Biological units of antimicrobial resistance and strategies for their containment in animal production.

The increasing prevalence of antimicrobial-resistant bacterial infections has ushered in a major global public health crisis. Judicious or restricted antimicrobial use in animal agriculture, aiming to confine the use for the treatment of infections, is the most commonly proposed solution to reduce selection pressure for resistant bacterial strains and resistance genes. However, a multifaceted solution will likely be required to make acceptable progress in reducing antimicrobial resistance, due to other common environmental conditions maintaining antimicrobial resistance and limited executionary potential as human healthcare and agriculture will continue to rely heavily on antimicrobials in the foreseeable future. Drawing parallels from systematic approaches to the management of infectious disease agents and biodiversity loss, we provide examples that a more comprehensive approach is required, targeting antimicrobial resistance in agroecosystems on multiple fronts simultaneously. We present one such framework, based on nested biological units of antimicrobial resistance, and describe established or innovative strategies targeting units. Some of the proposed strategies are already in use or ready to be implemented, while some require further research and discussion among scientists and policymakers. We envision that antimicrobial resistance mitigation strategies for animal agriculture combining multiple tools would constitute powerful ecosystem-level interventions necessary to mitigate antimicrobial resistance.

Antimicrobial use practices of veterinary clinicians at a veterinary teaching hospital in the United States.

Indiscriminate antimicrobial use (AMU) is a factor contributing to antimicrobial resistance (AMR). The objectives of this study were to (1) identify factors influencing AMU practices of veterinary clinicians at The University of Tennessee Veterinary Medical Center (UTVMC), (2) analyze the clinicians' preferential choices of antimicrobials, and (3) evaluate their perceptions, opinions, and concerns regarding AMU and AMR. A total of 121 clinicians were surveyed. Among the 62 respondents, culture and susceptibility test results and pressure from clients were the most and least important factors in their antimicrobial prescription decision-making, respectively. Compared to clinicians who obtained their veterinary degree from 1970 to 1999, those who graduated from 2000 to 2009 and 2010-2016 were 3.96 (P = 0.034) and 5.39 (P = 0.01) times less concerned about AMR, respectively. There is a critical need to increase awareness about judicious AMU practices among clinicians, increase emphasis about AMR in the present veterinary curriculum, and implement antimicrobial stewardship program (AMS) in this institution. Educational activities in combination with awareness campaigns and the stewardship programs could be used to improve AMU practices at this hospital. More client education on AMR is needed.