Preventive Use Of Antimicrobials Research Articles

Antimicrobial Use in Pig Farms in the Midwestern Region of Minas Gerais, Brazil.

The use of antimicrobials in swine production is an issue that concerns the whole world due to their impact on animal and public health. This study aimed to verify the antimicrobial use in 29 commercial full-cycle farms in the midwestern region of the state of Minas Gerais, since this region is a hub of intensive pig farming in Brazil, as well as the possible correlations between the use of antimicrobials, biosecurity, and productivity. A total of 28 different drugs used for preventive purposes were described. On average, the herds used seven drugs, exposing the piglets for 116 days and totaling 434.17 mg of antimicrobials per kilogram of pig produced. Just eight active ingredients made up 77.5% of the total number of drugs used on the studied herds. Significant differences were found between the variables, biosecurity score and number of sows, antimicrobial amount and number of drugs, number of drugs and number of sows, and between productivity and biosecurity scores. The use of antimicrobials was considered excessive in the swine farms in the state of Minas Gerais compared to what was reported in Brazil and in other countries. Educational measures and better control should be proposed to reduce the preventive use of antimicrobials.

Easy and reliable assessment of the prevalence of porcine post-weaning diarrhoea.

Post-weaning diarrhoea is a condition of increasing importance due to recent restrictions and bans on the preventive use of antimicrobials and medicinal zinc oxide. For various purposes, it is valuable to monitor the occurrence of post-weaning diarrhoea. The aim of this paper was to propose a protocol for easy and reliable assessment of the prevalence of post-weaning diarrhoea within a section of pigs as an alternative to clinical examination of a random sample of pigs. Two datasets were collected in two different observational field investigations, including more than 4000 individual clinical examinations of newly weaned pigs. First we identified a clinical marker for post-weaning diarrhoea. Second, we drew samples by simulation from our two dataset using different simplified sampling strategies and compared these to conventional random sampling strategies. The prediction error for estimates of the diarrhoea prevalence within a section was compared for the different sampling strategies. The study showed that pigs with diarrhoea had an increased risk of displaying diarrheic soiling of the hind part as well as dull, long, and bristly hair coat, and possibly also hollow flanks and a suboptimal body condition score. Diarrheic soiling of the hind part was the best clinical predictor of diarrhoea; our best estimate of the diagnostic sensitivity was 76.1% (95% credible interval: 72.0, 79.8), and the specificity was 97.1% (95% credible interval: 96.5 0.97.7). Diarrheic soiling of the hind is only a valid clinical predictor of diarrhoea for the first 14 days after insertion into the nursery unit. The precision and accuracy of prevalence estimates were similar for haphazard sampling compared to random sampling of the pigs. Likewise, sampling from a restricted number of pens produced prediction errors similar to sampling across all pens. Yet, the study had limitations regarding sample sizes, and furthermore it is difficult to provide certainty for absence of effects. We recommend sampling pigs haphazardly within at least three randomly selected pens for post-weaning diarrhoea prevalence surveys in order to easily obtain a reliable prevalence estimate. Based on our findings, we conclude the paper by proposing a simple four-step protocol for surveys of the within-section prevalence of post-weaning diarrhoea.

Evidence-Based Recommendations for Herd Health Management of Porcine Post-Weaning Diarrhea.

Simple SummaryIn this paper, you will find recommendations on how to prevent post-weaning diarrhea in pigs kept in indoor pig herds. The recommendations are based on the scientific knowledge that is currently available. The authors first validated that Danish veterinarians working with pigs demanded such recommendations. Then, we collected papers written by other researchers who had summarized the scientific knowledge on different topics related to post-weaning diarrhea. From the papers, we extracted and synthesized 79 specific recommendations that may help veterinarians and pig producers make good decisions for their pig herd. The paper exemplifies a novel approach to summarizing and transferring science into practice that may be of interest to people that are not involved with pigs and post-weaning diarrhea.Aided by their advising veterinarians, pig producers need to make difficult decisions regarding herd health management strategies. For instance, the preventive use of antimicrobials and medicinal zinc oxide must be substituted with more sustainable preventive approaches to porcine post-weaning diarrhea. Veterinarians and pig producers may find assistance in knowledge based on evidence in this regard; however, the overwhelming scientific literature is not always readily available. The overall aim of this paper is to suggest herd health management decision-support tools that can aid veterinary-assisted decision making in the control of porcine post-weaning diarrhea at a tactical level. The first objective was to validate the need for a herd health management concept, including two decision-support tools. The second objective was to develop evidence-based recommendations that can aid veterinary-assisted decision-making for the herd health management of post-weaning diarrhea. The first objective was investigated by a questionnaire-based study among veterinary pig practitioners in Denmark. For the second objective, we conducted a scientific summary based on scientific review papers identified through a systematic search in three databases. From the papers, we synthesized and extracted 79 specific recommendations. In this paper, we report comprehensive evidence-based recommendations for the herd health management of post-weaning diarrhea.

Effect of selective dry cow treatment on udder health and antimicrobial usage on Dutch dairy farms

Since 2013, selective dry cow treatment (SDCT) has been the standard approach in the Netherlands where farmers select cows for the use of antimicrobials at drying-off. Shortly after its introduction, antimicrobial usage decreased significantly, and no significant association was found between the level of SDCT and clinical mastitis (CM). Obviously, at that time long-term associations could not be evaluated. This study aimed to provide insight into the methods and level of implementation of SDCT on Dutch dairy farms with a conventional milking system (CMS) or an automatic milking system (AMS) in 2016 and 2017, several years after the implementation of SDCT. Udder health and antimicrobial use were also assessed. For this study, 262 farmers recorded dry cow treatments as well as all CM cases in the period from May 1, 2016, until April 30, 2017. Additionally, somatic cell count (SCC) data on cow and herd level, treatment data on herd level and questionnaire results on udder health management were collected. Data were analyzed using descriptive statistics with differences between milking systems being evaluated using nonparametric univariable statistics. In the study period, SDCT was applied on almost all (98.8%) of the participating dairy farms. The main reason for applying antimicrobials at drying-off was either the SCC history during the complete previous lactation or the SCC at the last milk recording before drying-off. The median percentage of cows treated with antimicrobials was 48.5%. The average incidence rate of CM was 27.3 cases per 100 cows per year. From all CM cases that were registered per herd, on average 32.8% were scored as mild, 42.2% as moderate, and 25.0% as severe CM. The mean bulk tank SCC of the herds was 168,989 cells/mL. A cow was considered to have subclinical mastitis (SCM) if individual SCC was ≥150,000 cells/mL for primiparous and ≥250,000 cells/mL for multiparous cows. Passing these threshold values after 2 earlier low SCC values was considered a new case of SCM. The mean incidence rate of SCM in these herds was 62.5 cases per 100 cows per year. Bulk tank SCC and the incidence rate of SCM on farms with a CMS were statistically lower than on farms with an AMS, whereas the incidence rate of CM did not significantly differ between both groups of farms. The AMS farms had more cows per herd treated with antimicrobials at drying-off and a larger proportion of severe CM cases than did CMS farms. It is unknown whether the differences are due to the milking system or to other differences between both types of farms. This study showed the level of adoption of SDCT, udder health, and antimicrobial usage parameters several years after the ban on the preventive use of antimicrobials in animal husbandry. It found that udder health parameters did not differ from those found in Dutch studies before and around the time of implementing SDCT, whereas SDCT was widely applied on Dutch dairy farms during the study period. Therefore, it was concluded that Dutch dairy farmers were able to handle the changed policy of antimicrobial use at drying-off while maintaining indicators of a good udder health.

Monitoring udder health on routinely collected census data: Evaluating the short- to mid-term consequences of implementing selective dry cow treatment

In 2013, the preventive use of antimicrobials in Dutch livestock was prohibited, including a ban on the blanket application of antimicrobial dry cow treatment (BDCT). Since then, selective dry cow treatment (SDCT) has become the standard approach. In this study, we aimed to determine the effect of the ban on BDCT and the extent of the subsequent adoption of SDCT on antimicrobial usage (AMU) and udder health on Dutch dairy farms. In the Dutch cattle health surveillance system, AMU for dry cow treatment (AMUDCT), AMU for intramammary treatment at any point in time (AMUIMM), and udder health indicators are routinely and continuously monitored. This provided the opportunity to study associations among SDCT, udder health, and AMU on census data of approximately 17,000 dairy herds, with about 1.67 million cows in total (>2 yr old) at one moment in time in the period from 2013 until 2017. Six udder health parameters were evaluated using multivariable population-averaged generalized estimating equation models. The year in which the ban on BDCT was introduced (2013) was compared with the period thereafter (2014-2017). Additionally, AMUIMM and AMUDCT were included as independent variables to evaluate whether the extent to which SDCT was implemented on the herd level was associated with udder health. Demographic parameters were included as potential confounders. Since the ban on BDCT, overall declines of 63% in AMUDCT and 15% in AMUIMM were observed. The raw data show an improvement in 5 out of 6 evaluated udder health parameters between 2013 and 2017. Nevertheless, the multivariable model results showed that the period since the ban on BDCT was associated with a small but significant increase in the percentage of cows with high somatic cell count (HSCC) and new HSCC (+0.41% and +0.06%, respectively). Additionally, the probability of belonging to the group of herds with more than 25% of primiparous cows having HSCC during the start of lactation increased slightly, associated with the period after which BDCT was banned (odds ratio = 1.08). The probability of belonging to the group of herds with more than 25% cows having a persistent HSCC during the dry period was not affected and bulk milk somatic cell count showed a slight but significant reduction. The only udder health parameter that notably worsened during the study period was the probability of belonging to the group of herds with more than 25% of multiparous cows with a new HSCC after the dry period, during the start of lactation (odds ratio = 1.23). In herds where the farmer decided not to apply any dry cow therapy (≈20% of all herds), all udder health parameters were poorer compared with herds in which dry cow therapy was applied to some extent. The ban on BDCT and implementation of SDCT in the Netherlands was associated with a considerable reduction in AMU without a major impairment in udder health at the national level. Although negative effects of changed dry cow management were observed in some herds, we conclude that SDCT can be introduced without substantial negative effects on udder health.

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.

Update on Streptococcus suis Research and Prevention in the Era of Antimicrobial Restriction: 4th International Workshop on S. suis.

Streptococcus suis is a swine pathogen and a zoonotic agent afflicting people in close contact with infected pigs or pork meat. Sporadic cases of human infections have been reported worldwide. In addition, S. suis outbreaks emerged in Asia, making this bacterium a primary health concern in this part of the globe. In pigs, S. suis disease results in decreased performance and increased mortality, which have a significant economic impact on swine production worldwide. Facing the new regulations in preventive use of antimicrobials in livestock and lack of effective vaccines, control of S. suis infections is worrisome. Increasing and sharing of knowledge on this pathogen is of utmost importance. As such, the pathogenesis and epidemiology of the infection, antimicrobial resistance, progress on diagnosis, prevention, and control were among the topics discussed during the 4th International Workshop on Streptococcus suis (held in Montreal, Canada, June 2019). This review gathers together recent findings on this important pathogen from lectures performed by lead researchers from several countries including Australia, Canada, France, Germany, Japan, Spain, Thailand, The Netherlands, UK, and USA. Finally, policies and recommendations for the manufacture, quality control, and use of inactivated autogenous vaccines are addressed to advance this important field in veterinary medicine.

A farm-to-fork quantitative risk assessment model for Salmonella Heidelberg resistant to third-generation cephalosporins in broiler chickens in Canada

Salmonella Heidelberg resistant to ceftiofur (a third-generation cephalosporin antimicrobial agent) in broiler chicken products pose a risk to public health in Canada. The objective of this study was to assess the extent of that risk and to evaluate the effect of intervention measures along the agri-food chain. A stochastic farm-to-fork quantitative microbial risk assessment model was developed following the Codex Alimentarius Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance. Different scenarios were analyzed to assess the individual relative effects of 18 possible interventions in comparison to a baseline scenario. The baseline scenario represented the first year of on-farm antimicrobial use surveillance in the Canadian broiler industry and the year before an industry-imposed ban on the preventive use of antimicrobials of very high importance to human health (2013), where 31.3% of broiler flocks consisted of birds to which ceftiofur was administered.The baseline scenario predicted an average probability of illness of 1.1 per 100,000 servings (SE: 0.064 per 100,000), corresponding to an average of 22,000 human infections (SE: 1900) with ceftiofur-resistant S. Heidelberg per year, which is likely an overestimation. This risk was reduced by 90% or 20% when two separate scenarios designed to capture the effect of withdrawing preventive ceftiofur use from poultry production were simulated using different approaches; data used for the former scenario were confounded by other potential concomitant control measures (e.g. Salmonella vaccination programme), so the true effect likely lies somewhere between the two estimates. A theoretical ‘worst case’ scenario where all flocks had birds exposed to ceftiofur increased the risk by 107%. A 50% reduction in the probability of human prior exposure to antimicrobials, which has a selective and competitive effect for Salmonella spp. following ingestion of contaminated products, reduced the risk by 65%. Other promising measures that could be considered for further risk management included improved cleaning and disinfection between broiler flocks on farm (risk reduction by 26%), exclusive use of air chilling (risk reduction by 34%), and the improvement of meat storage and preparation conditions, e.g., no temperature abuse at retail (risk reduction by 88%). These findings showed the importance of a structured approach to assessing and potentially implementing effective interventions to reduce the risk associated with ceftiofur-resistant S. Heidelberg at different steps along the agri-food chain.Major data gaps included information on concentrations of resistant bacteria, cross contamination at processing and how ceftiofur-resistant S. Heidelberg behave in comparison with susceptible ones, e.g., in terms of growth and survival ability, as well as pathogenicity and virulence.

The AVMA's definitions of antimicrobial uses for prevention, control, and treatment of disease.

Recent state and federal legislative actions and current recommendations from the World Health Organization seem to suggest that, when it comes to antimicrobial stewardship, use of antimicrobials for prevention, control, or treatment of disease can be ranked in order of appropriateness, which in turn has led, in some instances, to attempts to limit or specifically oppose the routine use of medically important antimicrobials for prevention of disease. In contrast, the AVMA Committee on Antimicrobials believes that attempts to evaluate the degree of antimicrobial stewardship on the basis of therapeutic intent are misguided and that use of antimicrobials for prevention, control, or treatment of disease may comply with the principles of antimicrobial stewardship. It is important that veterinarians and animal caretakers are clear about the reason they may be administering antimicrobials to animals in their care. Concise definitions of prevention, control, and treatment of individuals and populations are necessary to avoid confusion and to help veterinarians clearly communicate their intentions when prescribing or recommending antimicrobial use.

Veterinarians' attitudes toward antimicrobial use and selective dry cow treatment in the Netherlands

In the Netherlands, regulations have been in place since 2008 to reduce the overall use of antimicrobials to mitigate antimicrobial resistance. As part of these regulations, a ban on the preventive use of antimicrobials, such as applying blanket dry cow treatment, was introduced and alternative measures such as selective dry cow treatment (SDCT) were implemented. Both farmers and veterinarians play an important role in implementing these measures and have a shared responsibility with respect to prudent antimicrobial use (AMU). The attitude of Dutch dairy veterinarians toward restricted AMU and toward SDCT is unknown, but a favorable attitude toward this approach seems crucial for successful implementation. In 2015, an online questionnaire was collected from 181 veterinarians that contained questions with regard to their attitude and behavior toward reduction of AMU and toward SDCT. Descriptive statistics were used to describe the data, and multivariable logistic regression models with a logit link function were applied to evaluate potential associations between veterinarians' attitudes toward AMU and SDCT and the rationale behind their mindset, based on positive and negative aspects of reduction in AMU. The veterinarians were divided into 3 groups based on their opinion on 4 statements with regard to AMU and SDCT: veterinarians with an unfavorable, a neutral, and a favorable attitude toward reduction of AMU and toward SDCT. For the multivariable logistic regression analysis, the first 2 groups were combined and compared with the veterinarians with a favorable attitude. The general attitude of Dutch dairy veterinarians toward reduction of AMU was positive, and most expressed the belief that they can still be a good veterinarian when they prescribe less antimicrobials. Veterinarians indicated they progressively promoted SDCT beginning in 2013. Most veterinarians see the advice they provide to farmers on SDCT as the best possible approach and are convinced that their farmers apply this SDCT approach. The results of the multivariable analyses showed that veterinarians with a favorable attitude mentioned positive aspects of SDCT, such as an increased consciousness of AMU among farmers, improving animal health, reducing antimicrobial resistance, and a chance to add value for the farmer, more often than other veterinarians. The latter group significantly more often indicated negative aspects of SDCT, such as a higher risk of sick cows and feeling pushed to follow the rules. In conclusion, the general attitude of Dutch dairy veterinarians toward reduction of AMU and SDCT was found to be positive. However, given the influence veterinarians potentially have on the attitude of farmers and the variability found in their attitude and behavior, veterinarians need specific attention if regional or national programs are organized trying to change behavior of farmers and encourage prudent AMU and SDCT.

EMA and EFSA Joint Scientific Opinion on measures to reduce the need to use antimicrobial agents in animal husbandry in the European Union, and the resulting impacts on food safety (RONAFA).

EFSA and EMA have jointly reviewed measures taken in the EU to reduce the need for and use of antimicrobials in food‐producing animals, and the resultant impacts on antimicrobial resistance (AMR). Reduction strategies have been implemented successfully in some Member States. Such strategies include national reduction targets, benchmarking of antimicrobial use, controls on prescribing and restrictions on use of specific critically important antimicrobials, together with improvements to animal husbandry and disease prevention and control measures. Due to the multiplicity of factors contributing to AMR, the impact of any single measure is difficult to quantify, although there is evidence of an association between reduction in antimicrobial use and reduced AMR. To minimise antimicrobial use, a multifaceted integrated approach should be implemented, adapted to local circumstances. Recommended options (non‐prioritised) include: development of national strategies; harmonised systems for monitoring antimicrobial use and AMR development; establishing national targets for antimicrobial use reduction; use of on‐farm health plans; increasing the responsibility of veterinarians for antimicrobial prescribing; training, education and raising public awareness; increasing the availability of rapid and reliable diagnostics; improving husbandry and management procedures for disease prevention and control; rethinking livestock production systems to reduce inherent disease risk. A limited number of studies provide robust evidence of alternatives to antimicrobials that positively influence health parameters. Possible alternatives include probiotics and prebiotics, competitive exclusion, bacteriophages, immunomodulators, organic acids and teat sealants. Development of a legislative framework that permits the use of specific products as alternatives should be considered. Further research to evaluate the potential of alternative farming systems on reducing AMR is also recommended. Animals suffering from bacterial infections should only be treated with antimicrobials based on veterinary diagnosis and prescription. Options should be reviewed to phase out most preventive use of antimicrobials and to reduce and refine metaphylaxis by applying recognised alternative measures.

Effect of different scenarios for selective dry-cow therapy on udder health, antimicrobial usage, and economics

The goal of dry-cow therapy (DCT) is to reduce the prevalence of intramammary infections (IMI) by eliminating existing IMI at drying off and preventing new IMI from occurring during the dry period. Due to public health concerns, however, preventive use of antimicrobials has become questionable. In this study, we evaluated the effects of 8 scenarios for selecting animals for DCT, taking into account variation in parity and cow-level somatic cell count (SCC) at drying off. The aim of this study was to evaluate udder health, antimicrobial usage, and economics at the herd level when using different scenarios for selecting cows for DCT. To enable calculation and comparison of the effects of different scenarios to select cows for DCT in an “average” herd, we created an example herd, with a virtual herd size of 100 dairy cows to be calving during a year. Udder health, antimicrobial usage, and economics were evaluated during the dry period and the first 100 d in lactation, the period during which the greatest effect of DCT is expected. This leads to an estimated 13,551 cow-days at risk during a year in a 100-cow dairy herd. In addition to a blanket DCT (BDCT) scenario, we developed 7 scenarios to select cows for DCT based on SCC. The scenarios covered a range of possible approaches to select low-SCC cows for DCT, all based on cow-level SCC thresholds on the last milk recording before drying off. The incidence rate of clinical mastitis in the example herd varied from 11.6 to 14.5 cases of clinical mastitis per 10,000 cow-days at risk in the different scenarios, and the prevalence of subclinical mastitis varied from 38.8% in scenario 1 (BDCT) to 48.3% in scenario 8. Total antimicrobial usage for DCT and clinical mastitis treatment varied over the scenarios from 1.27 (scenario 8) to 3.15 animal daily dosages (BDCT), leading to a maximum reduction in antimicrobial usage of 60% for scenario 8 compared with BDCT. The total costs for each of the scenarios showed little variation, varying from €4,893 for scenario 5 to €5,383 for scenario 8. The effect of selective DCT compared with BDCT on udder health, antimicrobial usage, and economics is influenced by the SCC criteria used to select cows for DCT. Scenario 2 resulted in the lowest increases in clinical and subclinical mastitis compared with BDCT. The greatest reduction in antimicrobial usage was achieved under scenario 8. From an economic perspective, lowest costs were achieved with scenario 5. Drying off dairy cows with antimicrobials has an effect on udder health, antimicrobial usage, and economics.

Evaluation of udder health parameters and risk factors for clinical mastitis in Dutch dairy herds in the context of a restricted antimicrobial usage policy

Recently, many changes have been implemented in Dutch dairy herds. Herd sizes have increased and antimicrobial use has been reduced. Certain types of antimicrobials can only be used in specific circumstances, and the preventive use of antimicrobials in dry cows is prohibited. The aim of this study was to quantify clinical mastitis (CM), subclinical mastitis (SCM), and risk factors associated with CM in Dutch dairy herds in 2013, in the context of these changes. For this study, 240 dairy herds were randomly selected from farms that participated in test-day milk recording, used a conventional milking system, and agreed to participate in the study. Eventually, 233 Dutch dairy farmers had complete records of CM in their herds in 2013 and 224 of these farmers completed a questionnaire on management factors potentially associated with CM. All participating farmers gave consent to use their routinely collected herd data such as test-day records and cow identification and registration data. Clinical and subclinical mastitis incidence rate (CMI and SCMI, respectively) per 100 cows per year, subclinical mastitis prevalence, and average bulk tank milk somatic cell count were obtained for 2013. The risk factor analysis was conducted using a generalized linear model with a log link function and a negative binomial distribution on herd level in Stata 13.1. A median CMI of 28.6 per 100 cows at risk per year, SCMI of 70.1 per 100 cows at risk per year, SCM prevalence of 15.8%, and bulk tank milk somatic cell count of 171×103 cells/mL were observed in 2013. Factors that were significantly associated with a higher CMI were cleaning slatted floors only once per day compared with more than 4 times a day (i.e., mechanical), a higher percentage of Holstein Friesian cows present in the herd, treating less than 50% of the cows with CM with antimicrobials, postmilking teat disinfection, and treatment of cows with elevated somatic cell count with antimicrobials. The results of this study indicated that udder health had not deteriorated compared with udder health in previous Dutch studies where herd sizes were somewhat smaller and before the restrictions in antimicrobial use. Several of the risk factors that were found can be influenced by the farmer and can prevent the occurrence of CMI. Still, when cases of CM occur, treatment with antimicrobials might be necessary to cure the CM case and is beneficial for the overall udder health in the herd.

Cefazolin restriction and a guideline to improve the use of antimicrobials for prevention of surgical site infection

The aim of this study was to determine the effectiveness of an intervention (a guideline distribution associated with the restriction of the use of cefazolin) in order to improve the use of antimicrobials in the prevention of surgical site infection (SSI). The design of the study was a prospective one, before-after intervention. It was conducted at the Clinical Hospital of the Federal University of Uberlândia, a teaching institution with 510 beds. Two interventions were effected: a guideline for antimicrobial prevention of SSI was made available; and also the use of cefazolin was restricted. The suitability of the indication and of the prescribed antibiotic, and also the time of its use were evaluated in the prevention of SSI. This study was divided into three periods: I - baseline data collection; II - data collection after creation and availability of the guideline; III - data collection during cefazolin restriction period. The indication of prevention of SSI was considered adequate in the three collection periods. In the orthopaedic trauma ward, the choice of the antibiotics was considered adequate in the three periods. In the general surgery ward however, it was adequate in 20%, 63.9% and 61.5% of cases in periods I, II and III, respectively. The length of time for antimicrobial prevention was considered adequate in 23% in period I; 46.15% in period II and 82.46% in period III. In conclusion, educational, but especially administrative interventions can increase the adequacy of the use of an antimicrobial in surgical infection prevention.

Cefazolin restriction and a guideline to improve the use of antimicrobials for prevention of surgical site infection

Cefazolin restriction and a guideline to improve the use of antimicrobials for prevention of surgical site infection

Anti-microbial Use in Animals: How to Assess the Trade-offs.

Antimicrobials are widely used in preventive and curative medicine in animals. Benefits from curative use are clear – it allows sick animals to be healthy with a gain in human welfare. The case for preventive use of antimicrobials is less clear cut with debates on the value of antimicrobials as growth promoters in the intensive livestock industries. The possible benefits from the use of antimicrobials need to be balanced against their cost and the increased risk of emergence of resistance due to their use in animals. The study examines the importance of animals in society and how the role and management of animals is changing including the use of antimicrobials. It proposes an economic framework to assess the trade-offs of anti-microbial use and examines the current level of data collection and analysis of these trade-offs. An exploratory review identifies a number of weaknesses. Rarely are we consistent in the frameworks applied to the economic assessment anti-microbial use in animals, which may well be due to gaps in data or the prejudices of the analysts. There is a need for more careful data collection that would allow information on (i) which species and production systems antimicrobials are used in, (ii) what active substance of antimicrobials and the application method and (iii) what dosage rates. The species need to include companion animals as well as the farmed animals as it is still not known how important direct versus indirect spread of resistance to humans is. In addition, research is needed on pricing antimicrobials used in animals to ensure that prices reflect production and marketing costs, the fixed costs of anti-microbial development and the externalities of resistance emergence. Overall, much work is needed to provide greater guidance to policy, and such work should be informed by rigorous data collection and analysis systems.