Feasibility study of a field survey to measure antimicrobial usage in humans and animals in the Mekong Delta region of Vietnam.

Nguyen Van Cuong,Nguyen Thi Bich Van,Guy Thwaites,Marc Choisy,Pawin Padungtod,Nguyen Phuong Cam Ly,Vo Be Hien,Doan Hoang Phu,Juan Carrique-Mas,Bach Tuan Kiet

doi:10.1093/jacamr/dlab107

Abstract

BackgroundDevelopment of antimicrobial use (AMU) surveillance systems in humans and animals is a priority for many low- and middle-income countries; however accurate estimations are hampered by a diversity of animal production systems and metrics. The Mekong Delta region of Vietnam is a ‘hotspot’ of antimicrobial resistance and is home to a high density of humans and animal populations.ObjectivesTo measure and compare AMU using different metrics (standing population, biomass and population correction unit) in the Mekong Delta, and to explore the potential of field-based data collection methods in the design of AMU surveillance systems.MethodsWe collected AMU data from humans and animals (chickens, ducks, Muscovy ducks, pigs) from 101 small-scale farms in the Mekong Delta over a fixed period (90 days in humans, 7 days in animals).ResultsHumans used 7.1 DDDkg, or 175.9 mg of antimicrobial active ingredients (AAIs) per kg of standing body mass annually; animals consumed 60.9 ADDkg or 1324 mg. In the Mekong Delta humans represented 79.3% of the total body mass but consumed 29.6% of AAIs by weight. AAIs regarded of critical importance by WHO represented 56.9% and 50.2% of doses consumed by animals and humans, respectively.ConclusionsUsing a One Health approach, we show that AMU can potentially be estimated from cross-sectional surveys, although results are hypothetical due to small sample size and are sensitive to the chosen population denominator. The methodology proposed here can potentially be scaled up be applied to design AMU surveillance in low-resource settings, allowing AMU reduction efforts to be focused on particular animal species.

Highlights

The global crisis of antimicrobial resistance (AMR) has a severe impact on human and animal populations in low- and middle-income countries (LMICs) due to limited medical and veterinary care resources, high densities of farms and excessive levels of antimicrobial use (AMU).[1,2] There is considerable evidence of a link between excessive AMU and the occurrence of resistance in humans and animals.[3,4]The Tripartite Global Action Plan, jointly developed by WHO, the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE)[5] has established AMU surveillance as a key priority action
Quantification of AMU through surveillance in human and animal systems has been set by international agencies as a priority in order to successfully tackle the global threat of AMR.[5,28]
AMU surveillance systems have been established in a number of developed countries, these are only starting to emerge in LMICs

Summary

Introduction

The global crisis of antimicrobial resistance (AMR) has a severe impact on human and animal populations in low- and middle-income countries (LMICs) due to limited medical and veterinary care resources, high densities of farms and excessive levels of antimicrobial use (AMU).[1,2] There is considerable evidence of a link between excessive AMU and the occurrence of resistance in humans and animals.[3,4]. The Tripartite Global Action Plan, jointly developed by WHO, the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE)[5] has established AMU surveillance as a key priority action. Development of antimicrobial use (AMU) surveillance systems in humans and animals is a priority for many low- and middle-income countries; accurate estimations are hampered by a diversity of animal production systems and metrics. The Mekong Delta region of Vietnam is a ‘hotspot’ of antimicrobial resistance and is home to a high density of humans and animal populations

Objectives

Results

Conclusion