Exploring medical and veterinary student perceptions and communication preferences related to antimicrobial resistance in Ontario, Canada using qualitative methods.

BACKGROUND: Antimicrobial resistance (AMR) threatens our ability to treat and prevent infectious diseases worldwide. A significant driver of AMR is antimicrobial use (AMU) in human and veterinary medicine. Therefore, education and awareness of AMR among antimicrobial prescribers is critical. Human and animal health professionals play important roles in the AMR issue, both as contributors to the emergence of AMR, and as potential developers and implementers of effective solutions. Studies have shown that engaging stakeholders prior to developing communication materials can increase relevance, awareness, and dissemination of research findings and communication materials. As future antimicrobial prescribers, medical and veterinary students' perspectives on AMR, as well as their preferences for future communication materials, are important. The first objective of this study was to explore medical and veterinary student perceptions and understanding of factors associated with emergence and spread of AMR. The second objective was to identify key messages, knowledge translation and transfer (KTT) methods, and dissemination strategies for communication of AMR information to these groups. METHODS: Beginning in November 2018, focus groups were conducted with medical and veterinary students in Ontario, Canada. A semi-structured format, using standardized open-ended questions and follow-up probing questions was followed. Thematic analysis was used to identify and analyze patterns within the data. RESULTS: Analyses showed that students believed AMR to be an important global issue and identified AMU in food-producing animals and human medicine as the main drivers of AMR. Students also highlighted the need to address society's reliance on antimicrobials and the importance of collaboration between different sectors to effectively reduce the emergence and transmission of AMR. When assessing different communication materials, students felt that although infographics provide easily digestible information, other KTT materials such as fact sheets are better at providing more information without overwhelming the target audiences (e.g., professional or general public). CONCLUSION: Overall, the study participants felt that AMR is an important issue and emphasized the need to develop different KTT tools for different audiences. This research will help inform the development of future communication materials, and support development of AMR-KTT tools tailored to the needs of different student and professional groups.

Antimicrobial use in lactating sows, piglets, nursery, and grower-finisher pigs on swine farms in Ontario, Canada during 2017 and 2018.

BACKGROUND: Data on antimicrobial use (AMU) in pig production are needed for the development of good antimicrobial stewardship practices to reduce the risk of antimicrobial resistance in bacteria that can cause illness in animals and humans. In Canada, there is a lack of quantitative data on AMU in the farrowing and nursery stages of pig production. This study aimed to determine which antimicrobial active ingredients are currently used in farrowing, nursery, and grower-finisher herds in the province of Ontario, Canada, and to quantify AMU using various metrics. We collected data on herd demographics, biosecurity, health status, and AMU during one production cycle from 25 farrowing and 25 nursery herds in Ontario, between May 2017 and April 2018, and obtained data from 23 Ontario grower-finisher herds during the same time frame from the Public Health Agency's Canadian Integrated Program for Antimicrobial Resistance Surveillance. We applied frequency measures, and weight-, and dose-based metrics to the data. RESULTS: In all pigs, the highest quantity of AMU was administered in-feed. By all routes of administration and compared to other production stages, nursery pigs used more antimicrobials in mg/kg biomass and the number of Canadian defined daily doses per 1000 pig-days (doseCA rate), while grower-finisher pigs used more antimicrobials in total kilograms and the number of Canadian defined daily doses per pig. In suckling pigs in some herds, there was routine disease prevention use of ceftiofur, an antimicrobial active ingredient categorized as very highly important in human medicine by Health Canada. The top antimicrobial used in each stage of pig production often varied by the metric used. There was producer-reported growth promotion use of antimicrobials in suckling and grower-finisher feed. CONCLUSIONS: The results of this study provide a current picture of AMU in pigs in Ontario and can be used as a basis for further research on AMU in farrowing and nursery herds in Canada. Our findings confirm that it would be useful to include farrowing and nursery herds in routine AMU surveillance in Canada. A future analysis using data from this project will examine factors that affect the quantity of AMU.

"I Think There Should Be Photos": Female Indoor Tanners' Perceptions of Health Warning Labels for Tanning Beds.

This study explores female indoor tanners' perceptions of the current, text-only Canadian health warning label (HWL) for tanning equipment, as well as pictorial, evidence-based alternative HWLs. We created 10 test HWLs that depicted skin health effects, eye damage, premature aging, and death. Young women who had tanned indoors in the past year discussed these and the current federal HWL in focus groups. Although the current Canadian HWL was seen as informative, several participants did not recognize it, and many said that they would not read it due to the small text, wordiness, and lack of an image. Graphic images, particularly those depicting permanent conditions affecting the face, eyes, or appearance, were seen as effective. Common criticisms of the images were lack of believability, relatability, and comprehensibility. Although concise text was important for encouraging reading, many participants expressed a desire for more information in the test HWLs. Premature aging was of great concern to many participants, but the images selected for these HWLs were not perceived as effective. Although the text was seen as effective in the death HWLs, most participants dismissed the images. This research has implications for IT HWLs in Canada and globally. These results suggest that graphic images may be impactful in IT HWLs. Images must be supplemented with informative text that increases believability, relatability, and comprehensibility. These modifications would create HWLs that are engaging, informative, and that form part of a wider effort to spread awareness about the harmful effects of IT.

Epidemiology of norovirus and viral gastroenteritis in Ontario, Canada, 2009-2014.

BACKGROUND: Norovirus is the most common cause of acute gastroenteritis in Canada. The illness causes great morbidity and high societal costs. The objective of this article is to describe the epidemiology of norovirus in the province of Ontario, Canada from 2009 to 2014. METHODS: To assess activity of norovirus and viral gastroenteritis (VGE) in Ontario, three datasets were acquired from the provincial government: two traditional surveillance datasets (outbreak and laboratory) and syndromic surveillance data (telehealth), all spanning 2009-2014. All outbreaks, laboratory submissions and telehealth calls were first assessed for total VGE. Norovirus and norovirus-like illness totals were calculated as a proportion of VGE to estimate agent-specific activity levels. Affected institution types, sexes and age groups were also analyzed. RESULTS: Between 2009 and 2014, 41.5% of VGE outbreaks, 63.4% of VGE laboratory submissions and 36.6% of all acute gastroenteritis-related (not restricted to viral causes) telehealth calls were attributed to norovirus and norovirus-like illness in Ontario. The most commonly affected institution type was long-term care homes and the most commonly affected age groups were younger (younger than five years) and older (older than 65 years) individuals. Females were slightly more frequently affected than males. CONCLUSION: Norovirus and norovirus-like illnesses were the leading cause of VGE in Ontario between 2009 and 2014. They comprised the greatest percentage of VGE when compared with all other VGE-associated viruses. Additional work is needed to determine all component costs and necessary public health actions to reduce the burden of disease.

Increasing incidence and antimicrobial resistance in Escherichia coli bloodstream infections: a multinational population-based cohort study.

BACKGROUND: Escherichia coli is an important pathogen in humans and is the most common cause of bacterial bloodstream infections (BSIs). The objectives of our study were to determine factors associated with E. coli BSI incidence rate and third-generation cephalosporin resistance in a multinational population-based cohort. METHODS: We included all incident E. coli BSIs (2014-2018) from national (Finland) and regional (Australia [Canberra], Sweden [Skaraborg], and Canada [Calgary, Sherbrooke, and western interior]) surveillance. Incidence rates were directly age and sex standardized to the European Union 28-country 2018 population. Multivariable negative binomial and logistic regression models estimated factors significantly associated with E. coli BSI incidence rate and third-generation cephalosporin resistance, respectively. The explanatory variables considered for inclusion in both models were year (2014-2018), region (six areas), age (< 70-years-old and ≥ 70-years-old), and sex (female and male). RESULTS: We identified 31,889 E. coli BSIs from 40.7 million person-years of surveillance. Overall and third-generation cephalosporin-resistant standardized rates were 87.1 and 6.6 cases/100,000 person-years, respectively, and increased 14.0% and 40.1% over the five-year study. Overall, 7.8% (2483/31889) of E. coli BSIs were third-generation cephalosporin-resistant. Calgary, Canberra, Sherbrooke, and western interior had significantly lower E. coli BSI rates compared to Finland. The significant association between age and E. coli BSI rate varied with sex. Calgary, Canberra, and western interior had significantly greater odds of third-generation cephalosporin-resistant E. coli BSIs compared to Finland. Compared to 2014, the odds of third-generation cephalosporin-resistant E. coli BSIs were significantly increased in 2016, 2017, and 2018. The significant association between age and the odds of having a third-generation cephalosporin-resistant E. coli BSI varied with sex. CONCLUSIONS: Increases in overall and third-generation cephalosporin-resistant standardized E. coli BSI rates were clinically important. Overall, E. coli BSI incidence rates were 40-104% greater than previous investigations from the same study areas. Region, sex, and age are important variables when analyzing E. coli BSI rates and third-generation cephalosporin resistance in E. coli BSIs. Considering E. coli is the most common cause of BSIs, this increasing burden and evolving third-generation cephalosporin resistance will have an important impact on human health, especially in aging populations.

Escherichia coli bloodstream infections in the western interior of British Columbia, Canada: a population-based cohort study.

Our population-based study objectives were to describe characteristics and outcomes of Escherichia coli bloodstream infections (BSIs), and to evaluate factors associated with outcomes. We included incident E. coli BSIs from western interior residents (British Columbia, Canada; 04/2010-03/2020). We obtained data including patient demographics, location of onset, infection focus, Charlson comorbidity index (CCI), antimicrobial resistance, 30-day all-cause mortality and length of hospital stay (LOS). Using multivariable logistic regression models fitted with generalised estimating equations, we estimated factors associated with 30-day mortality and long post-infection LOS (>75th percentile). We identified 1080 incident E. coli BSIs in 1009 patients. The crude incidence and 30-day mortality rates were 59.1 BSIs and 6.8 deaths/100 000 person-years, respectively. The 30-day case fatality risk was 11.5%. Compared to community-acquired E. coli BSIs, either healthcare-associated or nosocomial cases had higher odds of 30-day mortality. Older cases, non-urogenital BSI foci and CCI ⩾ 3 had higher odds of 30-day mortality compared to younger cases, urogenital foci and CCI < 3. In patients that survived to discharge, those with extended-spectrum ß-lactamase (ESBL)-producing E. coli BSIs, nosocomial BSIs, and CCI ⩾ 3 had higher odds of long post-infection LOS compared to those with non-ESBL-producing, community-acquired and healthcare-associated, and CCI < 3. There is a substantial disease burden from E. coli BSIs.

Mortality in Escherichia coli bloodstream infections: a multinational population-based cohort study.

BACKGROUND: Escherichia coli is the most common cause of bloodstream infections (BSIs) and mortality is an important aspect of burden of disease. Using a multinational population-based cohort of E. coli BSIs, our objectives were to evaluate 30-day case fatality risk and mortality rate, and determine factors associated with each. METHODS: During 2014-2018, we identified 30-day deaths from all incident E. coli BSIs from surveillance nationally in Finland, and regionally in Sweden (Skaraborg) and Canada (Calgary, Sherbrooke, western interior). We used a multivariable logistic regression model to estimate factors associated with 30-day case fatality risk. The explanatory variables considered for inclusion were year (2014-2018), region (five areas), age (< 70-years-old, ≥70-years-old), sex (female, male), third-generation cephalosporin (3GC) resistance (susceptible, resistant), and location of onset (community-onset, hospital-onset). The European Union 28-country 2018 population was used to directly age and sex standardize mortality rates. We used a multivariable Poisson model to estimate factors associated with mortality rate, and year, region, age and sex were considered for inclusion. RESULTS: From 38.7 million person-years of surveillance, we identified 2961 30-day deaths in 30,923 incident E. coli BSIs. The overall 30-day case fatality risk was 9.6% (2961/30923). Calgary, Skaraborg, and western interior had significantly increased odds of 30-day mortality compared to Finland. Hospital-onset and 3GC-resistant E. coli BSIs had significantly increased odds of mortality compared to community-onset and 3GC-susceptible. The significant association between age and odds of mortality varied with sex, and contrasts were used to interpret this interaction relationship. The overall standardized 30-day mortality rate was 8.5 deaths/100,000 person-years. Sherbrooke had a significantly lower 30-day mortality rate compared to Finland. Patients that were either ≥70-years-old or male both experienced significantly higher mortality rates than those < 70-years-old or female. CONCLUSIONS: In our study populations, region, age, and sex were significantly associated with both 30-day case fatality risk and mortality rate. Additionally, 3GC resistance and location of onset were significantly associated with 30-day case fatality risk. Escherichia coli BSIs caused a considerable burden of disease from 30-day mortality. When analyzing population-based mortality data, it is important to explore mortality through two lenses, mortality rate and case fatality risk.

Detection of spatial and spatio-temporal Salmonella Heidelberg and Salmonella Typhimurium human case clusters focused around licensed abattoirs in Ontario in 2015, and their potential relation to known outbreaks.

Salmonellosis is one of several zoonotic diseases for which individuals with occupational animal contact, including abattoir workers, are at an increased risk. If meat is contaminated during slaughter, this can increase the risk of enteric illness for consumers. In this study, we investigated whether reported cases of Salmonella Heidelberg and Typhimurium were clustered around abattoirs in Ontario in 2015 and whether there was any evidence (laboratory/exposure) to suggest an abattoir at the centre of a cluster might be the source of exposure. Data for each reported case of S. Heidelberg and S. Typhimurium in Ontario in 2015 were collected. Multi-focused and non-focused spatial and space-time cluster detection tests were performed for each serotype, with and without cases linked to known outbreaks, using Poisson and space-time permutation models. Focused tests included the location of abattoirs operational in all or part of 2015. Laboratory data and exposure information were used to explore the relatedness of cases within identified clusters. Focused spatial tests identified clusters of S. Heidelberg and S. Typhimurium around abattoirs. Focused space-time permutation tests identified 2 significant space-time clusters of S. Heidelberg; one cluster (n = 11 cases) included 8 of 9 cases associated with a known outbreak and the other cluster (n = 18 cases) was not part of a previously identified outbreak. Review of laboratory and risk factor information suggested that cases within each cluster shared a common exposure. Cases were not asked about goat or sheep meat consumption. The focused cluster test, particularly with the space-time permutation model, could assist in identifying outbreaks associated with a particular physical location, such as an abattoir. Improvements to the current case investigation process, such as consistent collection and reporting of high-risk occupation information and more detailed food consumption history, could assist in outbreak identification when coupled with this statistic.

Non-antibiotic Approaches for Disease Prevention and Control in Nursery Pigs: A Scoping Review.

Swine producers are encouraged to practice antibiotic stewardship by reducing their use of antibiotics belonging to classes of medical importance to humans. We conducted a scoping review of non-antibiotic approaches in the form of products or management practices that might prevent or control disease and thus reduce the need for antibiotics in nursery pigs. Our objectives were to systematically describe the research on this broad topic for the North American context, identify specific topics that could feasibly support systematic reviews, and identify knowledge gaps. A search of multiple databases identified 11,316 articles and proceedings for relevance screening. From these, 441 eligible clinical trials and observational studies were charted. The majority were clinical trials (94%). Study results from EU countries were mostly communicated through journal articles, whereas study results from the USA were mostly communicated through conference proceedings. Interventions and health outcomes were diverse. The two most frequent intervention categories were feed additives and piglet vaccines. The three most frequent outcomes reported were diarrhea, mortality, and indices of vaccine immunity. There were 13 specific topics comprising various feed additives and vaccines that might feasibly support systematic reviews. There were relatively few studies in which interventions were compared with antibiotic comparison groups and relatively few studies evaluating management practices.

Choosing which metrics to use when reporting antimicrobial use information to veterinarians in the Canadian swine industry.

The objective of this study was to evaluate preferences for various metrics and denominators among Canadian swine veterinarians, in order to improve reporting of antimicrobial use (AMU) information to these stakeholders and to facilitate enhanced stewardship decisions. An online survey was made available to swine veterinarians across Canada; 12 responses (estimated response rate 17.6%) were submitted and analyzed. Responses represented veterinarians from every major pig-producing province and from a range of year of graduation from veterinary college. Participants self-evaluated their understanding of dose-based metrics as higher than weight- and frequency-based metrics and interpreted most results of AMU analyses correctly. Participants preferred dose-based metrics over others, and had various objectives for AMU information, including improving AMU on their clients' farms and enabling comparisons with other farms. The results are useful to those making decisions about which AMU metrics to use in reports targeted to swine veterinarians.

Choix des paramètres à utiliser lors de la communication d'informations sur l'utilisation des antimicrobiens aux vétérinaires de l'industrie porcine canadienne. L'objectif de la présente étude était d'évaluer les préférences pour divers paramètres et dénominateurs chez les vétérinaires porcins canadiens, afin d'améliorer la déclaration de l'information sur l'utilisation d'antimicrobiens (UMA) à ces intervenants et de faciliter des décisions de gérance améliorées. Un sondage en ligne a été mis à la disposition des vétérinaires porcins partout au Canada; 12 réponses (taux de réponse estimé à 17,6 %) ont été soumises et analysées. Les réponses représentaient des vétérinaires de toutes les grandes provinces productrices de porcs et d'une gamme d'années d'obtention du diplôme d'un collège vétérinaire. Les participants ont auto-évalué leur compréhension des mesures basées sur la dose comme étant supérieure aux mesures basées sur le poids et la fréquence et ont interprété correctement la plupart des résultats des analyses UMA. Les participants préféraient les mesures basées sur la dose aux autres, et avaient divers objectifs pour l'information sur l'UMA, notamment l'amélioration de l'UMA dans les fermes de leurs clients et la possibilité de comparer avec d'autres fermes. Les résultats sont utiles à ceux qui prennent des décisions sur les paramètres d'UMA à utiliser dans les rapports destinés aux vétérinaires porcins.(Traduit par Dr Serge Messier).

Readability and content of online pet obesity information.

OBJECTIVE: To assess the readability of pet obesity information, document the presence and absence of types of pet obesity information, and perform comparisons between dog and cat obesity information content on websites. SAMPLE: 68 websites containing pet obesity content. PROCEDURES: Websites were systematically retrieved with a search engine and predefined search terms and phrases. For each website, pet obesity information was scored by use of 2 established readability tools: the simple measure of gobbledygook (SMOG) index and Flesch-Kincaid (FK) readability test. A directed content analysis was conducted with a codebook that assessed the presence or absence of 103 variables across 5 main topics related to pet obesity on each website. RESULTS: The mean reading grade levels determined with the SMOG index and FK readability test were 16.61 and 9.07, respectively. Instructions for weight measurement and body condition scoring were found infrequently, as were nonmodifiable risk factors. There was a greater focus on addressing obesity through dietary changes than through increasing physical activity. Few websites recommended regular follow-up appointments with veterinarians. Weight management information and the emphasis on owners' commitment to achieve their pet's weight loss targets differed among dog- and cat-focused websites. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that pet obesity information on the studied websites was largely inaccessible to pet owners owing to the associated high reading grade levels. Readers of that information would benefit from clarification of information gaps along with provision of guidance regarding navigating online information and counseling on the importance of nutritional and dietary reassessments for individual pets performed by veterinarians.

Detection of spatial, temporal and space-time Salmonella Heidelberg and Salmonella Typhimurium clusters in Ontario in 2015, and comparisons to known outbreaks.

PURPOSE: Salmonellosis is one of several reportable diseases in Ontario (ON). Two or more cases of the same serotype that are linked to a common exposure or related to one another in time and/or space are considered a potential outbreak. While laboratory data can help to determine the molecular relatedness of cases, results may take up to several weeks. This study aimed to assess the utility of the retrospective spatial scan statistic in detecting clusters of Salmonella Heidelberg and Salmonella Typhimurium cases using data from ON in 2015. Identified clusters were validated by laboratory data (where available) to determine whether identified clusters were likely outbreaks. METHODS: Data representing the location of each reported S. Heidelberg or S. Typhimurium case in 2015, responsible serotype and symptom onset date were exported to SaTScan for retrospective spatial, temporal, and space-time analyses using the spatial scan statistic with Bernoulli models and a space-time permutation model. Analyses were performed with and without those cases linked to known outbreaks. Laboratory subtyping data (i.e. pulsed field gel electrophoresis (PFGE) and/or phage type) and food and environmental exposure information (e.g. travel, animal contact, poultry and other food item consumption) were used to explore the relatedness of cases within identified clusters. RESULTS: Spatial, temporal and space-time analyses identified a known outbreak of S. Heidelberg in 2015 (n = 9 cases) and a previously unidentified cluster of S. Heidelberg cases. Most cases (94%) within a cluster detected via a space-time permutation model of S. Heidelberg cases shared an identical PFGE pattern and appeared to represent a true outbreak. CONCLUSIONS: The spatial scan statistic, and particularly the space-time permutation model, could assist in outbreak identification before laboratory data are available, allowing for faster cluster identification and implementation of control measures.

A case-case study comparing the individual risk factors and symptomatology of Salmonella Heidelberg and Salmonella Typhimurium in Ontario in 2015, following implementation of the Ontario Investigation Tools.

Salmonella Heidelberg and Salmonella Typhimurium are among the most common serotypes responsible for human salmonellosis in Ontario. Introduction of the Ontario Investigation Tools (OIT) in 2014 allowed for standardized case investigation and reporting. This study compared the risk factors and symptomatology for sporadic S. Heidelberg and S. Typhimurium cases reported in Ontario in 2015, following implementation of the OIT. Multilevel logistic regression models were applied to assess associations between serotype and individual-level demographic characteristics, exposures and symptoms for sporadic confirmed cases of S. Heidelberg and S. Typhimurium in Ontario in 2015. There were 476 sporadic cases of S. Typhimurium (n = 278) and S. Heidelberg (n = 198) reported in Ontario in 2015. There were significant associations between the odds of the isolate from a case being one of these serotypes, and travel, consumption of sprouts (any type), contact with reptiles and development of malaise, fever or bloody diarrhoea. The S. Typhimurium and S. Heidelberg cases differed in both symptom presentation and risk factors for illness. Case-case comparisons of Salmonella serotypes have some advantages over case-control studies in that these are less susceptible to selection and recall bias while allowing for rapid comparison of cases to identify potential high-risk exposures that are unique to one of the serotypes when compared to the other. Comparing cases of two different Salmonella serotypes can help to highlight risk factors that may be uniquely associated with one serotype, or more strongly associated with one serotype compared to another. This information may be useful for understanding relative source attribution between common serotypes of Salmonella.

The Effect of Food Handler Certification on Food Premises in Ontario, Canada.

Although health units have implemented food handler certification to operators of food premises, evidence on its effectiveness to improve premise food safety remains inconclusive. Regression models were constructed using inspection data from a health unit in Ontario, Canada, to measure the effect of certification on premise inspection results. We found that premises without certified food handlers at the time of inspection were significantly more likely to fail inspections. The odds of inspection failure were significantly different depending on the premise's cultural cuisine classification. Independently owned establishments had lower odds of inspection failure versus chain operations. Inspector was a significant random effect explaining a small percentage of data variations. These results support the use of food handler certification to improve food safety outcomes at establishments. Further efforts should ensure training programs are accessible and relatable to premise operators, particularly those serving all types of cultural cuisines.

Antimicrobial Resistance of Human Campylobacter Species Infections in Saskatchewan, Canada (1999-2006): A Historical Provincial Collection of All Reported Cases.

To describe a historical baseline of antimicrobial resistance (AMR) profiles for human clinical Campylobacter species isolates obtained by laboratory surveillance in the province of Saskatchewan from 1999 to 2006; to determine if there were differences in resistance between Campylobacter jejuni and Campylobacter coli; and to determine if there were changes in the annual resistance levels in the two species. One thousand three hundred seventy-eight Campylobacter isolates were subjected to antimicrobial susceptibility testing using the E-test method. Annual resistance levels in C. jejuni and C. coli were compared using logistic regression models. One thousand two hundred (87.1%) isolates were C. jejuni and 129 (9.4%) were C. coli. Resistance in C. jejuni isolates included ciprofloxacin (CIP: 9.4%), erythromycin (ERY: 0.5%), and tetracycline (33.3%). CIP resistance in C. jejuni was higher in 1999 (15.5%, odds ratio [OR] = 3.96, p = 0.01), 2000 (12.7%, OR = 3.10, p = 0.01), 2005 (10.2%, OR = 2.47, p = 0.05), and 2006 (13.0%, OR = 3.22, p = 0.01) compared with 2004 (4.4%). C. coli had significantly higher CIP resistance (15.5%, OR = 1.78, p = 0.03), ERY resistance (13.2%, OR = 60.12, p < 0.01), multidrug resistance (2.3%, OR = 36.29, p < 0.01), and CIP-ERY resistance (3.1%, OR = 50.23, p < 0.01) compared with C. jejuni. This represents the first and most current report of AMR of the collective human Campylobacter isolates from a province in Canada and provides a baseline against which current and future resistance patterns can be compared. Fluoroquinolone resistance in C. jejuni isolates fluctuated from 1999 to 2006, including an increased prevalence in 2005-2006, while macrolide/lincosamide resistance remained very low. Human clinical C. jejuni isolates from Saskatchewan demonstrated resistance to multiple antimicrobials but had significantly less fluoroquinolone and macrolide resistance than C. coli isolates.

Resistance to antimicrobials used at hatchery level among clinical Escherichia coli isolates from Ontario broilers.

Antimicrobials are used for prophylactic purposes in some flocks because chicks are susceptible to pathogenic bacterial infection at the hatchery stage. The objectives of this study were to assess temporal changes in resistance to ceftiofur, gentamicin, and spectinomycin in Escherichia coli clinical isolates from Ontario broiler chickens between 2008 and 2015, to determine whether stage of production, year and season are predictors of resistance, and whether published data on antimicrobial use help to interpret the temporal patterns in resistance. Logistic regression revealed that stage of production, year, and season were significant predictors of resistance to all 3 antimicrobials. Resistance to ceftiofur fluctuated over time, with a trend towards decreasing resistance between 2013 to 2015; resistance to gentamicin and spectinomycin increased over the study period, with significantly high resistance clusters identified from 2013 to 2015. Comparisons with published hatchery-level antimicrobial use data suggest that these trends may reflect changes in use of ceftiofur and spectinomycin in Ontario.

Résistance aux antimicrobiens utilisés dans les couvoirs chez des isolats d' Escherichia coli provenant de poulets à griller de l'Ontario. Les antimicrobiens sont utilisés à des fins préventives dans certains troupeaux car les oiseaux sont susceptibles à des infections causées par des bactéries pathogènes lorsqu'ils sont au couvoir. Les objectifs de la présente étude étaient d'évaluer les changements temporaux dans la résistance au ceftiofur, à la gentamicine, et à la spectinomycine chez des isolats cliniques d'Escherichia coli provenant de poulets à griller de l'Ontario entre 2008 et 2015, afin de déterminer si le stade de production, l'année et la saison sont des prédicteurs de résistance, et si les données publiées sur l'utilisation des antimicrobiens aide à interpréter les patrons temporaux de résistance. Une régression logistique a révélé que le stade de production, l'année, et la saison étaient des prédicteurs significatifs de résistance pour les trois antibiotiques. La résistance au ceftiofur fluctuait dans le temps, avec une tendance vers une diminution de résistance entre 2013 et 2015; la résistance à la gentamicine et à la spectinomycine a augmenté durant la période d'étude, avec des agrégats de résistance élevée significative entre 2013 et 2015. Des comparaisons avec les données publiées sur l'utilisation des antimicrobiens dans les couvoirs suggèrent que ces tendances pourraient refléter des changements dans l'utilisation du ceftiofur et de la spectinomycine en Ontario.(Traduit par Dr Serge Messier).

Integrating Whole-Genome Sequencing Data Into Quantitative Risk Assessment of Foodborne Antimicrobial Resistance: A Review of Opportunities and Challenges.

Whole-genome sequencing (WGS) will soon replace traditional phenotypic methods for routine testing of foodborne antimicrobial resistance (AMR). WGS is expected to improve AMR surveillance by providing a greater understanding of the transmission of resistant bacteria and AMR genes throughout the food chain, and therefore support risk assessment activities. At this stage, it is unclear how WGS data can be integrated into quantitative microbial risk assessment (QMRA) models and whether their integration will impact final risk estimates or the assessment of risk mitigation measures. This review explores opportunities and challenges of integrating WGS data into QMRA models that follow the Codex Alimentarius Guidelines for Risk Analysis of Foodborne AMR. We describe how WGS offers an opportunity to enhance the next-generation of foodborne AMR QMRA modeling. Instead of considering all hazard strains as equally likely to cause disease, WGS data can improve hazard identification by focusing on those strains of highest public health relevance. WGS results can be used to stratify hazards into strains with similar genetic profiles that are expected to behave similarly, e.g., in terms of growth, survival, virulence or response to antimicrobial treatment. The QMRA input distributions can be tailored to each strain accordingly, making it possible to capture the variability in the strains of interest while decreasing the uncertainty in the model. WGS also allows for a more meaningful approach to explore genetic similarity among bacterial populations found at successive stages of the food chain, improving the estimation of the probability and magnitude of exposure to AMR hazards at point of consumption. WGS therefore has the potential to substantially improve the utility of foodborne AMR QMRA models. However, some degree of uncertainty remains in relation to the thresholds of genetic similarity to be used, as well as the degree of correlation between genotypic and phenotypic profiles. The latter could be improved using a functional approach based on prediction of microbial behavior from a combination of 'omics' techniques (e.g., transcriptomics, proteomics and metabolomics). We strongly recommend that methodologies to incorporate WGS data in risk assessment be included in any future revision of the Codex Alimentarius Guidelines for Risk Analysis of Foodborne AMR.

Extended-Spectrum ß-Lactamase and AmpC ß-Lactamase-Producing Escherichia coli Isolates from Chickens Raised in Small Flocks in Ontario, Canada.

Food-producing animals are recognized to play a role in the epidemiology of antimicrobial resistance in Canada. However, the presence of resistant organisms in particular groups of animals, such as chickens raised in small-holder flocks, has not been studied. The purpose of this study was, therefore, to identify and characterize Escherichia coli possessing broad-spectrum ß-lactamase genes among a collection of third-generation cephalosporin-resistant isolates recovered from 205 small flocks in southern Ontario. Extended-spectrum ß-lactamase (ESBL; CTX-M-1) positive strains were isolated from 26 out of 205 flocks (12.7%), whereas 39 strains possessing AmpC (CMY-2) were grown from 31 out of 205 flocks (15.1%). Pulsed-field gel electrophoresis (PFGE) revealed that the isolates were genetically heterogeneous. Further testing by multi-locus sequence typing confirmed that none of the PFGE-defined clusters belonged to ST131. Our results suggest that the dissemination of this resistance in bacteria isolated from chickens in small-holder flocks may be associated with the spread of plasmids rather than particular E. coli clones and that these isolates do not possess the ESBL types most commonly associated with human infections (CTX-M-15).

One Health-Its Importance in Helping to Better Control Antimicrobial Resistance.

Approaching any issue from a One Health perspective necessitates looking at the interactions of people, domestic animals, wildlife, plants, and our environment. For antimicrobial resistance this includes antimicrobial use (and abuse) in the human, animal and environmental sectors. More importantly, the spread of resistant bacteria and resistance determinants within and between these sectors and globally must be addressed. Better managing this problem includes taking steps to preserve the continued effectiveness of existing antimicrobials such as trying to eliminate their inappropriate use, particularly where they are used in high volumes. Examples are the mass medication of animals with critically important antimicrobials for humans, such as third generation cephalosporins and fluoroquinolones, and the long term, in-feed use of antimicrobials, such colistin, tetracyclines and macrolides, for growth promotion. In people it is essential to better prevent infections, reduce over-prescribing and over-use of antimicrobials and stop resistant bacteria from spreading by improving hygiene and infection control, drinking water and sanitation. Pollution from inadequate treatment of industrial, residential and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have now included a One Health Approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use, better regulation and policy, as well as improved surveillance, stewardship, infection control, sanitation, animal husbandry, and finding alternatives to antimicrobials.

Non-antibiotic approaches for disease prevention and control in beef and veal production: a scoping review.

Livestock producers are encouraged to reduce the use of antibiotics belonging to classes of medical importance to humans. We conducted a scoping review on non-antibiotic interventions in the form of products or management practices that could potentially reduce the need for antibiotics in beef and veal animals living under intensive production conditions. Our objectives were to systematically describe the research on this broad topic, identify specific topics that could feasibly support systematic reviews, and identify knowledge gaps. Multiple databases were searched. Two reviewers independently screened and charted the data. From the 13,598 articles screened, 722 relevant articles were charted. The number of relevant articles increased steadily from 1990. The Western European research was dominated by veal production studies whereas the North American research was dominated by beef production studies. The interventions and outcomes measured were diverse. The four most frequent interventions included non-antibiotic feed additives, vaccinations, breed type, and feed type. The four most frequent outcomes were indices of immunity, non-specific morbidity, respiratory disease, and mortality. There were seven topic areas evaluated in clinical trials that may share enough commonality to support systemic reviews. There was a dearth of studies in which interventions were compared to antibiotic comparison groups.