Stakeholder position paper: companion animal veterinarian

The total quantity of use in companion animals is generally believed to be relatively small in comparison with antimicrobial use in food animals. Use in companion animals is principally for treatment, whereas the greater proportion of use in food animals is for prophylaxis, metaphylaxis and growth promotion. Therefore, it is important to collect data on end use in companion animals so that overall estimates of use in companion animals can be generated and separated from estimates for food animals. However, data from antimicrobial use in companion animals are extremely limited and no serious attempts to collect such data have ever been made in the United States. The lack of usage data in is concomitant with the dearth of information on antimicrobial resistance in companion animals. Companion animals have been involved in the transmission to humans of, or become infected with, foodborne zoonotic bacteria such as Salmonella and Campylobacter. Companion animals are an integral part of the ecology of antimicrobial resistance through their contact with food animals and exposure to antimicrobials for disease treatment and through contact with humans and the environment. In the practice of companion animal medicine, antimicrobial use data are important for understanding the potential impact on companion animal heath posed by antimicrobial resistance transferred from food animals, humans and the environment, and the threat to humans and other companion animals posed by antimicrobial use in companion animals. Basic information on the patterns and quantities of antimicrobial use in combination with resistance surveillance data, could help companion animal veterinarians understand the potential for development, or evidence of, an antimicrobial resistance problem in their practices, the role of companion animals in the overall epidemiology of antimicrobial resistance, and for comparison with local, regional, or national data. The combination of data from either a sentinel site system of clinics or a use survey with national data from the pharmaceutical industry should provide sufficient data to credibly estimate the total volume and patterns of antimicrobial use in companion animal medicine. The time and effort for use monitoring or to complete a survey would likely become burdensome. Practice management software now utilized at most companion animal clinics could be used to generate antimicrobial use data as well as patient population data as surrogate for the true population at risk for patient encounters in a companion animal practice.     

Overview of issues pertaining to the manufacture, distribution, and use of antimicrobials in animals and other information relevant to animal antimicrobial use data collection in the United States

This paper provides condensed literature review and contextual information concerning antimicrobial use in animals and antimicrobial use data collection techniques. Information is summarized into the following topics: (I) antimicrobial use for animal growth promotion; (II) regulatory framework for approval of veterinary antimicrobials and feed additives in the United States; (III) animal health product manufacturing and distribution networks; (IV) existing estimates of animal antimicrobial use in the United States; (V) additional sources for animal use data in the United States; (VI) recommendations from international expert groups; (VII) animal antimicrobial use surveillance systems in other nations and (VIII) human use data collection systems in the United States.     

Evaluation of a veterinary-based syndromic surveillance system implemented for swine

Practicing veterinarians play an important role in detecting the initial outbreak of disease in animal populations. A pilot study was conducted to determine the feasibility of a veterinary-based surveillance system for the Ontario swine industry. A total of 7 practitioners from 5 clinics agreed to submit information from July 1, 2007 to June 30, 2008. The surveillance program was evaluated in terms of timeliness, compliance, geographic coverage, and data quality. Our study showed that the veterinary-based surveillance system was acceptable to practitioners and produced useful data. The program obtained information from 25% of pig farms in Ontario during this time period. However, better communication with practitioners, more user-friendly recording systems that can be adapted to each clinic's management system, active involvement of the clinics' technical personnel, and the use of financial incentives may help to improve compliance and timeliness.     

An original system for the continuous monitoring of antimicrobial use in poultry production in France

Data collection at the flock level on a continuous basis, for antimicrobial use surveillance purposes, provides a complex challenge. Using existing on-farm records, produced as part of the regulations for meat inspection, a sampling scheme was implemented to collect on a simple, representative and continuous basis, the forms providing history of antimicrobial consumption of poultry flocks slaughtered in Brittany. Relational database-stored information provided by the forms includes treatment purpose, antimicrobial drug administered, age at treatment and treatment duration. The aim of this study was to collect information describing antimicrobial drug use quantitatively and qualitatively, by computing the frequency of antimicrobial use according to species, therapeutic class, treatment purpose, duration, and animal age at treatment. A study was carried out to check the validity of farmers' declarations. Examples of data and results are presented such as the relative importance of the different antimicrobial classes in relation to the live weight treated, which shows that beta-lactams and tetracyclines are the main classes used in broilers and turkeys respectively. Average bird weight at treatment was 0.5 kg for a broiler and 3 kg for a turkey. Nevertheless, several 'at-risk' periods could be identified. Initial results after 1 year of data collection showed that this surveillance system provides valid, detailed and useful data about antimicrobial drug use in poultry production at a low cost and with only a moderate time involvement.     

我国动物源细菌耐药性数据库的建立与应用

为加强全国动物源细菌耐药性监测数据统一管理,实时掌握我国动物源细菌耐药性的流行动态,中国兽医药品监察所联合多家国内细菌耐药性监测单位,开发了我国的动物源细菌耐药性监测数据库。该数据库为B/S架构,全国不同地区动物源细菌耐药性监测实验室均可通过网页浏览器连接服务器,实现了监测数据即时储存、统计分析和上报,为我国兽医临床细菌耐药性监测提供了重要的技术支持。     

Public health and policy

Antimicrobial agent usage data are essential for focusing efforts to reduce misuse and overuse of antimicrobial agents in food producing animals because these practices may select for resistance in bacteria of animals. Transfer of resistant bacteria from animals to humans can lead to human infection caused by resistant pathogens. Resistant infections can lead to treatment failures, resulting in prolonged or more severe illness. Multiple World Health Organization (WHO) reports have concluded that both antimicrobial resistance and antimicrobial usage should be monitored on the national level. The system for collecting antimicrobial usage data should be clear and transparent to facilitate trend analysis and comparison within and among countries. Therapeutic, prophylactic and growth promotion use should be recorded, along with route of administration and animal species and/or production class treated. The usage data should be compared to resistance data, and the comparison should be made available in a timely manner. In the United States, surveillance of antimicrobial resistance in foodborne bacteria is performed by the National Antimicrobial Resistance Monitoring System (NARMS) for enteric bacteria, however, the United States still lacks a mechanism for collecting antimicrobial usage data. Combined with antimicrobial resistance information from NARMS, antimicrobial usage data will help to direct education efforts and policy decisions, minimizing the risk that people will develop antimicrobial resistant infections as a result of eating food of animal origin. Ultimately mitigation strategies guided by usage data will be more effective in maintaining antimicrobial drugs for appropriate veterinary use and in protecting human health.     

Veterinary syndromic surveillance: Current initiatives and potential for development

This paper reviews recent progress in the development of syndromic surveillance systems for veterinary medicine. Peer-reviewed and grey literature were searched in order to identify surveillance systems that explicitly address outbreak detection based on systematic monitoring of animal population data, in any phase of implementation. The review found that developments in veterinary syndromic surveillance are focused not only on animal health, but also on the use of animals as sentinels for public health, representing a further step towards One Medicine. The main sources of information are clinical data from practitioners and laboratory data, but a number of other sources are being explored. Due to limitations inherent in the way data on animal health is collected, the development of veterinary syndromic surveillance initially focused on animal health data collection strategies, analyzing historical data for their potential to support systematic monitoring, or solving problems of data classification and integration. Systems based on passive notification or data transfers are now dealing with sustainability issues. Given the ongoing barriers in availability of data, diagnostic laboratories appear to provide the most readily available data sources for syndromic surveillance in animal health. As the bottlenecks around data source availability are overcome, the next challenge is consolidating data standards for data classification, promoting the integration of different animal health surveillance systems, and also the integration to public health surveillance. Moreover, the outputs of systems for systematic monitoring of animal health data must be directly connected to real-time decision support systems which are increasingly being used for disease management and control.     

Review of antimicrobial therapy of selected bacterial diseases in broiler chickens in Canada

This paper reviews common therapeutic applications of antimicrobials in broiler chicken production in relation to Canadian guidelines, surveillance data, and emerging public health concerns about antimicrobial use (AMU). Escherichia coli, Clostridium perfringens, and Staphylococcus spp., were reviewed because of their animal health and economic significance. Enterococcus cecorum and Salmonella were included because of their importance in antimicrobial resistance (AMR) surveillance. This review identified that i) antimicrobials are available in Canada to treat infections by these agents, but may be through over the counter or extra-label use, ii) prevalence rates for these diseases are unknown, iii) antimicrobial use estimates in broilers are lacking, and iv) AMR has emerged in clinical isolates, though data are very sparse. This review highlights the need for surveillance of AMU and AMR in broiler chickens in Canada.     

Antimicrobial susceptibility of Escherichia coli F4, Pasteurella multocida,and Streptococcus suis isolates from a diagnostic veterinary laboratory and recommendations for a surveillance system

Antimicrobial susceptibility data on Escherichia coli F4, Pasteurella multocida, and Streptococcus suis isolates from Ontario swine (January 1998 to October 2010) were acquired from a comprehensive diagnostic veterinary laboratory in Ontario, Canada. In relation to the possible development of a surveillance system for antimicrobial resistance, data were assessed for ease of management, completeness, consistency, and applicability for temporal and spatial statistical analyses. Limited farm location data precluded spatial analyses and missing demographic data limited their use as predictors within multivariable statistical models. Changes in the standard panel of antimicrobials used for susceptibility testing reduced the number of antimicrobials available for temporal analyses. Data consistency and quality could improve over time in this and similar diagnostic laboratory settings by encouraging complete reporting with sample submission and by modifying database systems to limit free-text data entry. These changes could make more statistical methods available for disease surveillance and cluster detection.     

Animal health pharmaceutical industry

The animal health pharmaceutical industry has proactively reported on the volumes of member company antimicrobial active ingredients sold in the U.S. At the individual company level, reporting of finished product distribution data to the FDA is a regulatory requirement, with applications to surveillance and pharmacovigilance. An accounting of product manufactured is done for purposes of good business practices, as well as marketing analyses. Additional applications of antimicrobial usage data might include use in risk assessments, such as for the FDA's Center for Veterinary Medicine Guidance for Industry #152 for the evaluation of the microbiological safety of antimicrobials intended for use in food animals. Compilation of national usage data will be a complex undertaking, hindered by issues such as confidentiality, auditing, field use practice variations, population dynamics (e.g. disease incidence, market conditions for poultry and livestock production), and generic usage. The amounts or volumes in pounds should be considered relative to the large number of animals under husbandry in the United States. Large volumes might seem impressive unless put into proper context. Until such time as a clearly defined application of national usage data is agreed, it is recommended that local usage programs will provide more useful information to perpetuate prudent antimicrobial use in animals.     

Towards the establishment and standardization of a veterinary antimicrobial resistance surveillance and monitoring programme in South Africa

The objective of this study was to establish a repeatable, standardized laboratory procedure for monitoring the development of antimicrobial resistance in bacteria isolated from animals and food of animal origin in South Africa, with reagents prepared in-house. The emergence of resistance and the spread of resistant bacteria can be limited by implementing a veterinary antimicrobial drug policy, in which inter alia systematic monitoring and prudent use play essential roles. The bacteria included in this study represented three different categories, namely zoonotic bacteria (Salmonella), indicator bacteria (Escherichia coli, Enterococcus faecalis and Enterococcus faecium) and veterinary pathogens (Mannheimia haemolytica). Thirty isolates of each species were collected with the aim of standardizing the laboratory methodology for a future national veterinary surveillance and monitoring programme. Susceptibility to ten selected antimicrobial drugs was determined by means of minimum inhibitory concentrations (MICs) using the microdilution method. The method according to the National Committee for Clinical Laboratory Standards was used as the standard. Multi-well plates containing varying dilutions of antimicrobial drugs and prepared in-house for MIC determinations, yielded repeatable results. Storage of plates for 2 months at -70 degrees C did not influence results meaningfully. Within this limited sample of bacteria, MIC results did not indicate meaningful resistance against any of the ten selected antimicrobial drugs. The findings of the study will be used to establish a national veterinary antimicrobial resistance surveillance and monitoring programme in South Africa. To allow for international comparison of data, harmonisation of the surveillance and monitoring programme in accordance with global trends is encouraged. Ideally it should be combined with a programme monitoring the quantities of antimicrobial drugs used. The aim is to contribute to slowing down the emergence of resistance and the problems associated with this phenomenon by means of the rational use of antimicrobial drugs.     

Outpacing the resistance tsunami: Antimicrobial stewardship in equine medicine,an overview

Antimicrobial stewardship (AMS) is the term increasingly used to describe the multiple approaches needed to sustain the efficacy of antimicrobial drugs in the face of the increasing development and spread of antimicrobial resistance in bacterial pathogens, and the global crisis in medicine that it is engendering. The concept and the practices associated with AMS continue to evolve but the general approach is a dynamic and multifaceted one of continuous improvement based on reducing, improving, monitoring and evaluating the use of antimicrobials so as to preserve their future efficacy and to protect human and animal health. Using many equine examples, this basic overview discusses the multiple and interacting elements of AMS: Practice guidelines, infection control and prevention, clinical microbiology, resistance and use surveillance, dosage, pharmacokinetics and pharmacodynamics, regulation, education and owner compliance, leadership, coordination and measurement. There have been impressive advances in recent years in reporting and analysis of AMR in horses, in the scrutiny and assessment of how antimicrobial drugs are used in horses and in identification of areas for improvement including dosing, surgical prophylaxis, infection control, development of practice standards and the use of clinical microbiology. Antimicrobial stewardship is taking shape as we start to see the emergence of evidence-based recommendations but far more is required. Containing and even rolling back AMR will need the continued engagement of practitioners, equine national and international practitioner organisations, researchers and educators in the academic community, horse owners, regulators and others.     

Cystotomy practices and complications among general small animal practitioners in Ontario, Canada

Cystotomy is a common surgical procedure in small animal veterinary medicine, yet common pre-, intra-, and post-operative practices have not been described. This survey evaluated cystotomy practices of 106 veterinarians in Ontario. The majority of respondents reported practices consistent with standard recommendations, but some deficiencies in antimicrobial and analgesic use, as well as intra- and post-operative practices, were identified. Some factors associated with the likelihood that practitioners reported recurrent urolithiasis or urinary tract infection are contrary to typical recommendations, such as the association of the use of absorbable, multifilament suture or a dorsal (versus ventral) incision and a lesser likelihood of reporting post-operative urinary tract infections. While care must be taken interpreting these statistical associations, the results suggest that objective assessment of common cystotomy recommendations (use of monofilament, absorbable suture) is required. Re-assessment of certain peri-operative practices, such as analgesic and antimicrobial administration, and post-operative testing, is required for a minority of practitioners.     

Nosocomial infections and antimicrobial resistance in critical care medicine

Objective: To review the human and companion animal veterinary literature on nosocomial infections and antimicrobial drug resistance as they pertain to the critically ill patient. Data sources: Data from human and veterinary sources were reviewed using PubMed and CAB. Human data synthesis: There is a large amount of published data on nosocomially‐acquired bloodstream infections, pneumonia, urinary tract infections and surgical site infections, and strategies to minimize the frequency of these infections, in human medicine. Nosocomial infections caused by multi‐drug‐resistant (MDR) pathogens are a leading cause of increased patient morbidity and mortality, medical treatment costs, and prolonged hospital stay. Epidemiology and risk factor analyses have shown that the major risk factor for the development of antimicrobial resistance in critically ill human patients is heavy antibiotic usage. Veterinary data synthesis: There is a paucity of information on the development of antimicrobial drug resistance and nosocomially‐acquired infections in critically ill small animal veterinary patients. Mechanisms of antimicrobial drug resistance are universal, although the selection effects created by antibiotic usage may be less significant in veterinary patients. Future studies on the development of antimicrobial drug resistance in critically ill animals may benefit from research that has been conducted in humans. Conclusions: Antimicrobial use in critically ill patients selects for antimicrobial drug resistance and MDR nosocomial pathogens. The choice of antimicrobials should be prudent and based on regular surveillance studies and accurate microbiological diagnostics. Antimicrobial drug resistance is becoming an increasing problem in veterinary medicine, particularly in the critical care setting, and institution‐specific strategies should be developed to prevent the emergence of MDR infections. The collation of data from tertiary‐care veterinary hospitals may identify trends in antimicrobial drug resistance patterns in nosocomial pathogens and aid in formulating guidelines for antimicrobial use.     

Antimicrobial use in the Alberta sheep industry.

Information regarding antimicrobial use in sheep is scarce. In 2001, a scrapie surveillance program was initiated in Alberta that also provided a mechanism for collecting other sheep health data including antimicrobial use information between April 2001 and April 2002. A major objective of this study was to describe antimicrobial use in the Alberta sheep industry. This was done by obtaining qualitative antimicrobial use information from all flocks (n = 212) providing cull ewes to the program using a brief, primarily flock-level, questionnaire. The respondents' flocks represented 13.6% of the total provincial flock in Alberta in 2001. By a substantial amount, the most frequent method of administering antimicrobials was through injection followed by in-feed, oral (liquids, pills, boluses), and in-water routes, respectively. Drug-specific use data were collected for injectable antimicrobials only, with the most commonly used antimicrobial classes being penicillins followed by tetracyclines. Producers rarely treated some or all of their flock with injectable antimicrobials after discovering an individual sick animal. Adult sheep were the most common age group treated with injectable antimicrobials and the most frequent reason for injectable antimicrobial use was mastitis followed by respiratory problems. This study provides some initial insight regarding antimicrobial use in Alberta sheep flocks. However, collection of more drug-specific data (drug type, dose/concentration, duration of treatment) for noninjectable routes of administration should be conducted in future studies. Assessing antimicrobial use in other sectors of the Alberta sheep industry (feedlots) and other provinces across Canada would also be beneficial.     

OIE抗菌药耐药性国际标准

兽用抗菌药耐药性已经成为一个全球普遍关注的公共健康问题,各国际组织都积极采取相应的措施控制耐药性的产生和蔓延。介绍了国际组织世界动物卫生组织OIE制定的五个国际标准,包括协调抗菌药耐药性监督和检测程序指南、畜牧业抗菌药消耗量监测指南、兽用抗菌药慎用指南、抗菌药敏感性检测的实验室方法指南、动物源抗菌药耐药性对公共健康潜在影响的风险分析方法指南,以期为我国政策制定者和决策者参照国际标准制定出符合我国国情的耐药性相关指南。     

Stakeholder position paper: dairy producer

Bacterial antimicrobial resistance is a problem common to both animal and public health. An important public policy issue is to develop and implement prudent use practices where antimicrobials are used. As policy develops, there are questions regarding the use of antimicrobials in animal agriculture and whether these uses constitute prudent use. A series of papers assessing the risk to the public health from agricultural use of antimicrobials have consistently concluded that risk estimation is hampered by the lack of data that describe the amount, types, and uses of antimicrobials in animal agriculture. The absence of information has spurred efforts to develop a framework to collect these data. However, the reasons and benefit of collecting these data should be carefully defined. The dairy industry, contrasted to other major animal commodities, is not focused on meat production but on milk production. Milk production is constrained by disease and antimicrobial treatment is a common management tool, but unlike many other animal agricultural systems where the value and safety of the product is measured in the future; the value of milk is zero when an antimicrobial is used in a lactating cow and milk must be discarded because of residues. While there are exceptions, e.g. non-lactating cow therapy, this difference results in antimicrobials being used sporadically and directed at therapy rather than prophylactic uses. In the dairy industry, antimicrobial use data and its consequences may exist in sufficient detail or could be estimated from existing datasets without the expense of additional surveys. Finally, the main food product milk is mainly pasteurized and all shipments of milk from the farm to the processing plant are tested for the presence of antimicrobials. This makes the likelihood of farm-origin antimicrobials or bacteria appearing in finished product very low. This suggests that the use and quantity of antimicrobials in the dairy system has little impact on public health. This does not imply that the dairy industry does not have a significant role in developing guidelines for appropriate and careful application of antimicrobials, but the effort and cost to collect additional data should be used to fund efforts that improve our diagnostic and managerial skills. These data would change the use of antimicrobials by decreasing the rates of disease and ultimately decreasing prophylactic, metaphylactic and therapeutic use of antimicrobial. These studies and outcome are as important to the dairy industry as to public health.     

动物应用抗菌药的风险及防制对策

食品动物因大量应用抗菌药物产生耐药菌株，对动物和人类健康及生态环境造成危害，为此欧盟对多种促生长抗菌药颁布了禁令，导致了动物治疗用抗菌药的急剧增加及畜牧业经济效益的降低。本文就此展开讨论，强调必须开发新型抗菌药物，合理应用抗菌药，加强抗菌药药效学及药动学研究，健全食源性病原菌耐药性监测系统等。     

国家动物源细菌耐药性监测工作的探讨和建议

介绍了国外动物源细菌耐药性监测工作的情况及目标,对我国的动物源细菌耐药性监测工作需考虑的许多因素进行了介绍和讨论,包括动物品种、食品、采样方法、样本的收集、细菌品种、抗菌药物、标准药敏试验法、质控、结果记录和数据库设计、报告和结果分析等,并对今后的动物源细菌耐药性监测工作提出了建议。