Antimicrobial use and resistance in food animal production: food safety and associated concerns in Sub-Saharan Africa.

The use of antimicrobials in food animal (FA) production is a common practice all over the world, with even greater usage and dependence in the developing world, including Sub-Saharan Africa (SSA). However, this practice which serves obvious economic benefits to producers has raised public health concerns over the last decades, thus driving the selection and dissemination of antimicrobial resistance and adversely impacting food safety and environmental health. This review presents the current and comprehensive antimicrobial usage practices in food animal production across SSA. We further highlighted the overall regional drivers as well as the public health, environmental, and economic impact of antimicrobial use in the production of food animals. Antimicrobial use is likely to increase with even exacerbated outcomes unless cost-effective, safe, and sustainable alternatives to antibiotics, especially probiotics, prebiotics, bacteriocins, antimicrobial peptides, bacteriophages, vaccines, etc. are urgently advocated for and used in food animal production in SSA. These, in addition to the implementation of strong legislation on antimicrobial use, and improved hygiene will help mitigate the public health concerns associated with antimicrobial use in food animals and improve the well-being and safety of food animals and their products.

Healthcare-associated infections and antimicrobial use in acute care hospitals: a point prevalence survey in Lombardy, Italy, in 2022.

BACKGROUND: Healthcare-Associated Infections (HAIs) are a global public health issue, representing a significant burden of disease that leads to prolonged hospital stays, inappropriate use of antimicrobial drugs, intricately linked to the development of resistant microorganisms, and higher costs for healthcare systems. The study aimed to measure the prevalence of HAIs, the use of antimicrobials, and assess healthcare- and patient-related risk factors, to help identify key intervention points for effectively reducing the burden of HAIs. METHODS: A total of 28 acute care hospitals in the Lombardy region, Northern Italy, participated in the third European Point Prevalence Survey (PPS-3) coordinated by ECDC for the surveillance of HAIs in acute care hospitals (Protocol 6.0). RESULTS: HAIs were detected in 1,259 (10.1%, 95% CI 9.6-10.7%) out of 12,412 enrolled patients. 1,385 HAIs were reported (1.1 HAIs per patient on average). The most common types of HAIs were bloodstream infections (262 cases, 18.9%), urinary tract infections (237, 17.1%), SARS-CoV-2 infections (236, 17.0%), pneumonia and lower respiratory tract infections (231, 16.7%), and surgical site infections (152, 11.0%). Excluding SARS-CoV-2 infections, the overall prevalence of HAIs was 8.4% (95% CI 7.9-8.9%). HAIs were significantly more frequent in patients hospitalized in smaller hospitals and in intensive care units (ICUs), among males, advanced age, severe clinical condition and in patients using invasive medical devices. Overall, 5,225 patients (42.1%, 95% CI 41.3-43.0%) received systemic antimicrobial therapy. According to the WHO's AWaRe classification, the Access group accounted for 32.7% of total antibiotic consumption, while Watch and Reserve classes accounted for 57.0% and 5.9% respectively. From a microbiological perspective, investigations were conducted on only 64% of the HAIs, showing, however, a significant pattern of antibiotic resistance. CONCLUSIONS: The PPS-3 in Lombardy, involving data collection on HAIs and antimicrobial use in acute care hospitals, highlights the crucial need for a structured framework serving both as a valuable benchmark for individual hospitals and as a foundation to effectively channel interventions to the most critical areas, prioritizing future regional health policies to reduce the burden of HAIs.

Antimicrobial use, residues and resistance in fish production in Africa: systematic review and meta-analysis.

In low- and middle-income countries, data on antimicrobial use (AMU) and antimicrobial resistance (AMR) in aquaculture are scarce. Therefore, summarizing documented data on AMU, antimicrobial residue (AR), and AMR in aquaculture in Africa is key to understanding the risk to public health. Google Scholar, PubMed, African Journals online, and Medline were searched for articles published in English and French following the PRISMA guidelines. A structured search string was used with strict inclusion and exclusion criteria to retrieve and screen the articles. The pooled prevalence and 95% confidence intervals were calculated for each pathogen-antimicrobial pair using random effects models. Among the 113 full-text articles reviewed, 41 met the eligibility criteria. The majority of the articles reported AMR (35; 85.4%), while a few were on AMU (3; 7.3%) and AR (3; 7.3%) in fish. The articles originated from West Africa (23; 56.1%), North Africa (8; 19.7%), and East Africa (7; 17.1%). Concerning the antimicrobial agents used in fish farming, tetracycline was the most common antimicrobial class used, which justified the high prevalence of residues (up to 56.7%) observed in fish. For AMR, a total of 69 antimicrobial agents were tested against 24 types of bacteria isolated. Bacteria were resistant to all classes of antimicrobial agents and exhibited high levels of multidrug resistance. Escherichia coli, Salmonella spp., and Staphylococcus spp. were reported in 16, 10, and 8 studies, respectively, with multidrug resistance rates of 43.1% [95% CI (32.0-55.0)], 40.3% [95% CI (24.1-58.1)] and 31.3% [95% CI (17.5-49.4)], respectively. This review highlights the high multidrug resistance rate of bacteria from aquaculture to commonly used antimicrobial agents, such as tetracycline, ampicillin, cotrimoxazole, gentamicin, and amoxicillin, in Africa. These findings also highlighted the lack of data on AMU and residue in the aquaculture sector, and additional efforts should be made to fill these gaps and mitigate the burden of AMR on public health in Africa.

The effect of selective dry cow therapies based on two different algorithms on antimicrobial use, udder health, milk production, and culling in the absence of internal teat sealant use at dry-off.

The objective of this study was to evaluate the effect of selective dry cow therapy (SDCT) strategies based on 2 different algorithms as compared with blanket dry-cow therapy for measures of udder health, milk yield, and culling in herds not using internal teat sealant. Cows from 2 commercial farms in West Texas were randomized into 3 different groups: SDCT Algorithm 1 (ALG1; n = 455) cows treated with an intramammary antimicrobial at dry-off if somatic cell count (SCC) > 200,000 cells/mL at any Dairy Herd Improvement Association (DHIA) test date or if the cow had 2 or more cases of clinical mastitis during the enrollment lactation; SDCT Algorithm 2 (ALG2; n = 458) cows treated with an intramammary antimicrobial at dry-off if SCC >200,000 cell/mL at last test date or any case of clinical mastitis during the enrollment lactation; Control cows (CON = 447) received blanket dry cow therapy. All cows enrolled in the study did not receive an internal or external teat sealant. Data related to milk and somatic cell count linear score (LSCC) was collected monthly. Milk yield and LSCC during the first 6 mo of lactation were analyzed using repeated measures ANOVA models, while Cox's Proportional Hazards models were fitted to culling and clinical mastitis data. The farm was fitted as a random effect in all models. The percentage of cows receiving antimicrobials at dry cow was 51.3, 24.7, and 100% for ALG1, ALG2, and CON, respectively. Treatment did not influence the IMI dynamics during the dry period. Additionally, no statistical differences related to treatment were observed for LSCC and milk yield. The LSCC for ALG1, ALG2, and CON was 2.44, 2.41, and 2.26, respectively. The average milk yield for ALG1, ALG2, and CON cows was 43.2, 43.2, and 44.0 kg/d, respectively. Treatment did not affect clinical mastitis incidence and culling. The cumulative incidence of clinical mastitis was 19.6%, 19.4%, and 21.4% for ALG1, ALG2, and CON cows respectively. Additionally, the cumulative risk of death or culling was 18.5%, 17.1%, and 19.5% for ALG1, ALG2, and CON cows respectively. In conclusion, SDCT strategies led to a decrease in antimicrobial drug use at dry-off, without significantly impacting the incidence of clinical mastitis, the risk of culling, LSCC and milk yield of dairy cows. However, numerical differences in LSCC and milk yield were observed between treatment groups.

Redefining On-Farm Practices: The Perceived Impact of a Responsible Antimicrobial Use Regulation on Dairy Farmers.

The global food animal industry faces a growing concern regarding antimicrobial resistance (AMR), primarily driven by the use of antimicrobials (AMs) for the treatment, control, and prevention of diseases. Addressing this challenge requires promoting responsible antimicrobial use (AMU) practices. In 2019, the province of Québec, Canada, took a significant step by implementing a regulation that limits the use of AMs of very high importance for human medicine (category I AMs as defined by Health Canada) in the food animal industry. However, the implementation of such regulation can significantly influence behavioral shifts among producers, contributing to the wider effort against AMR. Therefore, the objective of this observational study was to describe the perceived changes in knowledge of dairy producers and on-farm practices following the implementation of this regulation, using a cohort design. Data collection involved administering questionnaires to 87 dairy producers from 3 regions of the province of Québec (Estrie, Montérégie, Centre-Du-Québec) before (2017-2018) and after (2020-2021) the implementation of the regulation. The questionnaires explored the descriptive characteristics of farms, the knowledge of producers about the categorization of AMs, their on-farm treatment practices, and the perceived impacts of the regulation. Statistical analysis included t-tests and McNemar tests to compare the paired data obtained using the 2 questionnaires. The results indicated an increase in the knowledge score (the number of AMs correctly categorized by the producers by their importance for human medicine) after the implementation of the regulation, suggesting an improved understanding of the categorization of AMs based on their importance for human medicine. Trends in AMU practices for treating clinical mastitis and reproductive diseases suggested that category I AMs were less likely to be reported as the primary treatment after the regulation, while category II AMs were more often reported as primary treatment. Adoption of the selective dry cow therapy method significantly increased, while the use of teat sealants remained unchanged. Moreover, producers had divergent perceptions regarding the effect of the regulation on the cure rates and disease frequencies. This disparity emphasizes the need for comprehensive data collection to discern the risks associated with such regulatory shifts. The study acknowledges several limitations, including the potential for recall bias, confirmation bias, and desirability bias. Despite these limitations, this study shows that implementing regulations to encourage responsible AMU drives positive transformations in producers' knowledge and on-farm practices. This underscores the pivotal impact of proactive interventions in combating the escalating threat of AMR within the global food animal industry.

Adoption and decision factors regarding selective treatment of clinical mastitis on Canadian dairy farms.

As clinical mastitis (CM) treatments are responsible for a large portion of antimicrobial use on dairy farms, many selective CM treatment protocols have been developed and evaluated against a blanket treatment approach of CM cases. Selective treatment protocols use outcomes of diagnostic tests to exclude CM cases from antimicrobial treatment when they are unlikely to benefit. To tailor interventions to increase uptake of selective treatment strategies, a comprehension of current on-farm treatment practices and factors affecting treatment decisions is vital. Two questionnaires were conducted among 142 farms across 5 provinces participating in the Canadian Dairy Network for Antimicrobial Stewardship and Resistance in this cross-sectional study. Self-reported adoption of selective CM treatments by dairy farmers was 64%, with median of 82% of cows treated in those herds using selective treatment. Using logistic regression models, the odds to implement a selective CM treatment protocol increased with a decreasing average cow somatic cell count. No other associations were identified between use of a selective CM treatment protocol and farm characteristics (herd size, CM incidence, province, milking system, and housing system). Three subsets of farmers making cow-level CM treatment decisions were identified using a cluster analysis approach: those who based decisions almost exclusively on severity of clinical signs, those who used various udder health indicators, and farmers who also incorporated more general cow information such as production, age, and genetics. When somatic cell count was considered, the median threshold used for treating was >300,000 cells/mL at the last Dairy Herd Improvement test. Various thresholds were present among those considering CM case history. Veterinary laboratories were most frequently used for bacteriological testing. Test results were used to start, change, and stop treatments. Regardless of protocol, reasons for antimicrobial treatment withheld included cow being on a cull list, having a chronic intramammary infection, or being at end of lactation (i.e., close to dry off). If clinical signs persisted after treatment, farmers indicated that they would ask veterinarians for advice, stop treatment, or continue with the same or different antibiotics. Results of this study can be used to design interventions targeting judicious mastitis-related antimicrobial use, and aid discussions between veterinarians and dairy producers regarding CM-related antimicrobial use.

Associations of Swiss national reporting system's antimicrobial use data and management practices in dairy cows on tie stall farms.

Antimicrobial use (AMU) in Switzerland is above target and requires reduction especially in dairy cattle. Measuring AMU is pivotal to identify starting points for AMU reduction and so are studies investigating its potential drivers in dairy farms worldwide. However, although AMU in dairy farms is high, studies estimating AMU specifically in tie stall farms are scarce. Tie stalls are a common housing system and their prevalence among dairy farms accounts to approximatively 73%, 41% and 40% in Canada, the US and Switzerland, respectively. The objectives of this cross-sectional, retrospective observational study were to estimate AMU using the newly established Swiss national reporting system for AMU in livestock and to identify associated factors on Swiss tie stall dairy farms. We calculated the treatment incidence (TI) by using the European Medicines Agency's methodology and their Defined Daily and Defined Course Dose (DDD/DCD) standards. Data on factors potentially associated with AMU were obtained through personal interviews with farm managers on 221 farms. Retrospectively, during a 1-year period, data on a total of 7,619 treatments were extracted from the national database. Associations between management factors and TI were analyzed using a generalized linear model with gamma distribution. The mean overall TI was 5.46 DDD/cow-year (±standard deviation: 4.10 DDD/cow-year). Intramammary treatment during lactation accounted for highest TI (3.24; ± 3.16 DDD/cow-year), whereas dry-cow therapy accounted for lowest TI (0.44; ± 0.49 DCD/cow-year). Five of the investigated management factors were significantly associated with TI. Organic production (estimate -2.16; 95% confidence interval [95 CI] -3.62, -0.70) and herd size (estimate -0.81; 95 CI -1.23, -0.39) were negatively associated with TI. Specific cow breeds (Brown Swiss and Holstein Friesian: estimate 1.56; 95 CI 0.45, 2.68; estimate 1.42; 95 CI 0.03, 2.82, respectively; reference: other breeds) and the use of hygienic powders on the lying area (estimate 1.10; 95 CI 0.04, 2.17) were positively associated with TI. In conclusion, the Swiss national reporting system is a valuable tool for AMU estimation. Several herd characteristics and management factors were associated with AMU in tie stall farms. Further studies focusing on factors associated with AMU and which are amenable to intervention will help improve stewardship programs and subsequently reduce AMU in dairy cows.

The Impact of an Antimicrobial Stewardship Program on Days of Therapy in the Pediatric Center: An Interrupted Time-Series Analysis of a 19-Year Study.

BACKGROUND: We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial-resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients. METHODS: A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001-2008) and the post-intervention (2009-2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patient-days, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ². RESULTS: The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = -16.5; 95% confidence interval [CI], -30.6 to -2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881). CONCLUSION: The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.

Antimicrobial use, healthcare-associated infections, and bacterial resistance in general hospitals in China: the first national pilot point prevalence survey report.

The purpose of this study is to implement point prevalence survey (PPS), assess antimicrobial prescribing and resistance in general hospitals and clinical specialties in China, and compare them with similar data from other parts of the world. Twenty general hospitals in China were surveyed in October or November, 2019. A standardized surveillance protocol was used to collect data on patient demographics, diagnosis of infection, the prevalence and intensity of antimicrobial use, prescribing quality, bacterium type and resistance spectrum, and the prevalence and type of healthcare-associated infections (HAIs). Overall, 10,881 beds and 10,209 inpatients were investigated. The overall prevalence of antibiotic use was 37.00%, the use of antibiotic prophylaxis in surgical patients was high (74.97%). The intensity of antimicrobial use was 61.25 DDDs/100 patient days. Only 11.62% of antimicrobial prescriptions recorded the reason for prescribing. Intravenous or combination treatments comprised 92.02% and 38.07%, respectively, and only 30.65% of prescriptions referred to a microbiological or biomarker tests. The incidence of HAIs in all patients was 3.79%. The main associated factors for HAIs included more frequent invasive procedures (27.34%), longer hospital stay (> 1-week stay accounting for 51.47%), and low use of alcohol hand rubs (only 29.79% placed it bedside). Most of the resistant bacteria declined; only carbapenem-resistant Enterobacter is higher than previously reported. The prevalence of antibiotic use in general hospitals fell significantly, the overall bacterial resistance declined, and the incidence of HAI was low. However, the low quality of antimicrobial use requires urgent attention.

Assessing antimicrobial resistance in Campylobacter jejuni and Campylobacter coli and its association with antimicrobial use in Canadian turkey flocks.

Turkeys are important sources of antimicrobial-resistant Campylobacter. A total of 1063 isolates were obtained from 293 turkey flocks across Canada between 2016 and 2021 to evaluate their antimicrobial resistance (AMR) prevalence, patterns, distribution, and association with antimicrobial use (AMU). A high proportion of C. jejuni and C. coli isolates were resistant to tetracyclines and fluoroquinolones, despite the very low use of these drugs. C. jejuni isolates had a higher probability of being resistant to tetracyclines than C. coli isolates. The chance of C. jejuni isolates being resistant to fluoroquinolones, macrolides, and lincosamides was lower compared to C. coli. Isolates from the western region had a higher probability of being resistant to fluoroquinolones than isolates from Ontario. Isolates from Ontario had higher odds of being resistant to tetracyclines than isolates from Quebec. No associations were noted between the resistance and use of the same antimicrobial, but the use of certain antimicrobial classes may have played a role in the maintenance of resistance in Campylobacter (fluoroquinolone resistance - bacitracin and streptogramin use, tetracycline resistance - flavophospholipids and streptogramins use, macrolide resistance - flavophospholipid use). Low-level multidrug-resistant Campylobacter was observed indicating a stable AMR in turkeys. This study provided insights aiding future AMU and AMR surveillance.

Necessity for a System Implementing Therapeutic Drug Monitoring in Outpatient Settings Based on the Actual Use of Voriconazole Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan: A Descriptive Epidemiological Study.

Voriconazole (VRCZ) is an antifungal drug that necessitates therapeutic monitoring (TDM). Typically, TDM is recommended for patients undergoing long-term outpatient treatment. However, in Japan, insurance reimbursement for TDM is only permitted for inpatients. There is a concern that VRCZ use is growing among outpatients, although information regarding this issue remains unavailable. Therefore, we aimed to clarify the use of VRCZ by utilizing data from the National Database of Health Insurance Claims and Specific Health Checkups in Japan. The use of branded and generic oral VRCZ from 2013 to 2019 was calculated using the defined daily doses/1000 inhabitants/d (DID) for each receipt type. Oral VRCZ was used more frequently in the outpatient setting than that in the inpatient setting, with use increasing over time. The use of generic drugs began in 2016 and accounted for 52.5% of the use in 2019 among outpatients. Considering outpatient prescriptions, 76.4-81.0% were dispensed at insurance pharmacies, indicating the need for community pharmacist involvement. Accordingly, the appropriate use of VRCZ in ambulatory care should be promoted in collaboration with community pharmacists, and a reimbursement system should be established to implement TDM in ambulatory care.

Antimicrobial veterinary drug sale pattern in correlation with critically important antimicrobials for human use: A five-year study in Montenegro.

Antimicrobial resistance (AMR) poses a significant threat in veterinary medicine due to the excessive and inappropriate use of antimicrobial agents, compromising the effectiveness of these drugs. To combat AMR, the collection of data on the consumption of antibiotics is paramount, as there is a well-established connection between antibiotic use and AMR in both humans and food-producing animals. Hence, the current study aimed to generate measurable data concerning the sales patterns of antimicrobial drugs used in animal treatment in Montenegro over a five-year period (from 2017 to 2021). Furthermore, the study aimed to compare these sales figures with the overall sales of antimicrobial veterinary medicine products (AMVMPs) during the same period, with particular emphasis on the utilization of critically important antimicrobials (CIAs) for human use. Data on AMVMPs consumption from 2017 to 2021 were expressed in euros and were sourced from the Institute for Medicines and Medical Devices of Montenegro (CInMED) annual reports, complying with the regulatory framework of the Law on Medicines in this country. Research results indicate that the sales of AMVMPs increased from 2017 to peak in 2019, followed by a stable decline of 21.79% in 2021. However, the portion of selected CIAs AMVMPs in total sales experienced a minor decline from 2017 to 2019, followed by a noticeable 6.11% increase from 2019 to 2021. In order to address AMR challenges, these findings emphasize the importance of enhancing surveillance and monitoring of veterinary antimicrobial use, as well as CIAs for human use.

Contextualized understandings of dairy farmers' perspectives on antimicrobial use and regulation in Alberta, Canada.

Antimicrobial resistance (AMR) has been largely attributed to antimicrobial use (AMU). To achieve judicious AMU, much research and many policies focus on knowledge translation and behavioral change mechanisms. To address knowledge gaps in contextual drivers of decisions made by dairy farmers concerning AMU, we conducted ethnographic fieldwork to investigate one community's understanding of AMU, AMR, and associated regulations in the dairy industry in Alberta, Canada. This included participation in on-farm activities and observations of relevant interactions on dairy farms in central Alberta for 4 mo. Interviews were conducted with 25 dairy farmers. The interviews were analyzed using thematic analysis and yielded several key findings. Many dairy farmers in this sample: (1) value their autonomy and hope to maintain agency regarding AMU; (2) have shared cultural and immigrant identities which may inform their perspectives of future AMU regulation as it relates to their farming autonomy; (3) feel that certain AMU policies implemented in other contexts would be impractical in Alberta and would constrain their freedom to make what they perceive to be the best animal welfare decisions; (4) believe that their knowledge and experience are undervalued by consumers and policy makers; (5) are concerned that the public does not have a complex understanding of dairy farming and, consequently, worry that AMU policy will be based on misguided consumer concerns; and (6) are variably skeptical of a link between AMU in dairy cattle and AMR in humans due to their strict adherence to milk safety protocols that is driven by their genuine care for the integrity of the product. A better understanding of the sociocultural and political-economic infrastructure that supports such perceptions is warranted and should inform efforts to improve AMU stewardship and future policies regarding AMU.

Antimicrobial and teat sealant use and selection criteria at dry-off on Canadian dairy farms.

Infections with antimicrobial resistant pathogens are a major threat to human and animal health worldwide. Further, reduction of livestock-associated antimicrobial use (AMU) is often identified as an area of focus. Selective dry cow therapy (DCT) warrants consideration as an important way to decrease AMU on Canadian dairy farms. In addition, teat sealants (TS) are a nonantimicrobial alternative for prevention of intramammary infection during the dry period. Therefore, objectives of this study were to determine how antimicrobials and TS are used at dry-off on Canadian dairy farms to determine selective DCT uptake and enacted selection protocols. It was expected that these data will provide a baseline understanding of DCT practices and highlight areas for future intervention to further reduce AMU. An observational study was conducted utilizing 2 in-person questionnaires conducted between July 2019 and September 2021 on 144 participating dairy farms in 5 Canadian provinces (British Columbia = 30, Alberta = 30, Ontario = 31, Québec = 29, and Nova Scotia = 24). Overall, 45 farms (31%) reported adopting selective DCT, 95 (66%) enacted blanket DCT, and 4 (3%) did not provide antimicrobial DCT. Farms enacting selective DCT had approximately 50% less intramammary antimicrobials used at dry-off compared with blanket DCT farms. Cow somatic cell count history was the most common criterion for selective DCT decision-making, followed by previous clinical mastitis history, bacteriological culture, and milk production. A slight majority of farms (56%) applied TS to all cows at dry-off, whereas 17 farms (12%) used TS selectively, and 46 farms (32%) did not use TS. Larger herds more often used TS, and farms with an automatic milking system more often used TS selectively than applied to all cows. Results highlighted the variability in antimicrobial treatment and TS use protocols at dry-off on Canadian dairy farms, and the potential for further antimicrobial reduction with increased adoption of selective DCT.

Invited review: Selective treatment of clinical mastitis in dairy cattle.

Treatment of clinical mastitis (CM) and use of antimicrobials for dry cow therapy are responsible for the majority of animal-defined daily doses of antimicrobial use (AMU) on dairy farms. However, advancements made in the last decade have enabled excluding nonsevere CM cases from antimicrobial treatment that have a high probability of cure without antimicrobials (no bacterial causes or gram-negative, excluding Klebsiella spp.) and cases with a low bacteriological cure rate (chronic cases). These advancements include availability of rapid diagnostic tests and improved udder health management practices, which reduced the incidence and infection pressure of contagious CM pathogens. This review informed an evidence-based protocol for selective CM treatment decisions based on a combination of rapid diagnostic test results, review of somatic cell count and CM records, and elucidated consequences in terms of udder health, AMU, and farm economics. Relatively fast identification of the causative agent is the most important factor in selective CM treatment protocols. Many reported studies did not indicate detrimental udder health consequences (e.g., reduced clinical or bacteriological cures, increased somatic cell count, increased culling rate, or increased recurrence of CM later in lactation) after initiating selective CM treatment protocols using on-farm testing. The magnitude of AMU reduction following a selective CM treatment protocol implementation depended on the causal pathogen distribution and protocol characteristics. Uptake of selective treatment of nonsevere CM cases differs across regions and is dependent on management systems and adoption of udder health programs. No economic losses or animal welfare issues are expected when adopting a selective versus blanket CM treatment protocol. Therefore, selective CM treatment of nonsevere cases can be a practical tool to aid AMU reduction on dairy farms.

Towards One Health surveillance of antibiotic resistance: characterisation and mapping of existing programmes in humans, animals, food and the environment in France, 2021.

BackgroundInternational organisations are calling for One Health approaches to tackle antimicrobial resistance. In France, getting an overview of the current surveillance system and its level of integration is difficult due to the diversity of surveillance programmes.AimThis study aimed to map and describe all French surveillance programmes for antibiotic resistance (ABR), antibiotic use (ABU) and antibiotic residues, in humans, animals, food and the environment, in 2021. Another objective was to identify integration points, gaps and overlaps in the system.MethodsWe reviewed the literature for surveillance programmes and their descriptions. To further characterise programmes found, semi-directed interviews were conducted with their coordinators.ResultsIn total 48 programmes in the human (n = 35), animal (n = 12), food (n = 3) and/or the environment (n = 1) sectors were identified; 35 programmes focused on ABR, 14 on ABU and two on antibiotic residues. Two programmes were cross-sectoral. Among the 35 ABR programmes, 23 collected bacterial isolates. Bacteria most targeted were Escherichia coli (n = 17 programmes), Klebsiella pneumoniae (n = 13), and Staphylococcus aureus (n = 12). Extended-spectrum beta-lactamase-producing E. coli was monitored by most ABR programmes (15 of 35) in humans, animals and food, and is a good candidate for integrated analyses. ABU indicators were highly variable. Areas poorly covered were the environmental sector, overseas territories, antibiotic-resistant-bacterial colonisation in humans and ABU in companion animals.ConclusionThe French surveillance system appears extensive but has gaps and is highly fragmented. We believe our mapping will interest policymakers and surveillance stakeholders. Our methodology may inspire other countries considering One Health surveillance of ABR.

Antimicrobial use and antimicrobial resistance monitoring in pig production in the United States of America.

Monitoring antimicrobial use (AMU) and antimicrobial resistance (AMR) on farms is recognised as an important component of antimicrobial stewardship, yet the process can be resource intensive. This paper describes a subset of findings from the first year of a collaboration across government, academia and a private sector veterinary practice focused on swine production in the Midwestern United States. The work is supported by participating farmers and the greater swine industry. Twice-annual collection of samples from pigs along with AMU monitoring occurred on 138 swine farms. Detection and resistance of Escherichia coli from pig tissues was assessed, and associations between AMU and AMR were evaluated. This paper describes the methods utilised and the first-year E. coli-related results from this project. Higher minimum inhibitory concentrations (MIC) for enrofloxacin and danofloxacin in E. coli from swine tissues were associated with the purchase of fluoroquinolones. There were no other significant associations between MIC and AMU combinations in E. coli isolated from pig tissues. This project represents one of the first attempts to monitor AMU as well as AMR in E. coli in a large-scale commercial swine system in the United States of America.

Alors même que la surveillance exercée sur l'utilisation des agents antimicrobiens (UAM) et sur la résistance aux agents antimicrobiens (RAM) dans les élevages est une composante majeure reconnue de la gestion des antimicrobiens, le processus en lui-même exige une mobilisation intensive de ressources. Les auteurs décrivent un sous-ensemble de résultats obtenus au cours de la première année d'une collaboration entre les pouvoirs publics, les universités et une clinique vétérinaire privée, axée sur la production porcine dans le Midwest des états-Unis d'Amérique. Ce travail est soutenu par les éleveurs participants et par le secteur porcin au sens large. Une collecte d'échantillons porcins a été effectuée deux fois par an, parallèlement à la surveillance de l'UAM dans 138 élevages. Il a été procédé à une recherche des Escherichia coli présents dans les tissus porcins prélevés puis à la détermination de la résistance aux antimicrobiens chez les microorganismes détectés ; les corrélations éventuelles entre l'UAM et la RAM ont ensuite été évaluées. Les auteurs décrivent les méthodes utilisées dans la cadre de ce projet ainsi que les résultats en lien avec les E. coli obtenus au cours de la première année. Une corrélation a été constatée entre l'augmentation des concentrations minimales inhibitrices (CMI) recueillies pour l'enrofloxacine et la danofloxacine vis-à-vis d'E. coli dans les tissus porcins analysés, d'une part, et l'achat de fluoroquinolones, d'autre part. Aucune autre corrélation significative n'a été décelée entre les CMI recueillies et les profils d'UAM concernant les E. coli isolés à partir des tissus porcins. Ce projet représente l'une des premières tentatives conduites aux états-Unis d'Amérique pour surveiller parallèlement l'UAM et la RAM chez les E. coli dans un système commercial de production porcine à grande échelle.

Aunque se tiene por sabido que la vigilancia en las explotaciones del uso de agentes antimicrobianos (UAM) y de la resistencia a los antimicrobianos (RAM) es un importante componente de la gestión de estos fármacos, no es menos cierto que el proceso puede consumir cuantiosos recursos. Los autores exponen un ubconjunto de observaciones realizadas durante el primer año de un proyecto de colaboración entre la administración pública, el mundo universitario y una clínica veterinaria privada que tenía por objeto de estudio la producción porcina en la zona del medio oeste de los Estados Unidos de América. Respaldaban el proyecto los productores que participaban en él y el sector de la industria porcina en general. Dos veces al año se obtuvieron muestras en 138 explotaciones porcinas, en las que también se seguía de cerca el UAM. Tras realizar pruebas de detección de Escherichia coli en tejidos porcinos y analizar la resistencia de esos microorganismos a antimicrobianos, se buscaron correlaciones entre el uso de estos fármacos y la presencia de eventuales resistencias. Los autores describen los métodos empleados y los resultados obtenidos el primer año del proyecto en relación con E. coli. Se observó una correlación entre la compra de fluoroquinolonas y el aumento de la concentración inhibitoria mínima (MIC) de enrofloxacina y de danofloxacina en los E. coli analizados. No se constató ninguna otra asociación significativa entre las MIC y el uso de diferentes antimicrobianos en los E. coli aislados a partir de tejido porcino. Este proyecto constituye una de las primeras tentativas de hacer seguimiento y balance del uso de agentes antimicrobianos y de la resistencia de E. coli a estos fármacos en el sistema de producción porcina industrial de los Estados Unidos de América.

Antimicrobial use in animals: a journey towards integrated surveillance.

In 2015, the World Organisation for Animal Health (WOAH, founded as OIE) initiated the annual collection of data on antimicrobials intended for use in animals using a Microsoft Excel questionnaire. In 2022, WOAH initiated the migration to a customised interactive online system: ANIMUSE Global Database. This system enables national Veterinary Services not only to monitor and report data more easily and more accurately, but also to visualise, analyse and use data for surveillance purposes to their own benefit in the implementation of national action plans on antimicrobial resistance. This journey started seven years ago, with progressive improvements in the way data are collected, analysed and reported and continuous adaptations to overcome various challenges encountered (e.g. data confidentiality, training of civil servants, calculation of active ingredients, standardisation to enable fair comparisons and trend analyses, and data interoperability). Technical developments have been key in the success of this endeavour. However, it is important not to underestimate the importance of the human element: to listen to WOAH Members and their needs, and to exchange to solve issues, adapt tools, and gain and maintain trust. The journey is not over yet, and more developments are foreseen, such as to complement current data sources with data collected directly at the farm level; strengthen interoperability and integrated analysis with cross-sectoral databases; and facilitate institutionalisation of data collection and systematic use in monitoring, evaluation, lesson learning, reporting and, eventually, surveillance of antimicrobial use and antimicrobial resistance when implementing and updating national action plans. This paper describes how all these challenges were overcome and how future challenges will be addressed.

En 2015, l'Organisation mondiale de la santé animale (OMSA, fondée en tant qu'OIE) a démarré, au moyen d'un questionnaire Microsoft Excel, une collecte annuelle de données sur les agents antimicrobiens destinés à être utilisés chez les animaux. L'OMSA a engagé, en 2022, la migration de cette collecte vers un système interactif en ligne sur mesure : la base de données mondiale ANIMUSE. Grâce à ce système, les Services vétérinaires pourront non seulement suivre et faire remonter les données plus facilement et avec davantage de précision, mais ils pourront aussi visualiser, analyser et utiliser ces données à leurs propres fins de surveillance, dans le cadre de la mise en oeuvre de plans d'action nationaux sur la résistance aux antimicrobiens. Ce travail a commencé il y a sept ans et des progrès constants ont été enregistrés en termes de collecte, d'analyse et de notification des données ; des adaptations continues ont également permis de dépasser les différents défis rencontrés (par exemple, en termes de confidentialité des données, de formation des fonctionnaires, de calcul des ingrédients actifs, de normalisation permettant d'établir des comparaisons équitables et des analyses de tendances et d'interopérabilité des données). Les avancées techniques ont joué un rôle clé dans la réussite de cette initiative. Il est cependant essentiel de ne pas sous-estimer l'importance du facteur humain : écoute des Membres de l'OMSA et de leurs besoins, échanges afin de résoudre les problèmes, adaptation des outils et obtention et préservation de la confiance. Cette aventure n'est pas terminée et des évolutions sont à venir : ajout des données collectées directement au niveau des élevages parmi les sources de données actuelles ; renforcement de l'interopérabilité et de l'analyse intégrée en recourant aux bases de données intersectorielles ; et institutionnalisation de la collecte de données et de son usage systématique dans le suivi, l'évaluation, les enseignements, les notifications et, à terme, la surveillance de l'utilisation des agents antimicrobiens et de l'antibiorésistance lors du déploiement et de la mise à jour des plans d'action nationaux. Cet article décrit comment tous ces défis ont été surmontés, ainsi que la manière dont les futurs défis seront relevés.

En 2015, la Organización Mundial de Sanidad Animal (OMSA, fundada como OIE) implantó un sistema de obtención anual de datos sobre los productos antimicrobianos destinados a los animales, empleando para ello un cuestionario en forma de hoja de cálculo Excel. En 2022, la OMSA inició la migración de este dispositivo a un sistema interactivo en línea especialmente adaptado al efecto: la base de datos mundial ANIMUSE. Este sistema permite a los Servicios Veterinarios nacionales no solo obtener y notificar datos con más facilidad y exactitud, sino también visualizar, analizar y aprovechar esta información con fines de vigilancia en la aplicación de planes nacionales de acción sobre la resistencia a antimicrobianos. Este viaje, que empezó hace siete años, ha supuesto una progresiva mejora de los métodos de obtención, análisis y notificación de los datos y continuas adaptaciones para superar las diversas dificultades que iban surgiendo (p.ej. en cuanto a confidencialidad de los datos, formación de funcionarios, cálculo de las cantidades de principio activo, normalización con fines de comparación y de análisis de tendencias, o compatibilidad de los datos). Aunque los avances técnicos han sido fundamentales para el éxito de la empresa, no cabe subestimar la importancia del factor humano, ese empeño de escuchar a los Miembros de la OMSA y tener en cuenta sus necesidades, favorecer el intercambio para resolver problemas, adaptar las herramientas y forjar y mantener relaciones de confianza. El viaje aún no ha terminado. Previsiblemente habrá nuevos avances que permitan, por ejemplo, complementar las actuales fuentes de información con datos obtenidos directamente en la explotación, mejorar la compatibilidad y los análisis integrados con bases de datos intersectoriales, o institucionalizar en mayor medida la obtención de datos y su uso sistemático con fines de seguimiento, evaluación, aprendizaje, notificación y a la postre vigilancia del uso de antimicrobianos y de eventuales resistencias a la hora de aplicar o actualizar planes nacionales de acción. Los autores explican cómo se fueron superando todas esas dificultades y cómo se abordarán los problemas que puedan ir surgiendo en el futuro.

Risk factors for meticillin-resistant Staphylococcus aureus (MRSA) carriage in MRSA-exposed household pets.

BACKGROUND: Household pets can carry meticillin-resistant Staphylococcus aureus (MRSA) introduced to the home by their human companions. Specific factors promoting pet carriage of this pathogen have not been fully elucidated. OBJECTIVE: This study evaluated MRSA cultured from pets and the home environment in households where a human infected with MRSA had been identified, and aimed to determine potential risk factors for pet MRSA carriage. MATERIALS AND METHODS: Humans diagnosed with community-associated MRSA (CA-MRSA) skin or soft-tissue infection (SSTI) in the mid-Atlantic United States were identified. One hundred forty-two dogs and cats from 57 affected households were identified of which 134 (94.4%) pets and the household environment were sampled for bacterial culture, PCR confirmation and spa-typing for MRSA strain determination. Samples were obtained 3 months later from 86 pets. RESULTS: At baseline, 12 (9.0%) pets carried MRSA. Potential risk factors associated with carriage included pet bed (environmental) MRSA contamination, flea infestation and prior antimicrobial use in the pet. Pets tended to carry human-adapted MRSA strains and spa-types of MRSA isolates cultured from pets were concordant with strains cultured from the home environment in seven of eight homes (87.5%) at baseline. CONCLUSIONS AND CLINICAL RELEVANCE: Results may inform risk-based veterinary clinical recommendations and provide evidence for selective pet testing as a possible alternative to early removal of pets from the homes of humans infected with MRSA. MRSA contamination of the home environment is likely an important risk factor for pet MRSA carriage, and household interventions should be considered to reduce risk of MRSA carriage in exposed pets.

KNOWLEDGE OF ANTIMICROBIAL DRUG RESISTANCE (AMR) AMONG PATIENTS IN A GENERAL OUTPATIENT CLINIC IN ABUJA MUNICIPAL AREA COUNCIL (AMAC), FEDERAL CAPITAL TERRITORY, NIGERIA.

Introduction: Antimicrobial resistance (AMR) is currently prevalent and has the potential to affect everyone, of any age, in any country. In humans, animals, and the environment, antimicrobial-resistant microbes are quickly emerging and spreading. This study aims to assess the knowledge of Antimicrobial Drug Resistance (AMR) among patients in a General Outpatient Clinic in Abuja Municipal Area Council (AMAC), Federal Capital Territory, Nigeria. Methodology: This was a descriptive cross-sectional study among 400 clients in a district hospital done in 2022 using a multistage sampling technique. Data was collected using a self-administered structured questionnaire and analyzed and presented as tables, proportions, and percentages using the IBM SPSS 28 Statistical Package for the Social Sciences. Ethical approval was granted by Bingham University Teaching Hospital Ethical Research Committee, Jos, and Plateau State. Results: The study revealed that 8.5% of female respondents had good knowledge, 20.75% had fair knowledge while 27.75% had poor knowledge. Of all the male respondents, 8.5% had good knowledge, 13% had fair knowledge and 21.5% had poor knowledge. Summarily, only 68 (17.0%) of participants had good knowledge of antimicrobial resistance, 135 (33.75%) had fair knowledge of antimicrobial resistance, and 197 (49.25%) had poor knowledge of antimicrobial resistance. Test of association between knowledge of antimicrobial resistance and socio-demographics showed that marital status (χ² = 44.28, p < 0.045), Education (χ²= 123.80, p < 0.001), and Age (χ² = 112.95, p < 0.001) were statistically significant. Conclusion: The Federal, State, and Local governments, health care providers, and community health workers should focus on increasing awareness of AMR risk factors through health campaigns and programs that will aid behavioral change.