives of this study were to describe the criteria for a Belgian RWA program; to coach farms towards reduced antimicrobial usage (AMU); to assess if it was possible to obtain and maintain the RWA status; and to determine differences between RWA and conventional pig farms. Pig farms (n = 28) were visited three times for the following reasons: (1) data collection, (2) farm-specific coaching (2 months later), and (3) evaluation (7 months later). AMU was followed from before the start of the study up to one year after the last visit. AMU, biosecurity (Biocheck.UGentTM), and farm characteristics of (non-)RWA farms were compared. RWA was defined as no antibiotics from birth until slaughter. Pigs requiring individual treatment received a special ear tag and were excluded from the program. The status of the farms varied over time, and the distribution of RWA vs. non-RWA was 10-18, 13-15, and 12-16, before intervention, after coaching, and after one year, respectively. For the non-RWA farms, there was a reduction in AMU of 61%, 38%, and 23%, for the suckling piglets, fattening pigs, and sows, respectively, indicating that they were moving toward the RWA status. There were no significant differences in biosecurity status between RWA and non-RWA farms, but biosecurity improved in all farms throughout the study. RWA farms were smaller (median 200 sows) compared to non-RWA farms (median 350 sows). The 4-week system was used more in non-RWA farms, while the 3- and 5-week systems were used most often in RWA farms. This study showed that farmers could achieve and maintain the RWA status through farm-specific coaching related to prudent AMU and improved biosecurity.

Coaching Belgian and Dutch Broiler Farmers Aimed at Antimicrobial Stewardship and Disease Prevention.

A reduction in antimicrobial use (AMU) is needed to curb the increase in antimicrobial resistance in broiler production. Improvements in biosecurity can contribute to a lower incidence of disease and thereby lower the need for AMU. However, veterinary advice related to AMU reduction or biosecurity is often not complied with, and this has been linked to the attitudes of farmers. Behavior change promoted by coaching may facilitate uptake and compliance regarding veterinary advice. Thirty broiler farms in Belgium and the Netherlands with high AMU were included in this study for 13 months. For each farmer, the attitude towards AMU reduction was quantified using an adjusted Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR®) change management model, and farm biosecurity was assessed with the Biocheck.UGent™ tool. Subsequently, farmers were coached to improve disease prevention and antimicrobial stewardship. After the individual coaching of farmers, there was a change in their attitudes regarding AMU, reflected by an increase in ADKAR® scores. Biosecurity levels improved by around 6% on average, and AMU was reduced by 7% on average without negative effects on performance parameters. Despite these improvements, no significant association could be found between higher ADKAR® scores and lower AMU. Further investigation into sociological models is needed as a tool to reduce AMU in livestock production.

Comparing Farm Biosecurity and Antimicrobial Use in High-Antimicrobial-Consuming Broiler and Pig Farms in the Belgian-Dutch Border Region.

As antimicrobial resistance is a worldwide problem, threatening both livestock and public health, understanding the drivers for resistance in different settings and countries is essential. Therefore, 30 pig and 30 poultry farms with country-specific high antimicrobial use (AMU) were recruited in the Belgian-Dutch border region. Information regarding production parameters, farm characteristics, biosecurity, and AMU was collected. On average, more biosecurity measures were implemented on Dutch farms, compared to Belgian farms in both animal species. In addition, more opportunities were found to increase the level of internal biosecurity compared to external biosecurity in both countries. AMU, quantified as treatment incidence (TI), differed marginally significant between broiler farms in Belgium and the Netherlands (median BE: 8; NL: 3), whereas in weaned piglets (median BE: 45 and NL: 14) and finishing pigs (median BE: 5 and NL: 1), there was a substantial difference in AMU between farms from both countries. Overall, Dutch farms showed less between-farm variation in TI than did Belgian farms. In both poultry and pig production, the majority of antimicrobials used were extended-spectrum penicillins (BE: 32 and 40%; NL: 40 and 24% for poultry and pigs, respectively). Compared to Belgian farms, Dutch poultry farms used high amounts of (fluoro)quinolones (1 and 15% of total AMU, respectively). None of the production parameters between broiler farms differed significantly, but in pig production, weaning age in Belgian farms (median: 23) was lower than in Dutch farms (median: 27). These results indicate considerable room for improvement in both countries and animal species. Farm-specific preventive strategies can contribute to lowering the risk for animal disease and hence the need for AMU.

Effectiveness of alternative measures to reduce antimicrobial usage in pig production in four European countries.

BACKGROUND: The reduction of antimicrobial usage (AMU) is in the focus in modern pig production. The objective of this study was to assess the effectiveness of alternatives to reduce AMU at herd level. In a prospective study, 68 farrow-to-finish pig herds located in Belgium, France, Germany and Sweden were recruited on a voluntary basis to implement tailor-made intervention plans to reduce their AMU. Alternative measures included improvement of biosecurity (n = 29 herds), vaccination (n = 30), changes of feeding schemes or drinking water quality (n = 45), improved pig health and welfare care (n = 21) as well as changes in stable climate and zootechnical measures (n = 14). Herds were followed for 1 year after implementation of measures. Annual antimicrobial expenditures or treatment records, as well as disease incidence scores were collected and compared to those of the year before intervention. AMU was measured as the treatment incidence and calculated by age category, antimicrobial class and administration route. RESULTS: Compliance with the intervention plans was high (median 93%). AMU was significantly reduced following the implementation of alternative measures: in the median herd of the four countries, pigs were treated before intervention 25% of their expected lifespan (200 days from birth to slaughter) and after intervention 16%. AMU of suckling and weaned pigs were significantly reduced by 37 and 54%, respectively. The usage of polymyxins and tetracyclines was significantly reduced by 69 and 49%, respectively. AMU via feed and water, as well as parenteral AMU were significantly reduced by 46 and 36%, respectively. Herds with a higher AMU level before intervention achieved a bigger reduction. The majority of disease incidence were similar before and after intervention, with a few exceptions of disorders related to the gastro-intestinal tract in suckling pigs (decreased) and in breeding pigs (increased). CONCLUSION: Following tailor-made implementation of alternative measures, a substantial reduction of AMU in pig production was achievable without jeopardizing animal health. The AMU reduction in the youngest age categories (suckling and weaned pigs) and the reduction of group treatments via feed and water was in line with the recent European Guidelines on the prudent use of antimicrobials in veterinary medicine.

Using the Biocheck.UGent™ scoring tool in Irish farrow-to-finish pig farms: assessing biosecurity and its relation to productive performance.

BACKGROUND: Biosecurity is one of the main factors affecting disease occurrence and antimicrobial use, and it is associated with performance in pig production. However, the importance of specific measures could vary depending on the (national) context. The aim of this study was to describe the biosecurity status in a cohort of Irish pig farms, to investigate which of those biosecurity aspects are more relevant by using the Biocheck.UGent™ scoring system, and to study the impact of such aspects on farm performance. RESULTS: External biosecurity score was high compared to most countries due to the characteristics of the Irish pig sector (i.e. purchasing only semen and breeding gilts on farm). The internal biosecurity score was lower and had greater variability among farms than other EU countries. Using multivariable linear regression, the biosecurity practices explained 8, 23, and 16% of variability in piglet mortality, finisher mortality, and average daily gain, respectively. Three clusters of farms were defined based on their biosecurity scores (0 to 100) using principal components and hierarchical clustering analysis. Scores for clusters 1, 2 and 3 were (mean ± SD) 38 ± 7.6, 61 ± 7.0 and 66 ± 9.8 for internal and 73 ± 5.1, 74 ± 5.3 and 86 ± 4.5 for external biosecurity. Cluster 3 had lower piglet mortality (P = 0.022) and higher average daily gain (P = 0.037) when compared to cluster 2. CONCLUSIONS: Irish farms follow European tendencies with internal biosecurity posing as the biggest liability. Our results suggest that practices related to the environment and region, feed, water and equipment supply, and the management of the different stages, need to be addressed in lower performing farms to improve productive performance. Further studies on the economic impact of these biosecurity practices including complementary data on herd health, gilt rearing, piglet management, vaccination and feeding strategies are needed.

Quantitative Outcomes of a One Health approach to Study Global Health Challenges.

Having gained momentum in the last decade, the One Health initiative promotes a holistic approach to address complex global health issues. Before recommending its adoption to stakeholders, however, it is paramount to first compile quantitative evidence of the benefit of such an approach. The aim of this scoping review was to identify and summarize primary research that describes monetary and non-monetary outcomes following adoption of a One Health approach. An extensive literature search yielded a total of 42,167 references, of which 85 were included in the final analysis. The top two biotic health issues addressed in these studies were rabies and malaria; the top abiotic health issue was air pollution. Most studies described collaborations between human and animal (n = 42), or human and environmental disciplines (n = 41); commonly reported interventions included vector control and animal vaccination. Monetary outcomes were commonly expressed as cost-benefit or cost-utility ratios; non-monetary outcomes were described using disease frequency or disease burden measurements. The majority of the studies reported positive or partially positive outcomes. This paper illustrates the variety of health challenges that can be addressed using a One Health approach, and provides tangible quantitative measures that can be used to evaluate future implementations of the One Health approach.

Profile of pig farms combining high performance and low antimicrobial usage within four European countries.

Pig farmers are strongly encouraged to reduce their antimicrobial usage because of the rising threat from antimicrobial resistance. However, such efforts should not compromise the herd health status and performance. This study aimed to describe the profile of so-called 'top-farms' that managed to combine both high technical performance and low antimicrobial usage. A cross-sectional study was conducted among 227 farrow-to-finish farms in Belgium, France, Germany and Sweden. Among them, 44 farms were allocated to the top-farms group and were compared with the 'regular' farms group in terms of farm characteristics, biosecurity and health status. Top-farms had fewer gastrointestinal symptoms in suckling pigs and fewer respiratory symptoms in fatteners, which could partly explain their reduced need for antimicrobials and higher performance. They also had higher biosecurity and were located in sparsely populated pig areas. However, 14 farms of the top-farms group were located in densely populated pig areas, but still managed to have low usage and high technical performance; they had higher internal biosecurity and more extensive vaccination against respiratory pathogens. These results illustrate that it is possible to control infectious diseases using other approaches than high antimicrobial usage, even in farms with challenging environmental and health conditions.

Farm-economic analysis of reducing antimicrobial use whilst adopting improved management strategies on farrow-to-finish pig farms.

Due to increasing public health concerns that food animals could be reservoirs for antibiotic resistant organisms, calls for reduced current antibiotic use on farms are growing. Nevertheless, it is challenging for farmers to perform this reduction without negatively affecting technical and economic performance. As an alternative, improved management practices based on biosecurity and vaccinations have been proven useful to reduce antimicrobial use without lowering productivity, but issues with insufficient experimental design possibilities have hindered economic analysis. In the present study a quasi-experimental approach was used for assessing the economic impact of reduction of antimicrobial use coupled with improved management strategies, particularly biosecurity strategies. The research was performed on farrow-to-finish pig farms in Flanders (northern region of Belgium). First, to account for technological progress and to avoid selection bias, propensity score analysis was used to compare data on technical parameters. The treatment group (n=48) participated in an intervention study whose aim was to improve management practices to reduce the need for use of antimicrobials. Before and after the change in management, data were collected on the technical parameters, biosecurity status, antimicrobial use, and vaccinations. Treated farms were matched without replacement with control farms (n=69), obtained from the Farm Accountancy Data Network, to estimate the difference in differences (DID) of the technical parameters. Second, the technical parameters' DID, together with the estimated costs of the management intervention and the price volatility of the feed, meat of the finisher pigs, and piglets served as a basis for modelling the profit of 11 virtual farrow-to-finish pig farms representative of the Flemish sector. Costs incurred by new biosecurity measures (median +€3.96/sow/year), and new vaccinations (median €0.00/sow/year) did not exceed the cost reduction achieved by lowering the use of antimicrobials (median -€7.68/sow/year). No negative effect on technical parameters was observed and mortality of the finishers was significantly reduced by -1.1%. Even after a substantial reduction of the antimicrobial treatments, the difference of the enterprise profit increased by +€2.67/finisher pig/year after implementing the interventions. This result proved to be robust after stochastic modelling of input and output price volatility. The results of this study can be used by veterinarians and other stakeholders to incentivise managers of farrow-to-finish operations to use biosecurity practices as a cost-effective way to reduce antimicrobial use.

Evaluation of the relationship between the biosecurity status, production parameters, herd characteristics and antimicrobial usage in farrow-to-finish pig production in four EU countries.

BACKGROUND: High antimicrobial usage and the threat of antimicrobial resistance highlighted the need for reduced antimicrobial usage in pig production. Prevention of disease however, is necessary to obtain a reduced need for antimicrobial treatment. This study aimed at assessing possible associations between the biosecurity level, antimicrobial usage and farm and production characteristics in order to advice on best practices for a low antimicrobial usage and maximum animal health and production. A cross-sectional study was conducted in 227 farrow-to-finish pig herds in Belgium, France, Germany and Sweden between December 2012 and December 2013. Associations between biosecurity status, antimicrobial usage, and production parameters were evaluated with multivariable general linear models, according to an assumed causal pathway. RESULTS: The results showed that higher antimicrobial usage in sows tended to be associated with higher antimicrobial usage from birth until slaughter (p = 0.06). The antimicrobial usage from birth until slaughter was positively associated with the number of pathogens vaccinated against (p < 0.01). A shorter farrowing rhythm (p < 0.01) and a younger weaning age (p = 0.06) tended to be also associated with a higher antimicrobial usage from birth until slaughter whereas a better external biosecurity (p < 0.01) was related with a lower antimicrobial usage from birth until slaughter. CONCLUSION: Management practices such as weaning age and biosecurity measures may be important factors indirectly impacting on antimicrobial usage. We therefore promote a holistic approach when assessing the potential to reduce the need for antimicrobial treatments.

Alternatives to the use of antimicrobial agents in pig production: A multi-country expert-ranking of perceived effectiveness, feasibility and return on investment.

Nineteen alternatives to antimicrobial agents were ranked on perceived effectiveness, feasibility and return on investment (ROI) from 0 (not effective, not feasible, no ROI) to 10 (fully effective, completely feasible, maximum ROI) by 111 pig health experts from Belgium, Denmark, France, Germany, Sweden and Switzerland. The top 5 measures in terms of perceived effectiveness were (1) improved internal biosecurity, (2) improved external biosecurity, (3) improved climate/environmental conditions, (4) high health/Specific Pathogen Free/disease eradication and (5) increased vaccination. The top 5 measures in terms of perceived feasibility were (1) increased vaccination, (2) increased use of anti-inflammatory products, (3) improved water quality, (4) feed quality/optimization and (5) use of zinc/metals. The top 5 measures in terms of perceived ROI were (1) improved internal biosecurity, (2) zinc/metals, (3) diagnostics/action plan, (4) feed quality/optimization and (5) climate/environmental improvements. Univariate linear regression showed that veterinary practitioners rank internal biosecurity, vaccination, use of zinc/metals, feed quality optimization and climate/environmental on average highest, while researchers and professors focused more on increased use of diagnostics and action plans. Financial incentives/penalties ranked low in all countries. Belgian respondents ranked feed quality significantly lower compared to the German respondents while reduction of stocking density was ranked higher in Belgium compared to Denmark. Categorical Principal Component Analysis applied to the average ranking supported the finding that veterinary practitioners had a preference for more practical, common and already known alternatives. The results showed that improvements in biosecurity, increased use of vaccination, use of zinc/metals, feed quality improvement and regular diagnostic testing combined with a clear action plan were perceived to be the most promising alternatives to antimicrobials in industrial pig production based on combined effectiveness, feasibility and ROI.

Assigning defined daily doses animal: a European multi-country experience for antimicrobial products authorized for usage in pigs.

OBJECTIVES: To establish a consensus defined daily dose animal (DDDA) for each active substance (AS) and administration route for porcine veterinary antimicrobial products authorized in four European countries, thus allowing cross-country quantification and comparison of antimicrobial usage data. METHODS: All veterinary antimicrobial products authorized for porcine use in Belgium, France, Germany and Sweden were listed for each administration route. First, separate DDDAs for each product were defined based on the recommended dosing for the main indication. Second, a consensus DDDA was established by taking the mean of the DDDAs for each product within a certain category of AS plus administration route. RESULTS: One-hundred-and-fifty-nine, 240, 281 and 50 antimicrobial products were licensed in Belgium, France, Germany and Sweden, respectively, in February 2013. Large variations were observed for dosage and treatment duration recommendations between products and between countries for the same ASs. Only 6.8% of feed/water and 29.4% of parenteral AS groups had the same recommended dosage in the four countries. CONCLUSIONS: This study presents a consensus DDDA list for use in the quantification and comparison of antimicrobial consumption. Four major recommendations have been formulated: (i) urgent need for harmonization of authorization and recommended summary of product characteristics (SPC) dosages; (ii) expand the developed preliminary DDDA list to include all authorized veterinary medicinal products in all EU member states and for all (food-producing) animal species; (iii) improved accessibility of country-specific SPC data would be preferable; and (iv) statement of the 'long-acting' duration of a product in the SPC.

Prophylactic and metaphylactic antimicrobial use in Belgian fattening pig herds.

The monitoring of antimicrobial use is an essential step to control the selection and spread of antimicrobial resistance. Between January and October 2010 data on prophylactic and metaphylactic antimicrobial use were collected retrospectively on 50 closed or semi-closed pig herds. Ninety-three percent of the group treatments were prophylactic whereas only 7% were methaphylactic. The most frequently used antimicrobials orally applied at group level were colistin (30.7%), amoxicillin (30.0%), trimethoprim-sulfonamides (13.1%), doxycycline (9.9%) and tylosin (8.1%). The most frequently applied injectable antimicrobials were tulathromycin (45.0%), long acting ceftiofur (40.1%) and long acting amoxicillin (8.4%). The treatment incidences (TI) based on the used daily dose pig (UDD(pig) or the actually administered dose per day per kg pig of a drug) for all oral and injectable antimicrobial drugs was on average 200.7 per 1000 pigs at risk per day (min=0, max=699.0), while the TI based on the animal daily dose pig (ADD(pig) or the national defined average maintenance dose per day per kg pig of a drug used for its main indication) was slightly higher (average=235.8, min=0, max=1322.1). This indicates that in reality fewer pigs were treated with the same amount of antimicrobials than theoretically possible. Injectable products were generally overdosed (79.5%), whereas oral treatments were often underdosed (47.3%). In conclusion, this study shows that prophylactic group treatment was applied in 98% of the visited herds and often includes the use of critically important and broad-spectrum antimicrobials. In Belgium, the guidelines for prudent use of antimicrobials are not yet implemented.