Responsible Use Of Antimicrobials Research Articles

The Role of Pharmaceutical Companies in Antimicrobial Stewardship: A Case Study.

Rising levels of antimicrobial resistance pose serious dangers to patients, population health, food security, and economic stability worldwide. In response to this threat, the United Nations and the World Health Organization have called for multisectoral, multidisciplinary action, recognizing that human, animal, and environmental health are interdependent. Although the pharmaceutical industry clearly has a leading role in developing novel antimicrobials and vaccines, it is also active in many areas supporting antimicrobial stewardship. This article describes why pharmaceutical companies invest in antimicrobial stewardship, outlines why they are well suited to help address this issue, and provides examples of how the pharmaceutical industry can support the responsible use of antimicrobials. Merck & Co., Inc. (Kenilworth, NJ, USA), a large, globally operating pharmaceutical company that develops and markets both human and veterinary antimicrobials and vaccines is used as a case study for illustrating industry involvement in antimicrobial stewardship efforts.

Sustainability of antimicrobial stewardship programs in Australian rural hospitals: a qualitative study.

Objective The aim of this study was to explore the features of sustainable antimicrobial stewardship (AMS) programs in Australian rural hospitals and develop recommendations on incorporating these features into rural hospitals' AMS programs. Methods Lead AMS clinicians with knowledge of at least one AMS program sustained for >2 years in a health service in rural Australia were recruited to the study. A series of interviews was conducted and the transcripts analysed thematically using a framework method. Results Fifteen participants from various professional disciplines were interviewed. Key features that positively affected the sustainability of AMS programs in rural hospitals included a hospital executive who provided strong governance and accountability, dedicated resources, passionate local champions, area-wide arrangements and adaptability to engage in new partnerships. Challenges to building AMS programs with these features were identified, particularly in engaging hospital executive to allocate AMS resources, managing the burn out of passionate champions and formalising network arrangements. Conclusions Strategies to increase the sustainability of AMS programs in rural hospitals include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop formal network arrangements and a framework for integrated AMS programs across primary, aged and acute care. What is known about the topic? AMS programs facilitate the responsible use of antimicrobials. Implementation challenges have been identified for rural hospitals, but the sustainability of AMS programs has not been explored. What does this paper add? Factors that positively affected the sustainability of AMS programs in rural hospitals were a hospital executive that provided strong governance and accountability, dedicated resources, network or area-wide arrangements and adaptability. Challenges to building AMS programs with these features were identified. What are the implications for practitioners? Recommended actions to boost the sustainability of AMS programs in rural hospitals are required. These include using accreditation as a mechanism to drive direct resource allocation, explicit staffing recommendations for rural hospitals, greater support to develop network arrangements and support to create integrated AMS programs across acute, aged and primary care.

Antimicrobial susceptibility of bacterial isolates from ambulatory practice and from a referral hospital.

BackgroundResponsible use of antimicrobials in equine practice relies on knowledge of common bacterial isolates and their antimicrobial sensitivities.ObjectivesTo assess the frequency of bacterial resistance to a combination of parenteral penicillin and gentamicin and to trimethoprim and sulfamethoxazole for PO use in a selection of clinical isolates, and subsequently to determine the prevalence of resistance to antimicrobials that might then be used as alternatives to first‐line antimicrobials for the same isolates.MethodsRetrospective analysis of minimal inhibitory concentrations (MICs) of antimicrobials for 6354 bacterial isolates from 365 ambulatory practices and 519 isolates from a referral hospital. The MICs were used to indicate sensitivity or resistance to commonly used antimicrobials and the prevalences of resistance were compared between origin of the isolates, and among antimicrobial drugs.ResultsIsolates from the referral hospital were significantly (P < .05) more likely to be resistant to the antimicrobials tested than those derived from ambulatory practice. Overall, 91% of the ambulatory isolates and 64% of the hospital isolates were sensitive to penicillin‐gentamicin. For trimethoprim‐sulfamethoxazole combination, 82% of the ambulatory practice isolates and 56% of the referral hospital isolates were sensitive.Conclusions and Clinical ImportanceMost isolates were sensitive to penicillin and gentamicin as well as trimethoprim‐sulfamethoxazole. No predictable efficacious second choice antimicrobial was identified for those isolates resistant to the first‐line antimicrobials. The likelihood of isolates being sensitive to second choice antimicrobials was variable but generally higher for ambulatory isolates compared to referral isolates. Bacterial identification and measurement of MIC are essential to make the appropriate antimicrobial choice.

Prevalence and risk factors for multi-drug resistant Escherichia coli among poultry workers in the Federal Capital Territory, Abuja, Nigeria.

Antimicrobial resistance has emerged as a global health threat. Antimicrobial resistant Escherichia coli infections are associated with high morbidity and expenditure when compared with infections caused by susceptible strains. In Nigeria, antimicrobial drugs are readily available over-the-counter with potential for indiscriminate use by poultry farmers and eventual development of drug resistance. The objective of this study was to investigate prevalence and risk factors for multi-drug resistant E. coli among poultry workers (PW) in Abuja, Nigeria. A cross-sectional study was conducted among 122 randomly selected apparently healthy poultry workers (poultry-farmers/ sellers) in Municipal and Kuje Area Councils from December 2018 to April 2019. Data was collected on socio-demographics and exposure factors using a structured interviewer-administered questionnaire. E. coli was isolated and identified from stool samples of poultry workers. Antibiotic susceptibility testing was done using Kirby-Bauer disk diffusion method. Multidrug resistance (MDR) was defined as resistance to three or more classes of antimicrobials. Data was analyzed by computing proportions, prevalence odds-ratios (POR) and logistic regression at 5% significance level. Among PW, there were 121 males (99.2%). Mean age of the male workers was 30.6 ± 9.7years, 54.6% (n = 66) married, 57.9% (n = 70) had secondary education and 62.0% (n = 75) were farm-workers. Prevalence of E. coli was 39.7% (n = 48), highest among farm-workers (POR = 2.7, 95% Confidence Interval [CI] = 1.3-5.7; p = 0.01) compared to poultry-sellers. Of the 48 E. coli isolates, 16.7% (n = 8) were extended spectrum beta lactamase (ESBL) producers and 79.2% (n = 38) were MDR. We detected resistance against Tetracycline: (83.3%, n = 40), Sulfamethoxazole-Trimethoprim: (79.2%, n = 38), Ampicillin: (77.1%, n = 37), Streptomycin: (72.9%, n = 35), Nalidixic acid: (50%, n = 24), Gentamicin: (41.7%, n = 20), Chloramphenicol: (31.3%, n = 15), Cephalothin: (27.1%, n = 13), Nitrofurantoin: (10.4%, n = 5) and Imipenem: (6.3%, n = 3). Absence of lavatory (POR = 2.7, 95% CI = 1.1-6.7); existence of farm/market for >10years (POR = 2.5, 95% CI = 1.1-5.4) and PW's history of diarrhea in last three months (POR = 2.8, CI = 1.2-6.3) were associated with MDR. Controlling for age, absence of lavatory (adjusted OR [aOR] = 4.31, 95% CI = 1.6-11.9); PW's history of diarrhea in last three months (aOR = 3.3,95%CI = 1.3-8.5) and work exposure >10years (aOR = 0.3, 95%CI = 0.1-0.9) remained independent risk factors for MDR. Prevalence of resistant E. coli was highest among farm-workers and associated with older farms/markets, occupational exposure of over 10 years and poor hygienic measures. The management of Municipal and Kuje Area Councils were recommended to provide lavatories for public use in farm-settlements/markets. The importance of hand-hygiene and responsible use of antimicrobials in poultry production was emphasized.

Gonorrhoea.

The bacterium Neisseria gonorrhoeae causes the sexually transmitted infection (STI) gonorrhoea, which has an estimated global annual incidence of 86.9 million adults. Gonorrhoea can present as urethritis in men, cervicitis or urethritis in women, and in extragenital sites (pharynx, rectum, conjunctiva and, rarely, systemically) in both sexes. Confirmation of diagnosis requires microscopy of Gram-stained samples, bacterial culture or nucleic acid amplification tests. As no gonococcal vaccine is available, prevention relies on promoting safe sexual behaviours and reducing STI-associated stigma, which hinders timely diagnosis and treatment thereby increasing transmission. Single-dose systemic therapy (usually injectable ceftriaxone plus oral azithromycin) is the recommended first-line treatment. However, a major public health concern globally is that N. gonorrhoeae is evolving high levels of antimicrobial resistance (AMR), which threatens the effectiveness of the available gonorrhoea treatments. Improved global surveillance of the emergence, evolution, fitness, and geographical and temporal spread of AMR in N. gonorrhoeae, and improved understanding of the pharmacokinetics and pharmacodynamics for current and future antimicrobials in the treatment of urogenital and extragenital gonorrhoea, are essential to inform treatment guidelines. Key priorities for gonorrhoea control include strengthening prevention, early diagnosis, and treatment of patients and their partners; decreasing stigma; expanding surveillance of AMR and treatment failures; and promoting responsible antimicrobial use and stewardship. To achieve these goals, the development of rapid and affordable point-of-care diagnostic tests that can simultaneously detect AMR, novel therapeutic antimicrobials and gonococcal vaccine(s) in particular is crucial.

Implementation and evaluation of an antimicrobial stewardship programme in companion animal clinics: A stepped-wedge design intervention study.

To curb increasing resistance rates, responsible antimicrobial use (AMU) is needed, both in human and veterinary medicine. In human healthcare, antimicrobial stewardship programmes (ASPs) have been implemented worldwide to improve appropriate AMU. No ASPs have been developed for and implemented in companion animal clinics yet. The objective of the present study was to implement and evaluate the effectiveness of an ASP in 44 Dutch companion animal clinics. The objectives of the ASP were to increase awareness on AMU, to decrease total AMU whenever possible and to shift AMU towards 1st choice antimicrobials, according to Dutch guidelines on veterinary AMU. The study was designed as a prospective, stepped-wedge, intervention study, which was performed from March 2016 until March 2018. The multifaceted intervention was developed using previous qualitative and quantitative research on current prescribing behaviour in Dutch companion animal clinics. The number of Defined Daily Doses for Animal (DDDAs) per clinic (total, 1st, 2nd and 3rd choice AMU) was used to quantify systemic AMU. Monthly AMU data were described using a mixed effect time series model with auto-regression. The effect of the ASP was modelled using a step function and a change in the (linear) time trend. A statistically significant decrease of 15% (7%-22%) in total AMU, 15% (5%-24%) in 1st choice AMU and 26% (17%-34%) in 2nd choice AMU was attributed to participation in the ASP, on top of the already ongoing time trends. Use of 3rd choice AMs did not significantly decrease by participation in the ASP. The change in total AMU became more prominent over time, with a 16% (4%-26%) decrease in (linear) time trend per year. This study shows that, although AMU in Dutch companion animal clinics was already decreasing and changing, AMU could be further optimised by participation in an antimicrobial stewardship programme.

2042. Impact of an Antimicrobial Stewardship Program on the Healthcare-Associated Infections in a Third-Level Hospital in Yucatán, México

BackgroundAntimicrobial stewardship programs (ASPs) promote the responsible use of antimicrobials by limiting inappropriate use. This study evaluates the impact of a prospective ASP implementation on the health-care-associated infections (HCAIs) in a third-level hospital in Yucatán, México, after the establishment of an ASP in October 2017.MethodsThis was a prospective, single-center (Hospital de Alta de Especialidad de la Península de Yucatán -HRAEPY-), pre and post-intervention study, designed to analyze the impact of an ASP on health-care-associated infections rate, during January–October 2017 (pre-ASP) and January–October 2018 (post-ASP) by using comparative descriptive statistic of the monthly and annual rate of health-care-associated infections according to hospital network of epidemiological surveillance (RHOVE) in Mexico.ResultsDuring 2017, RHOVE reported 225 cases of HCAIs equivalent to a rate of 7.46/1,000 days of hospital stay. After ASP in 2018, the RHOVE reported 111 cases of HCAIs, equivalent to a rate of 4.38/1,000 days of hospital stay. This difference represented a reduction of −41.28% of the rate of HCAIs in the HRAEPY (Graphic 1). Antimicrobial susceptibility increased (pre-ASP vs. post-ASP) for 3 Gram-negatives associated with HCAIs at HRAEPY: TMP/SMX for E. coli (49% to 62%), Ciprofloxacino for K. pneumoniae (42% to 51%) and Piperacillin/Tazobactam (62% to 93%); Meropenem (61% to 72%) and Ciprofloxacino (67% to 79%) for P. aeruginosa (Graphic 2).ConclusionASP contributed to reducing the rate of HCAIs in the HRAEPY when it was implemented as an additional measure to the strategies for control of nosocomial infections. Additionally, this ASP caused an increase in the bacterial susceptibility of the most important microorganisms as a cause of infections associated with healthcare in HRAEPY. Disclosures All authors: No reported disclosures.

Use of antimicrobial agents in periodontology

With mechanical cleaning, it is never possible to remove all bacteria from tooth surfaces, in, for example, furcation sites and at the bottom of the pocket. Supporting non-surgical periodontal treatment with the use of antimicrobial agents is, therefore, an obvious approach in order to achieve a better treatment outcome.. The combination of amoxicillin and metronidazole has been thoroughly investigated as a support in periodontal treatment and deserves a place among the tools the dental care professional has for effective treatment. However, there is at present no strict indication in which clinical situations antibiotics can be successfully prescribed. Considering responsible use of antimicrobials by healthcare professionals (antimicrobial stewardship) the decision to support periodontal treatment with antibiotics should be in the hands of those authorised to provide a prescription. Additional rinsing with chlorhexidine twice daily during periodontal treatment and the subsequent two weeks (6-8 weeks) can be considered in order to enhance the effect of clinical treatment.

A survey of free-range egg farmers in the United Kingdom: Knowledge, attitudes and practices surrounding antimicrobial use and resistance

Antimicrobial resistance (AMR) is a significant global challenge affecting human health and attention has been drawn to practices of all stakeholders involved in antimicrobial prescription and administration, including in the livestock sector. This survey of free-range egg farmers (n = 117) was conducted to investigate knowledge, attitudes and practices surrounding antimicrobial use, and identify farmer-led solutions towards responsible antimicrobial use. Most participants proved knowledgeable of AMR and selected treatments based on principles of responsible medicine use. ‘Worms’ and ‘infectious diseases’ were the most common reasons for medicine use. Farms with a higher number of poultry houses, younger flock ages at depopulation and farms visited by a vet less than once a year or 3–4 times a year (compared to annually or twice a year) were more likely to select ‘ANTIBIOTICS ONLY’, as opposed to ‘BOTH ANTIBIOTICS AND ANTIPARASITICS’ or ‘ANTIPARASITICS ONLY’ as their most frequently used medicines. Participants from farms with a younger flock age at depopulation, from company-owned farms, and participants purchasing medicines from agricultural merchants instead of veterinary practices were less likely to be taking measures to reduce or replace antimicrobial use. Participants from larger farms and those that had less contact with their vet were less likely to think that they could reduce or replace the amount of antibiotics used. Survey results provided evidence for the important role of veterinarians in guiding antimicrobial stewardship through engagement, collaboration and education. Discussion groups in which farmers share best practices could assist the free-range egg industry in further promoting responsible antimicrobial use.

Whole blood RNA-Seq analysis of stocker calves reveals insights into BRD

Bovine respiratory disease (BRD) is the leading cause of morbidity and mortality in stocker cattle. It is difficult to predict which cattle will develop BRD. Improved prediction could facilitate more responsible and rational use of antimicrobials and vaccines to limit BRD. We hypothesize that altered transcriptional profiles in the blood of stocker calves on arrival represent regulatory pathways including biomarkers useful to improve prediction of BRD risk.

Balancing conflicting demands: factors influencing vets’ choice of antimicrobial agent

Antimicrobial resistance (AMR) is a major threat to both human and animal health.1,2 Antimicrobial stewardship – also referred to as prudent or responsible antimicrobial use – by veterinary surgeons is...

Antimicrobial use and suitability in long-term care facilities: A retrospective cross-sectional study

Background: Antimicrobial stewardship is the promotion of responsible antimicrobial use to reduce antimicrobial resistance, antimicrobial toxicity and cost, and to reduce the incidence of nosocomial infections. Our objectives were to measure antibiotic use rate in 10 long-term care facilities (LTCF) during a 1-year period, and to determine the appropriateness of antimicrobial prescriptions. Methods: Antibiotic prescriptions from 10 long-term care facilities, between January 2015 and January 2016, were collected from a pharmacy database. A sample of500 prescriptions was randomly selected for chart review to determine the appropriateness of the prescribed antibiotic based on published guidelines. Results: We analyzed 3,148 prescriptions for 1,313 residents (2.40 prescriptions/patient/year, median duration 7 days). Antibiotic use rate was 21.16 Defined Daily Doses/1,000 patient-days/year, or 5.42 antibiotic days/1,000 patient-days/month. Of the 500 randomly selected prescriptions, 448 were analyzed for appropriateness. Mean age of included residents was 82.5 (SD 12.1 years). 288/448 (64.3%) were female, with an average activities of daily living (ADL) score of 19.3 (SD 8.5). Urinary tract infection was the most common indication for antibiotics (177/448, 39.5%), followed by lower respiratory tract infection (144/448, 32.1%) and skin and soft-tissue infection (76/448, 17.0%). 259/448 (57.8%) of prescriptions were inappropriate, including 115/163 (70.5%) given for urinary tract infection, 78/140 (55.7%) given for lower respiratory tract infection, and 15/68 (22.0%) given for skin and soft-tissue infection. Inappropriateness varied by long-term care facility (LTCF) between 18/41 (43.9%) and 15/21 (71.4%), and by drug class between 0/5 (0%) among penicillinase-resistant penicillins and 29/38 (76.3%) among macrolides. Conclusions: Antimicrobial use rate is high, and 57.8% of prescriptions are inappropriate. The least appropriate prescriptions are given for urinary tract infections. Appropriateness is highly variable by LTCF, indication, and drug class.

977. An Innovative 3-Year Medical Student Spiral Curriculum in Antimicrobial Stewardship and Infectious Diseases

BackgroundBy 2050, infections due antimicrobial-resistant organisms are predicted to account for 10 million deaths/year worldwide. Physician antibiotic prescribing patterns are a significant factor in the development of antibiotic resistance organisms. Early, continual, and integrated medical student education may help students develop a framework for responsible antimicrobial use as they develop prescribing patterns.MethodsWe designed a spiral antimicrobial stewardship curriculum (defined as revisiting the same concept but with increasing complexity) for medical students in years 2–4. Data provided by the Graduation Questionnaire (GQ) administered by the US Association of American Colleges were used. We compared student responses during the curriculum rollout in 2013–2015 between students at our institution and other schools. We also surveyed graduating seniors in 2015 about antimicrobial stewardship training.ResultsUsing GQ data for the class of 2013 (preintervention), a similar proportion of UCSF medical students compared with other US medical students rated microbiology clinical preparation as excellent (43.6% vs. 45.1%, P > 0.20). For the 2014 class, we developed interactive case-based sessions at the beginning of years 3 and 4. After this first intervention, a higher proportion of UCSF students rated the microbiology clinical preparation as excellent (51.3%) compared with responses at all schools (39.8%, odds ratio [OR] 1.59, 95% confidence interval [CI] 1.1–2.3, P = 0.013). For the class of 2015, we added content during the medicine clerkship and 1 week before graduation. For the 2015 class, an even higher proportion of UCSF students rated microbiology preparation as excellent (57.6%), compared with all schools (41.2%, OR 2.23, 95% CI 1.54–3.22, P < 0.0001). From our survey, 88% were very or extremely satisfied with antimicrobial stewardship training.ConclusionA spiral curriculum focusing on antimicrobial stewardship and infectious diseases increases student perception of clinical preparation prior to graduation. As the curriculum was incrementally introduced, students’ knowledge increased indicating a dose–response pattern. Based on these positive results, we plan to introduce more content throughout UME, and link to curriculum for GME and practicing clinicians.Disclosures All authors: No reported disclosures.

Antimicrobial stewardship

Antimicrobial stewardship is a strategy, a coherent set of actions which promote using antimicrobials responsibly. They can be applied from individual to global level in human and veterinary medicine and agriculture. Complying to these measures will ensure appropriate and responsible antimicrobial use and thus prolong their activity, decrease antimicrobial resistance, optimize patient outcome, decrease morbidity and mortality caused by multidrug resistant microorganisms and decrease costs. Antimicrobial resistance has risen up the global agenda, resulting in a series of recommendations on responsible antimicrobial use.

Assessment of Consumer Perceptions on the Use of Antimicrobials in Production Animals in Chile

Successful treatment of diseases that sicken food-producing animals requires the use of antimicrobials. However, these drugs could result in serious consequences for human, animal, and environmental health. The emergence of antimicrobial resistance requires better communication with consumers to inform them about the risks associated with the use of these drugs, as well as the benefits gained from their rational use. This work studied consumer perceptions about the use of antimicrobials in the production of animal origin foods by questioning 72 consumers in nine focus groups. The participants were all inhabitants of the Metropolitan Region, Chile, and were assigned to focus groups of 5 to 12 individuals each, according to their age: age groups I, II, and III spanned age ranges of 25 to 35, 36 to 50, and older than 50 years, respectively. Consumers regarded the use of antimicrobials in farm animals as a relevant and necessary practice, as long as it was done adequately by veterinarians to ensure productivity and to guarantee food quality and safety. Even though most consumers identified antimicrobial use as a potential risk to their health, only a few recognized that antimicrobial resistance could be transferred from animals to humans via food consumption. Also, consumers complained that they did not have access to enough information about foods of animal origin. Consequently, they stated that food industry and regulatory entities should ensure transparency of production processes and also educate the population on this topic. Consumer perceptions about responsible and judicious use of antimicrobials may become an ally in the effort to reduce and improve the use of these drugs in animal production systems.

Preparing for the Practice Standards Scheme medicines assessment: part 2

The medicines module is one of the largest modules of the new-look Practice Standards Scheme. This article, the second in a two-part series, discusses how practices should deal with controlled...

Preparing for the Practice Standards Scheme medicines assessment: part 1

If you have a Practice Standards Scheme assessment approaching and are responsible for meeting the standards for one of the largest modules – medicines – then this article will be...

Successful therapy in unusual generalized Dermatophilus congolensis infection in a calf based on modified in vitro disk diffusion test

ABSTRACT: Bovine dermatophilosis is a dermatitis characterized by typical focal or localized lesions with “paintbrush” aspect and occasionally as disseminated cutaneous disease. We report the case of a one-year-old Nelore female with history of chronic cutaneous disseminated lesions that appeared immediately after a rainfall period. Serous to purulent exudates, hair with tufted appearance, hyperkeratotic, non-pruritic, hardened, yellowish to brown, and coalescent crusty lesions were observed distributed all over its body. Removal of the crusts revealed ulcerated or hemorrhagic areas, with irregular elevated crusts like “paintbrush”. Microbiological diagnosis enabled the identification of a microorganism, the Dermatophilus congolensis. Despite disseminated and chronic lesions, we obtained a successful therapy with parenteral therapy using long-acting tetracycline based on modified in vitro disk diffusion test. The present report highlights success therapy in uncommon generalized bovine dermatophilosis with selection of first-choice drugs based on modified in vitro susceptibility test, and need of responsible use of antimicrobials in livestock.

Antimicrobial residues and resistance against critically important antimicrobials in non-typhoidal Salmonella from meat sold at wet markets and supermarkets in Vietnam

Excessive antimicrobial usage and deficiencies in hygiene in meat production systems may result in undesirable human health hazards, such as the presence of antimicrobial drug residues and non-typhoidal Salmonella (NTS), including antimicrobial resistant (AMR) NTS. Recently, Vietnam has witnessed the emergence of integrated intensive animal production systems, coexisting with more traditional, locally-sourced wet markets. To date no systematic studies have been carried out to compare health hazards in beef, pork and chicken in different production systems. We aimed to: (1) estimate the prevalence of antimicrobial residues in beef, pork and chicken meat; (2) investigate the prevalence and levels of NTS contamination; and (3) investigate serovar distribution and AMR against critically important antimicrobials by animal species and type of retail (wet market vs. supermarket) in Vietnam. Fresh pork, beef and chicken meat samples (N=357) sourced from wet markets and supermarkets in Ho Chi Minh City (HCMC), Hanoi and Dong Thap were screened for antimicrobial residues by PremiTest, and were further investigated by Charm II. Samples from HCMC (N=113) were cultured using ISO 6579:2002/Amd 1:2007. NTS bacteria were quantified using a minimum probable number (MPN) technique. NTS isolates were assigned to serovar by Multilocus Sequence Typing (MLST), and were investigated for their phenotypic susceptibility against 32 antimicrobials. A total of 26 (7.3%) samples tested positive by PremiTest (9.5% beef, 4.1% pork and 8.4% chicken meat). Sulfonamides, tetracyclines and macrolides were detected by Charm in 3.1%, 2.8% and 2.0% samples, respectively. Overall, meat samples from wet markets had a higher prevalence of residues than those from supermarkets (9.6% vs. 2.6%) (p=0.016). NTS were isolated from 68.4% samples from HCMC. Chicken samples from wet markets had by far the highest NTS counts (median 3.2 logMPN/g). NTS isolates displayed high levels of resistance against quinolones (52.2%) and β-lactams (49.6%), but low levels against 3rd generation cephalosporins (4.4%) and aminoglycosides (0.8%). The highest adjusted prevalence of multidrug resistance (MDR) corresponded to isolates from chicken meat and pork (OR 8.3 and 1.8, respectively) (baseline=beef). S. Kentucky was the most common serovar identified (11 from chicken, 1 from beef) and 91.7% isolates was MDR. 11/12 isolates corresponded to ST198, a worldwide-disseminated multi-resistant NTS clone. We recommend stepping up policy measures to promote responsible antimicrobial use in animal production, as well as awareness about withdrawal periods to limit the hazard of residues in animal products, and improving slaughtering/hygiene procedures to limit cross-contamination with NTS, particularly in poultry wet markets.

Reducing antimicrobial use: a practitioner experience

In late 2015, the farm team at Friars Moor Livestock Health made a decision to improve responsible antimicrobial use on their dairy farms. In this article, Julian Allen and Jenny...