Antimicrobial Usage Data Research Articles

Investigating the WHO's AWaRe classification for assessing antimicrobial stewardship programs: A single-center study

BackgroundAWaRe (Access, Watch, Reserve) classification proposed by the World Health Organization (WHO) holds potential for assessing antimicrobial stewardship programs (ASPs). However, increase in antibiotics for non-infectious treatment might undermine the effectiveness of using the AWaRe classification for assessing ASPs. The study aimed to evaluate the antimicrobial usage by AWaRe classification and specify issues for assessing ASPs. MethodsThe retrospective study was conducted in a single center within an 845-bed hospital. Antimicrobial usage data for outpatients were obtained from medical records used for billing purposes. Antimicrobials for non-infectious treatment were defined by smaller dose of macrolides, tetracyclines with pemphigoid, rifaximin, and prophylactic sulfamethoxazole-trimethoprim (ST) agent. ResultsThe usage of antimicrobials for non-infectious treatment increased from 25.3 % to 50.1 % for the ratio of the amount to defined daily doses (DDDs) and from 46.3 % to 65.9 % for prescription days between January 2015 and March 2024. The usage of prophylactic sulfamethoxazole-trimethoprim (ST) agents increased by 2.4 times, and the usage of rifaximin increased by more than 100 times. Macrolides for non-infectious treatment was stable or fluctuated while that for infection treatment decreased to that amount for non-infectious treatment. The ratios for Access increased from 31.9 % to 58 % and 42 % to 78 % by excluding the antimicrobials for non-infectious treatment. ConclusionsThe findings suggested that the AWaRe classification might not be appropriate for assessing ASPs and comparing them among hospitals.

A registry-based comparative analysis of antibiotic usage reporting for adult cattle on Danish dairy farms

BackgroundAntimicrobial resistance (AMR) is a significant global health concern, necessitating the monitoring of antimicrobial usage (AMU). However, there is a lack of consensus on the standardized collection and reporting of AMU data in the veterinary field. In Denmark, the Danish Cattle Database (DCDB) contains treatment information on animal level, which allows counting of number of treatments carried out, used daily doses (UDD). The Danish VetStat database (VetStat) contains information on veterinary medicinal prescriptions at farm level and uses fixed standard doses of each product to calculate number of daily treatments, animal daily doses (ADD). This study aimed to compare two different numerators, UDD and ADD, used to describe AMU on Danish cattle farms, and estimate their correlation.ResultsRoutinely collected registry data from conventional dairy farms in Denmark for 2019 were used, including a total of 2,197 conventional dairy farms. The data from VetStat and the DCDB were aggregated and analysed, and treatment frequencies (TF) were calculated for both UDD and ADD, adjusting for farm size. Spearman correlation analysis and Bland–Altman plots were employed to assess the relationship and agreement between TF for ADD and UDD, respectively.The results showed a high correlation between TF for ADD and UDD for most prescription groups, i.e., groups used to categorise antibiotics based on target organs. An exception is found for the Udder prescription group, where a systematic underreporting of UDD compared to ADD was observed. This discrepancy may be due to combination treatments, and potential missing or grouped registrations in the DCDB.ConclusionsOur UDD and ADD comparison yields valuable insights on farm-level AMU. We observe strong correlations between UDD and ADD, except for udder treatments, where some farms report only 1/3 UDD compared to ADD, indicating potential underreporting. Further investigations are needed to understand the factors contributing to these patterns and to ensure the accuracy and completeness of recorded information. Standardizing AMU data collection and reporting remains crucial to tackle the global challenge of AMR effectively.

Antimicrobial surveillance in South Australian prisons: a pilot study.

ObjectivesThis study aimed to determine the feasibility of capturing antimicrobial usage data from prisons for inclusion in the Antimicrobial Use and Resistance in Australia (AURA) surveillance system and to analyse 2021 and 2022 South Australian (SA) usage data for notable trends.MethodsMonthly antimicrobial supply data for eight SA prisons were collected. Antimicrobial volume was converted into the World Health Organization metric, defined daily doses (DDD). Usage rates were calculated relative to prison occupied bed days (OBD).ResultsAnnual usage of systemic antimicrobials across eight SA prisons totalled 26,448 DDD and 23,526 DDD in 2021 and 2022 respectively. Antibacterials accounted for 80.6% of all antimicrobials dispensed during the study period. The average antibacterial usage rate in female prisons was higher on average than in male prisons. The state-wide systemic antibacterial usage rate in SA prisons declined by 11.3% from 23.8 DDDs/1000 OBD in 2021 to 21.1 DDDs/1000 OBD. Doxycycline, amoxicillin, flucloxacillin, amoxicillin-clavulanic acid, and cefalexin accounted for 72% of the total systemic antibacterial usage rate. Variation in the oral and topical antifungal agents used and the rate of use was observed between prisons.ConclusionsThis SA pilot study demonstrates the feasibility of including prisons in routine national antimicrobial surveillance using similar methodology to hospital surveillance. The contributing facilities comprised 6.1% of all Australian prison beds, and extrapolation of the results suggests that the identified gap in surveillance may equate to over 400,000 DDD per annum in prisons nationwide, equating to approximately 5% of hospital inpatient antimicrobial usage.

ANTIMICROBIAL PROPHYLAXIS IN SURGERY: A CROSS-SECTIONAL STUDY IN THE SURGICAL WARD OF A TERTIARY CARE CENTRE IN CENTRAL NEPAL

Background: Surgical Antimicrobial Prophylaxis is administration of a short course of antimicrobial agent prior to surgery. It has long been recommended for routine use in preventing occurrence of surgical site infections. The choice of drug, dosage, route, duration and timing of antimicrobial prophylaxis has been specified in the clinical practice guideline issued by American Society of Health-System Pharmacists. In the present study, we aim to seek the practice of antibiotic prophylaxis at a tertiary care centre in central Nepal and report the adherence to American and National Antimicrobial Treatment Guideline where applicable. Methods: This hospital-based cross-sectional study was conducted between January to June 2023 among 232 patients undergoing surgery at Chitwan Medical College Teaching Hospital. Data collection tool prepared with slight modification from previous studies recorded the demographic details, surgical data, surgical antimicrobial prophylaxis usage data and assessment of Prophylaxis data. Data analysis was done using SPSS-20. Results: We observed compliance to selection of drug, route of administration, dosage of antimicrobial prophylaxis with American guideline. All (100%) prophylaxis was administered parenterally for more than 72 hours in over 40% cases. Choice of drug was appropriate in over 84% of cases and dosage adequacy was observed in over 61% cases. Surgical antimicrobial prophylaxis was administered most frequently 30 minutes before surgery (52.59%). Conclusions: All the surgical patients were found to receive surgical antimicrobial prophylaxis. Ceftriaxone was the most commonly administered drug followed by combination of piperacillin and tazobactam. The duration of treatment post-surgery was found to be unnecessarily broader than recommended guideline.

Collecting Multi-country Retrospective Antimicrobial Consumption and Use Data: Challenges and Experience.

Excessive or inappropriate antimicrobial use contributes to antimicrobial resistance, emphasizing the need to monitor and document the types and quantities of antibiotics used. Thus, data on antimicrobial consumption (AMC) and antimicrobial usage (AMU) are key in informing and promoting judicious use. Our study, conducted during 2019-2023, as part of the CAPTURA project, aimed to understand the state of data availability and quality for AMC and AMU monitoring in Asia. In this article, we describe the challenges and opportunities faced and provide examples of AMU and AMC analysis. World Health Organization (WHO) and country-tailored methodologies and tools were applied to collect retrospective data from 2016 to 2019 in Bangladesh, Bhutan, Laos, Nepal, Pakistan, Papua New Guinea, Sri Lanka, and Timor-Leste. The primary indicator for national AMC was total level of consumption, expressed as total defined daily doses (DDD) per 1000 inhabitants per day for the year or period of data collected. For facility AMC and AMU, the primary indicator was total DDD per admissions per day for the year or period of data collected. Although many countries faced infrastructural challenges in data collection and storage, we managed to collect and analyze AMC data from 6 countries and AMU data from 5. The primary indicators, and additional findings, were visualized to facilitate dissemination and promote the development of action plans. Looking ahead, it is crucial that future initiatives empower each country to establish surveillance infrastructures tailored to their unique contexts, ensuring sustainable progress in the fight against antimicrobial resistance.

Markers of epidemiological success of methicillin-resistant Staphylococcus aureus isolates in European populations

ObjectivesMethicillin-resistant Staphylococcus aureus (MRSA) infections impose a considerable burden on health systems, yet there is remarkable variation in the global incidence and epidemiology of MRSA. The MACOTRA consortium aimed to identify bacterial markers of epidemic success of MRSA isolates in Europe using a representative MRSA collection originating from France, the Netherlands and the United Kingdom. MethodsOperational definitions of success were defined in consortium meetings to compose a balanced strain collection of successful and sporadic MRSA isolates. Isolates were subjected to antimicrobial susceptibility testing and whole-genome sequencing; genes were identified and phylogenetic trees constructed. Markers of epidemiological success were identified using genome-based time-scaled haplotypic density analysis and linear regression. Antimicrobial usage data from ESAC-Net was compared with national MRSA incidence data. ResultsHeterogeneity of MRSA isolate collections across countries hampered the use of a unified operational definition of success; therefore, country-specific approaches were used to establish the MACOTRA strain collection. Phenotypic antimicrobial resistance varied within related MRSA populations and across countries. In time-scaled haplotypic density analysis, fluoroquinolone, macrolide and mupirocin resistance were associated with MRSA success, whereas gentamicin, rifampicin and trimethoprim resistance were associated with sporadicity. Usage of antimicrobials across 29 European countries varied substantially, and β-lactam, fluoroquinolone, macrolide and aminoglycoside use correlated with MRSA incidence. DiscussionOur results are the strongest yet to associate MRSA antibiotic resistance profiles and antibiotic usage with the incidence of infection and successful clonal spread, which varied by country. Harmonized isolate collection, typing, resistance profiling and alignment with antimicrobial usage over time will aid comparisons and further support country-specific interventions to reduce MRSA burden.

Antimicrobial‐impregnated bone cement use in Australian hospitals: scoping pharmacist awareness and involvement in management

AbstractBackgroundAntibiotic‐impregnated bone cement (AIBC) is frequently used in arthroplasty surgery to minimise the risk of infection in the prosthetic knee or hip joint.AimTo gain greater insight into the use, documentation, and stock‐management of AIBC in Australian hospitals.MethodA mixed‐methods study was conducted. Antimicrobial surveillance data were analysed to identify Australian hospitals including AIBC in their monthly pharmacy data submissions. An online survey was distributed to pharmacists registered with the National Antimicrobial Utilisation Surveillance Program to investigate knowledge of the use, documentation, and stock‐management of bone cement.ResultsSurveillance data from January to June 2021 showed 13% (n = 28) of the 222 participating hospitals included bone cement in their antimicrobial usage data. All reported AIBC usage data contained an aminoglycoside antibiotic. Fifty‐two pharmacists responded (17% response rate) to the online survey. When asked about inventory, 35% of participants stated that their hospital pharmacies manage bone cements. Of 82 responses, 6% (n = 5) had knowledge of additional antibiotics or antifungals loaded into bone cements intraoperatively. More than half of the respondents reported that documentation of AIBC use was unclear, while others knew to search for it in prosthesis or theatre notes.ConclusionThis study has illustrated a gap in pharmacists' knowledge in the perioperative setting regarding the use and documentation of bone cement, and highlights a possible focus for future education to assist with antimicrobial stewardship in this setting. Consistency in the management and documentation of AIBC would assist in surveillance of usage, help identify variations in practice and provide opportunities for quality improvement.

Calves as Main Reservoir of Antibiotic Resistance Genes in Dairy Farms.

A side effect of antibiotic usage is the emergence and dissemination of antibiotic resistance genes (ARGs) within microbial communities. The spread of ARGs among pathogens has emerged as a public health concern. While the distribution of ARGs is documented on a global level, their routes of transmission have not been clarified yet; for example, it is not clear whether and to what extent the emergence of ARGs originates in farms, following the selective pressure exerted by antibiotic usage in animal husbandry, and if they can spread into the environment. Here we address this cutting edge issue by combining data regarding antimicrobial usage and quantitative data from selected ARGs (blaTEM, blaCTXM, ermB, vanA, qnrS, tetA, sul2, and mcr-1) encoding for resistance to penicillins, macrolides-lincosamides-streptogramins, glycopeptides, quinolones, tetracyclines, sulfonamides, and colistin at the farm level. Results suggest that dairy farms could be considered a hotspot of ARGs, comprising those classified as the highest risk for human health and that a correlation existed between the usage of penicillins and blaTEM abundances, meaning that, although the antibiotic administration is not exclusive, it remains a certain cause of the ARGs' selection and spread in farms. Furthermore, this study identified the role of calves as the main source of ARGs spread in dairy farms, claiming the need for targeted actions in this productive category to decrease the load of ARGs along the production chain.

Antibiotic Usage Pattern in Broiler Chicken Flocks in Germany.

In this work, antimicrobial usage data from 2,546 commercial broiler chicken flocks originating from 37 farms are presented. Antimicrobial usage data at the flock level were based on mandatory documentation of antibiotic treatments in livestock in Germany, collected retrospectively for the time period of 2013–2018. The data encompasses all antimicrobial treatments during the fattening period of each flock, starting with the placement of day-old chicks at the barn. The aim of this analysis was to investigate antibiotic usage patterns in broiler chicken flocks in Germany, temporal trends in treatment frequency, the proportions of different antimicrobial classes and the weights of the broiler chickens at the time of treatment. The median treatment frequency over all flocks was six, and veterinary medicinal products belonging to nine different antimicrobial classes were used. Overall, the most frequently used classes were aminoglycosides (25.6%) and lincosamides (25.6%), followed by polypeptides (21.4%) and beta-lactams (16.2%). Over the 6 years evaluated, a considerable increase in the relative usage of lincosamides and aminoglycosides was observed. Compared to the first year of data collection, the percentage of treatments with fluoroquinolones, macrolides and polypeptides decreased in consecutive years. The median age of the broiler chickens at the time of treatment was 5 days, which corresponded to a median body weight at the time of treatment of 111 g, with substantial differences among various antimicrobial classes. We showed that in Germany, the median weight of broiler chickens at the time of treatment was substantially lower than the standard weight of broilers of 1,000 g proposed by the European Surveillance of Veterinary Antimicrobial Consumption. The median weight at treatment is very much influenced by the frequency of age-specific diseases. As different antimicrobial classes are used to combat these diseases, variations in the weight at treatment may have a considerable impact on the estimated treatment indicators. Additionally, a decrease in the relative usage of the highest-priority critically important antimicrobials, such as fluoroquinolones, macrolides and polypeptides, was shown, which might be the consequence of increasing awareness of the antibiotic resistance situation as well as of antibiotic monitoring and benchmarking systems currently running in Germany.

White Paper: Bridging the gap between surveillance data and antimicrobial stewardship in the animal sector-practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks.

BackgroundThe JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions to link the surveillance of antimicrobial usage (AMU) and antimicrobial resistance (AMR) with antimicrobial stewardship (AMS) activities in four different settings. This White Paper focuses on the veterinary setting and embraces the One Health approach.MethodsA review of the literature was carried out addressing research questions in three areas: AMS leadership and accountability; AMU surveillance and AMS; and AMR surveillance and AMS. Consensus on target actions was reached through a RAND-modified Delphi process involving over 40 experts in infectious diseases, clinical microbiology, AMS, veterinary medicine and public health, from 18 countries.Results/discussionForty-six target actions were developed and qualified as essential or desirable. Essential actions included the setup of AMS teams in all veterinary settings, building government-supported AMS programmes and following specific requirements on the production, collection and communication of AMU and AMR data. Activities of AMS teams should be tailored to the local situation and capacities, and be linked to local or national surveillance systems and infection control programmes. Several research priorities were also identified, such as the need to develop more clinical breakpoints in veterinary medicine.ConclusionsThis White Paper offers a practical tool to veterinary practitioners and policy makers to improve AMS in the One Health approach, thanks to surveillance data generated in the veterinary setting. This work may also be useful to medical doctors wishing to better understand the specificities of the veterinary setting and facilitate cross-sectoral collaborations.

An observational cohort study on antimicrobial usage on dairy farms in Quebec, Canada

Quantification of antimicrobial usage (AMU) is crucial to measure the effect of intervention programs, to determine associations between usage and resistance, to compare populations, and for benchmarking purposes. The primary objective of the study was to describe quantitatively the AMU on Quebec dairy farms over 1 yr: (1) the total AMU, (2) the AMU per administration route (intramammary, injectable, oral, intrauterine), and (3) the AMU per antimicrobial class and according to the categorizations of Health Canada and the World Health Organization. The secondary objective was to assess the effect of several characteristics (herd size, level of milk production, and incidence rate of common infectious diseases) on AMU rate. The AMU data were obtained for 101 dairy farms randomly selected in 3 important Quebec dairy regions by collecting and recording all empty drug packaging and invoices for medicated feed (spring 2017 to spring 2018). The AMU rate was reported in number of Canadian defined course doses for cattle per 100 cow-years. The average herd size was 67 cows per farm, and 2/101 farms were certified organic. Overall, an estimated mean of 537 Canadian defined course doses for cattle/100 cow-years was observed. The intramammary route during lactation was the most frequently observed, followed, in decreasing order of usage, by oral route in the feed, intramammary route at drying-off, and injectable route. Oral (other than in animal feed) and intrauterine formulations were infrequently collected from the garbage cans. The 5 most frequently observed antimicrobial classes were, by decreasing order of usage, ionophores, penicillins, aminocoumarins, aminoglycosides, and polymyxins. Highest priority critically important antimicrobials as defined by the World Health Organization were mainly collected from intramammary formulations during lactation followed by injectable and drying-off intramammary formulations. The herd size was positively associated with the total AMU rate but not with the usage rate of highest priority critically important antimicrobials. Incidence of diseases along with preventive use of antimicrobials (drying-off and medicated feed with antimicrobials) explained 48% of the variance in total AMU rate.

Antimicrobial Usage and Detection of Multidrug-Resistant Staphylococcus aureus, Including Methicillin-Resistant Strains in Raw Milk of Livestock from Northern Kenya.

The association of antimicrobial usage (AMU) with prevalence of antimicrobial-resistant (AMR) Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA) in livestock raw milk consumed by pastoralists in Kenya remains unclear. We investigated the relationship between AMU and emergence of multidrug-resistant (MDR) S. aureus, including MRSA in raw milk of livestock. AMU data were obtained using sales records from veterinary pharmacies. S. aureus was isolated from 603 milk samples from various livestock species, including sheep, goat, cow, and camel reared in Isiolo and Marsabit counties in Kenya. Resistant phenotypes and genotypes were determined by disc diffusion and molecular methods, respectively. Correlation between AMU and occurrence of resistance was determined by Pearson's correlation coefficient (r) method. The consumption of various antimicrobial classes were as follows; 4,168 kg of oxytetracycline, 70 kg of sulfonamides, 49.7 kg of aminoglycosides, 46 kg of beta-lactams, 39.4 kg of macrolides, and 0.52 kg for trimethoprim. The S. aureus isolates were mainly resistant to tetracycline (79%), ampicillin (58%), and oxacillin (33%), respectively. A few isolates (5-18%) were resistant to clindamycin, cephalexin, erythromycin, kanamycin, and ciprofloxacin. Most of the MDR-S. aureus isolates were MRSA (94%). The genetic determinants found in the AMR isolates included tetK/tetM (96.5%/19%) for tetracycline, blaZ (79%) for penicillin, aac (6')/aph (2'')/aph (3')-IIIa (53%) for aminoglycosides, mecA (41%) for oxacillin, and msrA/ermA (24%/7%) for macrolides. Oxytetracycline usage was correlated to tetK/tetM (r = 0.62/1) detection, penicillins to mecA/blaZ (r = 0.86/0.98), aminoglycoside to aac (6')/aph (2'')/aph (3')-IIIa (r = 0.76/-13), and macrolide usages for detection of ermA/msrA (r = 0.94/0.77). AMU appeared to be associated with occurrence of MDR-SA and the tetM detection. Consumption of raw milk contaminated with MRSA could pose a serious public health risk in pastoral communities in northern Kenya.

Antimicrobial Usage in Horses: The Use of Electronic Data, Data Curation, and First Results.

The usage of antimicrobial drugs (AMs) leads to an increase in antimicrobial resistance (AMR). Although different antimicrobial usage (AMU) monitoring programs exist for livestock animals in Germany, there is no such system for horses. However, with the increasing usage of electronic practice management software (EPMS), it is possible to analyze electronic field data generated for routine purposes. The aim of this study was to generate AMU data for German horses with data from the Clinic for Horses (CfH), University of Veterinary Medicine Hannover (TiHo), and in addition to show that different processes of data curation are necessary to provide results, especially considering quantitative indices. In this investigation, the number of antimicrobial doses used and the amount and percentage of active ingredients applied were calculated. Data contained all drugs administered between the 1st of January and the 31st of December 2017. A total of 2,168 horses were presented for veterinary care to the CfH and 34,432 drug applications were documented for 1,773 horses. Of these, 6,489 (18.85%) AM applications were documented for 837 (47.21%) horses. In 2017, 162.33 kg of active ingredients were documented. The most commonly used antibiotic classes were sulfonamides (84.32 kg; 51.95 %), penicillins (30.11 kg; 18.55%) and nitroimidazoles (24.84 kg; 15.30%). In 2017, the proportion of Critically Important Antibiotics (CIA)—Highest Priority used was 0.15% (0.24 kg) and the proportion of CIA—High Priority used was 20.85% (33.85 kg). Of the total 9,402 entries of antimicrobial active ingredients, the three with the largest number used were sulfonamides [n = 2,798 (29.76%)], trimethoprim [n = 2,757 (29.76%)] and aminoglycosides [n = 1,381 (14.69%)]. Comparison between Administered Daily Dose (ADA) and Recommended Daily Dose of CfH (RDDCfH), showed that 3.26% of ADA were below RDDCfH, 3.18% exceeded RDDCfH and 93.55% were within the range around RDDCfH. This study shows that data generated by an EPMS can be evaluated once the method is set up and validated. The method can be transferred to evaluate data from the EPMS of other clinics or animal species, but the transferability depends on the quality of AMU documentation and close cooperation with respective veterinarians is essential.

Antimicrobial resistance prevalence in commensal Escherichia coli from broilers, fattening turkeys, fattening pigs and veal calves in European countries and association with antimicrobial usage at country level.

The aim of this article is to report on antimicrobial resistance (AMR) in commensal Escherichia coli from livestock from several European countries. The relationships with antimicrobial usage (AMU) at country level and harmonized indicators to cover the most relevant AMR aspects for human health in animal production were also investigated. E. coli were isolated in faeces from broilers and fattening pigs (from nine countries), and fattening turkeys and veal calves (from three countries) and screened against a fixed antimicrobial panel. AMU data were collected at farm and average treatment incidences stratified by antimicrobial class, country and livestock species were calculated. Associations between AMR and AMU at country level were analysed. Independent of animal species, the highest resistance was observed for ampicillin, sulphamethoxazole, tetracycline and trimethoprim. E. coli from broilers showed the highest resistance level for (fluoro)quinolones, and multidrug resistance peaked in broilers and fattening turkeys. Colistin resistance was observed at very low levels with the exception of fattening turkeys. High resistance to third- and fourth-generation cephalosporins was detected in broilers and fattening turkeys. The lowest levels of resistance were for meropenem, azithromycin and tigecycline (<1 %). Significant correlations between resistance and usage at country level were detected in broilers for polymyxins and aminoglycosides, and in fattening pigs for cephalosporins, amphenicols, fluoroquinolones and polymyxins. None of the correlations observed between AMR and AMU were statistically significant for fattening turkey and veal calves. The strength of the analysis performed here is the correlation of aggregated data from the same farms at country level for both AMU and AMR within antimicrobial classes.

1004. Interactive Dashboards for Antimicrobial Usage and Standardized Antimicrobial Administration Ratio Data

BackgroundAntimicrobial stewardship (AMS) programs can report to the NHSN Antimicrobial Usage and Resistance (AU) module and receive Standardized Antimicrobial Administration Ratios (SAARs) to allow for inter- and intra-facility benchmarking. Output from NHSN for antimicrobial usage is a line listing, rate table, pie chart, or bar chart showing one location at a time, and a line listing for SAAR data We aimed to create interactive data visualization dashboards for end-user’s consumption and for the AMS program staff to identify potential areas of intervention.MethodsA multidisciplinary work group consisting of data analysts, infectious diseases physicians, and infectious diseases pharmacists determined dashboard content, layout, and comparison charts. Graph types were tested to determine the best visual output for antimicrobial usage data and SAAR. Patient-days and antimicrobial usage data based on bar-code administration were captured from the electronic medical record and imported into the NHSN platform for analysis. Analyzed data were then exported from the NHSN site for building the dashboards.ResultsA multi-faceted dashboard was developed in Tableau® to view antimicrobial usage data and SAAR. Dashboard capabilities include the option to view as facility wide, location type, or at a specific unit level for comparison of the usage of antimicrobial classes, specific agents, or SAARs for multiple locations. It can be visualized as a monthly or quarterly display. This allows for quick direct comparison of antimicrobial usage on the same graph by unit to determine outliers (Figure 1). The dashboard allows visualization of all SAAR types by location and unit level on one page showing the entire picture for the location type or unit (figures 2,3). These dashboards give the ability to trend antimicrobial usage and SAARs across units easier than reviewing a line listing or graph of each unit individually.ConclusionWe developed interactive antimicrobial usage and SAAR dashboards. These dashboards can be used by hospitals reporting to NHSN for informing front line staff and for decision-making at the AMS program level. Disclosures All authors: No reported disclosures.

Monitoring Antibiotic Usage in German Dairy and Beef Cattle Farms-A Longitudinal Analysis.

It is well-established that antimicrobial use is a major factor for the development of antimicrobial resistance. To analyze the associations between antimicrobial resistance and usage of antimicrobial agents, data from monitoring and surveillance systems are crucial. Within the project VetCAb (Veterinary Consumption of Antibiotics), antibiotic usage data in German livestock is regularly collected and evaluated. Based on a cross-sectional study in 2011, the project was continued as the longitudinal study VetCAb-Sentinel with ongoing participant recruitment and data collection from 2013. The data collection is based on official German application and delivery forms (ADF), voluntarily provided by veterinarians and farmers. In this study the results of antibiotic usage data of dairy cows, dairy calves and beef cattle were described, using a semi-annual treatment frequency, and 95,944 ADF issued between 2011 and 2015 were analyzed. Results show that the median of the treatment frequency in dairy calf and beef cattle holdings slightly decreased from 0.4 to 0.3 and from 0.2 to 0 days, respectively, whereas the median in dairy cow holdings ranged between 1.9 and 2.3 during the observed period. Temporal changes and the effect of the factors “farm size” and “region” on the treatment frequency were investigated, using multiple linear mixed and logistic regression models. Generally, the factor “time” has a statistically significant impact on the treatment frequency in all production types. In addition, a temporal trend test over the first six half-years shows that an increasing linear trend can be stated in dairy cows and dairy calves (p = 0.017; p = 0.004, respectively). If the time-period is extended to all eight half-years under study, this turns into a quadratic effect (dairy cows: p = 0.006; dairy calves: p < 0.001). In dairy calves and beef cattle the factor “farm size” also has a statistically significant impact. The factor “region,” in contrast, shows no statistically significant impact at all. Compared to other livestock populations in Germany, the use of antimicrobials in dairy cows, dairy calves, and beef cattle appears to be low, but varies across several associated factors. Considering these effects, it is recommended that the size of dairy calf and beef cattle holdings is regularly considered in the evaluation of antimicrobial usage data over time.

Trends and correlates of antimicrobial use in broiler and turkey farms: a poultry company registry-based study in Italy.

Antimicrobial usage (AMU) in livestock plays a key role in the emergence and spread of antimicrobial resistance. Analysis of AMU data in livestock is therefore relevant for both animal and public health. To assess AMU in 470 broiler and 252 turkey farms of one of Italy's largest poultry companies, accounting for around 30% of national poultry production, to identify trends and risk factors for AMU. Antimicrobial treatments administered to 5827 broiler and 1264 turkey grow-out cycles in 2015-17 were expressed as DDDs for animals per population correction unit (DDDvet/PCU). A retrospective analysis was conducted to examine the effect of geographical area, season and prescribing veterinarian on AMU. Management and structural interventions implemented by the company were also assessed. AMU showed a 71% reduction in broilers (from 14 to 4 DDDvet/PCU) and a 56% reduction in turkeys (from 41 to 18 DDDvet/PCU) during the study period. Quinolones, macrolides and polymyxins decreased from 33% to 6% of total AMU in broilers, and from 56% to 32% in turkeys. Broiler cycles during spring and winter showed significantly higher AMU, as well as those in densely populated poultry areas. Different antimicrobial prescribing behaviour was identified among veterinarians. This study evidenced a decreasing trend in AMU and identified several correlates of AMU in broilers and turkeys. These factors will inform the design of interventions to further reduce AMU and therefore counteract antimicrobial resistance in these poultry sectors.

Quantitative and qualitative analysis of antimicrobial usage patterns in 180 selected farrow-to-finish pig farms from nine European countries based on single batch and purchase data.

Farm-level quantification of antimicrobial usage (AMU) in pig farms. In a cross-sectional study, AMU data on group treatments administered to a single batch of fattening pigs from birth to slaughter (group treatment data) and antimicrobials purchased during 1 year (purchase data) were collected at 180 pig farms in nine European countries. AMU was quantified using treatment incidence (TI) based on defined (DDDvet) and used (UDDvet) daily doses and defined (DCDvet) and used (UCDvet) course doses. The majority of antimicrobial group treatments were administered to weaners (69.5% of total TIDDDvet) followed by sucklers (22.5% of total TIDDDvet). AMU varied considerably between farms with a median TIDDDvet of 9.2 and 7.1 for a standardized rearing period of 200 days based on group treatment and purchase data, respectively. In general, UDDvet and UCDvet were higher than DDDvet and DCDvet, respectively, suggesting that either the defined doses were set too low or that group treatments were often dosed too high and/or administered for too long. Extended-spectrum penicillins (31.2%) and polymyxins (24.7%) were the active substances most often used in group treatments, with the majority administered through feed or water (82%). Higher AMU at a young age was associated with higher use in older pigs. Collecting farm-level AMU data of good quality is challenging and results differ based on how data are collected (group treatment data versus purchase data) and reported (defined versus used daily and course doses).

Dynamics of antimicrobial resistance in intestinal Escherichia coli from children in community settings in South Asia and sub-Saharan Africa

The dynamics of antimicrobial resistance (AMR) in developing countries are poorly understood, especially in community settings, due to a sparsity of data on AMR prevalence and genetics. We used a combination of phenotyping, genomics and antimicrobial usage data to investigate patterns of AMR amongst atypical enteropathogenic Escherichia coli (aEPEC) strains isolated from children younger than five years old in seven developing countries (four in sub-Saharan Africa and three in South Asia) over a three-year period. We detected high rates of AMR, with 65% of isolates displaying resistance to three or more drug classes. Whole-genome sequencing revealed a diversity of known genetic mechanisms for AMR that accounted for >95% of phenotypic resistance, with comparable rates amongst aEPEC strains associated with diarrhoea or asymptomatic carriage. Genetic determinants of AMR were associated with the geographic location of isolates, not E. coli lineage, and AMR genes were frequently co-located, potentially enabling the acquisition of multi-drug resistance in a single step. Comparison of AMR with antimicrobial usage data showed that the prevalence of resistance to fluoroquinolones and third-generation cephalosporins was correlated with usage, which was higher in South Asia than in Africa. This study provides much-needed insights into the frequency and mechanisms of AMR in intestinal E. coli in children living in community settings in developing countries.

Presence of antimicrobial resistance and antimicrobial use in sows are risk factors for antimicrobial resistance in their offspring.

This study investigated whether antimicrobial-resistant Escherichia coli in apparently healthy sows and antimicrobial administration to sows and piglets influenced antimicrobial resistance in fecal commensal E. coli from piglets. Sixty sows from three herds and three of their piglets were sampled at several time points. Antimicrobial usage data during parturition and farrowing were collected. Clinical resistance was determined for two isolates per sampling time point for sows and piglets using disk diffusion. Only 27.4% of E. coli isolates from newborn piglets showed no resistance. Resistance to one or two antimicrobial classes equaled 41.2% and 46.8% in isolates from sows and piglets, respectively, for the overall farrowing period. Multiresistance to at least four classes was found as frequently in sows (15.6%) as in piglets (15.2%). Antimicrobial resistance in piglets was influenced by antimicrobial use in sows and piglets and by the sow resistance level (p≤0.05). Using aminopenicillins and third-generation cephalosporins in piglets affected resistance levels in piglets (odds ratios [OR] >1; p≤0.05). Using enrofloxacin in piglets increased the odds for enrofloxacin resistance in piglets (OR=26.78; p≤0.0001) and sows at weaning (OR=4.04; p≤0.05). For sows, antimicrobial exposure to lincomycin-spectinomycin around parturition increased the resistance to ampicillin, streptomycin, trimethoprim-sulfadiazine in sows (OR=21.33, OR=142.74, OR=18.03; p≤0.05) and additionally to enrofloxacin in piglets (OR=7.50; p≤0.05). This study demonstrates that antimicrobial use in sows and piglets is a risk factor for antimicrobial resistance in the respective animals. Moreover, resistance determinants in E. coli from piglets are selected by using antimicrobials in their dam around parturition.