The Evolution of Cystic Echinococcosis in Humans and Ruminants in Portugal-A One Health Approach.

Cystic echinococcosis, also known as hydatid disease, is a significant parasitic zoonosis with public health implications, albeit often neglected. In Portugal, data on this zoonosis are scarce despite being a mandatory notifiable disease in both humans and animals. To assess the impact of cystic echinococcosis on both livestock and humans, we compiled data from slaughterhouse records of ruminants, human hospitalizations, and confirmed cases of human echinococcosis. Overall, a total of 298 cases of cystic echinococcosis were identified in ruminants slaughtered from national farms for human consumption in Portugal between 2008 and 2022, comprising 192 cases in ovines, 95 in bovines, and 11 in caprines. Echinococcosis led to 582 hospitalizations in Portuguese public hospitals, with an average hospital stay of 11 days (±15.66), and resulted in 13 deaths (2.23%) from 2008 to 2018. Each infected animal was associated with a 7% increase in the incidence rate of human hospitalization (p = 0.002, IRR = 1.070, 95% CI: 1.025-1.117). Additionally, for every 100,000 person-years observed between 2008 and 2018, the total number of hospitalizations was 0.528. Residence in the Alentejo region was associated with a 5.3-fold increase in the incidence rate of human hospitalizations and an 8-fold higher risk of death from echinococcosis.

Effectiveness of antimicrobial interventions directed at tackling antimicrobial resistance in animal production: A systematic review and meta-analysis.

BACKGROUND: In the last decades, a more prudent and rational use of antimicrobials has been progressively directed towards animal production to reduce antimicrobial selective pressure and antimicrobial resistance (AMR) in microorganisms and safeguard the antimicrobial efficacy of treatments in human medicine. This systematic review evaluated the effectiveness of interventions that have been applied to reduce or improve veterinary antimicrobial usage and aimed at decreasing resistant bacteria in chicken broiler and pig production contexts. METHODS: Original articles were identified by searching PubMed™, Scopus™, The Cochrane Library™, and Web of Science™, and grey literature by searching DANS EASY™, WorldCat™ and RCAAP™. Inclusion criteria included: chicken broiler or pig populations (predestined for meat production), interventions intended to reduce/improve antimicrobial use, comparator with standard or no use of antimicrobials, outcomes related to prevalence of resistant bacteria, farm level studies, original data, and analytical observational studies. Data was extracted from eligible studies and meta-analysis using random or fixed effects models was conducted for combinations including type of intervention, bacterial species, production type and animal populations. Models were selected according to heterogeneity between studies. The effectiveness of interventions was assessed using pooled odds ratio of resistance to antimicrobial substances/classes by bacteria for associations between animal populations with and without intervention. RESULTS: A total of 46 studies were eligible for review. For chicken broilers, most interventions were identified as antimicrobial restrictions on all non-therapeutic use (46%), complete restriction (27%), and prohibition on antimicrobials used for growth promotion (23%). As for pig populations, restrictions were mainly observed on all non-therapeutic use (37%), complete restriction (37%) and group treatments (22%). For meta-analysis, 21 studies were pooled after assessment of existing combinations. These combinations demonstrated a protective effect for most antimicrobial classes in Escherichia coli, Campylobacter and Enterococcus isolates from samples of chicken broilers as well in Escherichia coli and Campylobacter spp. from samples of pigs, compared to animals raised under conventional production or without intervention. Increased odds of resistance were only observed for cephalosporins in E. coli and broilers raised without antimicrobials, and to fluoroquinolones and quinolones in Campylobacter and pigs raised without antimicrobials, compared to conventional production. CONCLUSIONS: Our study indicates that organic production, antimicrobial-free farms, and group treatment restrictions are recommended for AMR reduction, providing information that may support decision-making to tackle AMR and better reporting to improve comparability of results between studies.

Assessing antimicrobial resistance occurrence in the Portuguese food system: Poultry, pigs and derived food, 2014-2018.

Antimicrobial resistance (AMR) spread in the food system is a major threat to public and animal health. We describe AMR trends in zoonotic bacteria and identify risk factors associated with AMR occurrence in animals and derived food in Portugal. Data from the Portuguese AMR surveillance programme on food-producing animals, 2014-2018, were used. AMR frequencies were calculated for Escherichia coli, Campylobacter and Salmonella in broilers, turkeys, pig populations and their derived food products. AMR-associated factors were studied for Salmonella isolates: population, sampling stage (farm, slaughterhouse and processing plant), sample type (environmental, carcase and food), sampler (HACCP, industry, official and official and industry), sample context (control and eradication programmes and monitoring), year (2014-2018) and season. Logistic regression was applied to estimate crude odds ratio and adjusted odds ratio (aOR) with 95% confidence intervals (95% CI). The final models were obtained using a backward stepwise method. This study included 2,157 Escherichia coli, 561 Campylobacter and 1,071 Salmonella isolates. The highest prevalence estimates amongst tested antimicrobials for each bacterial species in 2014-2018 had the following ranges: (i) (fluoro)quinolones: E. coli: 84%-93%, Campylobacter: 94%-98%; (ii) tetracyclines: E. coli: 68%-91%, Campylobacter: 87%-91%, Salmonella: 72%; (iii) penicillins: E. coli: 82%-100%; (iv) sulphonamides: E. coli: 68%-82%. Compared with the reference categories for host (broiler), year (2014), season (winter) and sampler (HACCP own checks), resistance to at least one antimicrobial in Salmonella was significantly less likely in laying hens (aOR 0.28; 95% CI: 0.18-0.42), 2016 (aOR 0.56; 95% CI: 0.33-0.93), 2017 (aOR 0.29; 95% CI: 0.17-0.51) and 2018 (aOR 0.35; 95% CI: 0.20-0.61), autumn (aOR 0.63; 95% CI: 0.40-0.97) and more likely to occur in broiler products (aOR 5.14; 95% CI: 2.61-10.54), pork products (aOR 6.84; 95% CI: 3.74-12.98) and official and industry combined sampling (aOR 2.16; 95% CI: 1.06-4.47). This study reveals a high prevalence of Salmonella resistance, especially during the summer and in post-farm stages of the Portuguese food system to nearly all antimicrobials and in the summer in farms to (fluoro)quinolones. Measures to tackle resistance are required.

Multi-Drug and ß-Lactam Resistance in Escherichia coli and Food-Borne Pathogens from Animals and Food in Portugal, 2014-2019.

Animal and food sources are seen as a potential transmission pathway of antimicrobial resistance (AMR) to humans. The aim of this study is to describe Campylobacter, Salmonella, and commensal Escherichia coli multi-drug resistance (MDR) in the food chain between 2014 and 2019 in Portugal. AMR surveillance data from food-producing animals and food were assessed. MDR relative frequencies were estimated by bacterial genus and year. AMR profiles were created using observations of resistance to antimicrobial classes from each isolate. Antimicrobial susceptibility testing results were clustered using k-modes. Clusters were described by population, AMR classification, ß-lactamases, sample stage, sample type, season, and year. Overall, MDR was more prevalent for E. coli, ranging from 74-90% in animal and 94-100% in food samples. MDR was found to be more widespread in resistance profiles that were common among E. coli and Salmonella isolates and in those exclusively observed for E. coli, frequently including (fluoro)quinolones and cephalosporins resistance. ß-lactam resistance was observed around 75% to 3rd/4th-generation cephalosporins in E. coli. Clusters suggest an escalating MDR behaviour from farm to post-farm stages in all bacteria and that Salmonella (fluoro)quinolones resistance may be associated with broilers. These findings support policy and decision making to tackle MDR in farm and post-farm stages.