Abstract
Early detection of emerging carbapenem-resistant Enterobacteriaceae (CPE) in food-producing animals is essential to control the spread of CPE. We assessed the risk of CPE introduction from imported livestock, livestock feed, companion animals, hospital patients, and returning travelers into livestock farms in The Netherlands, including (1) broiler, (2) broiler breeder, (3) fattening pig, (4) breeding pig, (5) farrow-to-finish pig, and (6) veal calf farms. The expected annual number of introductions was calculated from the number of farms exposed to each CPE source and the probability that at least one animal in an exposed farm is colonized. The total number of farms with CPE colonization was estimated to be the highest for fattening pig farms, whereas the probability of introduction for an individual farm was the highest for broiler farms. Livestock feed and imported livestock are the most likely sources of CPE introduction into Dutch livestock farms. Sensitivity analysis indicated that the number of fattening pig farms determined the number of high introductions in fattening pigs from feed, and that uncertainty on CPE prevalence impacted the absolute risk estimate for all farm types. The results of this study can be used to inform risk-based surveillance for CPE in livestock farms.
Highlights
Antimicrobial-resistant (AMR) bacteria have been one of the greatest public health challenges since the 1950s [1]
The results indicate that 22% of the 2652 fattening pig farms and 12% of the 4513 pig farms in The Netherlands would be exposed to Carbapenemase-producing Enterobacteriaceae (CPE)
Feed and imported livestock are expected to pose the highest risk of CPE introduction to pig, broiler, and veal calf farms
Summary
Antimicrobial-resistant (AMR) bacteria have been one of the greatest public health challenges since the 1950s [1]. Increased use of broad-spectrum antibiotics has resulted in a race between resistant bacteria and treatments. The lagging development of new antibiotics and the speed at which resistance emerges are propelling the healthcare sector toward using “drugs of last resort”, administered only after other antibiotics have failed. One antimicrobial class of last resort, carbapenems, represents extremely potent, broad-spectrum drugs for treating serious infections, primarily from multidrug-resistant Enterobacteriaceae [2]. Enterobacteriaceae with carbapenem-resistant genes have a 50% mortality rate in humans due to the absence of alternative antibiotic treatments [3]. Carbapenemase-producing Enterobacteriaceae (CPE) have spread globally since early 2010 in hospital facilities and have risen at an alarming rate in the human community [4,5]
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