Perceptions of antimicrobial usage, antimicrobial resistance and policy measures to reduce antimicrobial usage in convenient samples of Belgian, French, German, Swedish and Swiss pig farmers

Redefining On-Farm Practices: The Perceived Impact of a Responsible Antimicrobial Use Regulation on Dairy Farmers

The global food animal industry faces a growing concern regarding antimicrobial resistance (AMR), primarily driven by the use of antimicrobials (AMs) for the treatment, control, and prevention of diseases. Addressing this challenge requires promoting responsible antimicrobial use (AMU) practices. In 2019, the province of Québec, Canada, took a significant step by implementing a regulation that limits the use of AMs of very high importance for human medicine (category I AMs as defined by Health Canada) in the food animal industry. However, the implementation of such regulation can significantly influence behavioral shifts among producers, contributing to the wider effort against AMR. Therefore, the objective of this observational study was to describe the perceived changes in knowledge of dairy producers and on-farm practices following the implementation of this regulation, using a cohort design. Data collection involved administering questionnaires to 87 dairy producers from 3 regions of the province of Québec (Estrie, Montérégie, Centre-Du-Québec) before (2017-2018) and after (2020-2021) the implementation of the regulation. The questionnaires explored the descriptive characteristics of farms, the knowledge of producers about the categorization of AMs, their on-farm treatment practices, and the perceived impacts of the regulation. Statistical analysis included t-tests and McNemar tests to compare the paired data obtained using the 2 questionnaires. The results indicated an increase in the knowledge score (the number of AMs correctly categorized by the producers by their importance for human medicine) after the implementation of the regulation, suggesting an improved understanding of the categorization of AMs based on their importance for human medicine. Trends in AMU practices for treating clinical mastitis and reproductive diseases suggested that category I AMs were less likely to be reported as the primary treatment after the regulation, while category II AMs were more often reported as primary treatment. Adoption of the selective dry cow therapy method significantly increased, while the use of teat sealants remained unchanged. Moreover, producers had divergent perceptions regarding the effect of the regulation on the cure rates and disease frequencies. This disparity emphasizes the need for comprehensive data collection to discern the risks associated with such regulatory shifts. The study acknowledges several limitations, including the potential for recall bias, confirmation bias, and desirability bias. Despite these limitations, this study shows that implementing regulations to encourage responsible AMU drives positive transformations in producers' knowledge and on-farm practices. This underscores the pivotal impact of proactive interventions in combating the escalating threat of AMR within the global food animal industry.

Public awareness, risk perceptions and behaviour towards antibiotic use in food-producing animals and antimicrobial resistance in Malaysia: A cross-sectional study

Antimicrobial resistance (AMR) is a growing global public health problem, particularly in low- and middle-income countries, including Malaysia. Understanding risk perceptions on antimicrobial use (AMU) in food-producing animals from the general public perspective is an essential component in addressing AMR. However, little is known about public risk perceptions of AMU and AMR in food-producing animals in Malaysia. The objectives of this study were to assess the level of awareness, risk perceptions, and behaviour regarding antibiotic use in food-producing animals and antimicrobial resistance and to examine the factors associated with risk perceptions and the relationship between knowledge, awareness, risk perceptions and behaviour among the general public in Malaysia. A cross-sectional survey was used. Both descriptive and analytical statistics were used to analyse data and present results. Correlation and regression analyses were conducted to examine the factors associated with risk perceptions and the relationship between risk perceptions and behaviour. A total of 416 individuals participated in the study. The majority of the participants (69.2 %) had low knowledge of antibiotics and antibiotic use in food-producing animals. The levels of awareness of antibiotic use and the perceived route of antibiotic resistance transfer were moderate. Participants had a high level of general risk perception (GRP) of antibiotic use, a moderate level of personal-level risk perception (PRP) of antibiotic resistance transmission, and a high level of societal-level risk perception (SRP) of antibiotic resistance transmission. Awareness of antibiotic use was a significant predictor of GRP (β = 0.27, 95 %CI: 0.12-0.31, P < 0.001). Awareness of route of resistance transfer was a significant predictor of PRP (β = 0.54, 95 %CI: 0.32-0.44, P < 0.001) and SRP (β = 0.47, 95 %CI: 0.32-0.46, P < 0.001). PRP is the only significant predictor of behavioural changes towards antibiotic use and antibiotic resistance (OR = 1.45 [1.02-2.07], P = 0.041). Overall, there is a general lack of knowledge and little awareness of antibiotic use and antibiotic resistance in food-producing animals in Malaysia. Risk perceptions were moderate to high and were significantly predicted by awareness of antibiotic use and route of resistance transfer. Personal-level risk perception was a significant predictor of behavioural changes aimed at reducing the risk of AMU and AMR. It is imperative to raise public awareness and understanding of the risks associated with AMU in food-producing animals. Risk communication should be emphasised to ensure the translation of public risk perceptions into behavioural changes.

The effect of a One Health message intervention on willingness to pay for antibiotic-free animal foods: A randomized controlled trial among Chinese college students

Routine use of antibiotics in livestock for prophylactic purposes is a main driver of antimicrobial resistance, posing a significant threat to the health of humans, animals, and the environment. Ways to motivate farmers to voluntarily reduce antibiotics use need to be explored. Promoting antibiotic-free animal foods is one of the promising strategies. A three-arm double-blind randomized controlled trial was conducted online to explore the impact of a One Health message intervention on Chinese college students' willingness to pay for antibiotic-free animal foods. A total of 389 individuals participated in this study and were randomly assigned to one of the One Health message group, the food nutrition and safety message group, and the no message group. Each participant read a message from the corresponding group and answered a self-report questionnaire. Participants' willingness to pay (WTP) and willingness to buy (WTB) for antibiotic-free pork, eggs, and milk were measured before and after viewing the One Health message, and the results were compared to the other two groups using the Kruskal-Wallis rank sum test and the Bonferroni correction. In the One Health message group, 30.2% (39/129) reported improved WTP for all three foods, compared to 6.2% (8/130) and 13.6% (17/125) in the food nutrition and safety message group and the no message group, respectively. The One Health message intervention had a significant effect on increasing participants' WTP (p < 0.001) and WTB (p < 0.05) for antibiotic-free pork, eggs, and milk. The One Health message intervention is effective in raising participants' WTP for antibiotic-free animal foods. It is hopeful to motivate farmers and producers to voluntarily reduce prophylactic antibiotic use through market demand and consumer choice, leading to a potential decrease in total antibiotics use in livestock. Additionally, integrated approaches based on One Health principles need to be found in the future.

The increasing antimicrobial resistance of Shigella species among Iranian pediatrics: a systematic review and meta-analysis

BACKGROUND

Shigellosis remains one of the global causes of morbidity and mortality. However, the global emergence of antibiotic resistance has become the leading cause of treatment failure in shigellosis. This review aimed to provide an updated picture of the antimicrobial resistance rates in Shigella species in Iranian pediatrics.

METHODS

A comprehensive systematic search was performed on PubMed, Scopus, Embase, and Web of Science until 28 July 2021. The meta-analysis was performed by computing the pooled using a random-effects model with Stata/SE software, v.17.1. The discrepancy within articles was surveyed by the forest plot in addition to the I2 statistic. All statistical interpretations were reported on a 95% confidence interval (CI) basis.

RESULTS

Totally, of 28 eligible studies published between 2008 and 2021. The pooled prevalence rate of multidrug-resistant (MDR) was 63% (95% CI 50-76). Regarding suggested antimicrobial agents for Shigella species, the prevalence of resistance for ciprofloxacin, azithromycin, and ceftriaxone as first- and second-line treatments for shigellosis were 3%, 30%, and 28%, respectively. In contrast, resistance to cefotaxime, cefixime, and ceftazidime was 39%, 35%, and 20%. Importantly, subgroup analyses indicated that an increase in resistance rates during the periods (2008-2014, 2015-2021) was recognized for ciprofloxacin (0 % to 6%) and ceftriaxone (6% to 42%).

CONCLUSION

Our findings revealed that ciprofloxacin is an effective drug for shigellosis in Iranian children. The substantially high prevalence estimation proposes that the first- and second-line treatments for shigellosis are the major threat to public health and active antibiotic treatment policies are essential.

Prevalence and Antimicrobial-Resistant Features of Shigella Species in East Africa from 2015-2022: A Systematic Review and Meta-Analysis

Background

Shigellosis is the most common cause of epidemic dysentery found worldwide, particularly in developing countries, where it causes infant diarrhea and mortality. The prevalence of Shigella species resistant to commonly used antimicrobial drugs has steadily increased. The purpose of this review is to describe the prevalence and antimicrobial resistance (AMR) characteristics of Shigella species in East Africa between 2015 and 2022.

Methods

Studies were identified using a computerized search of Medline/PubMed, Google Scholar, and Web of Science databases, with a detailed search strategy and cross-checking of reference lists for studies published between 2015 and 2022. Articles presenting data on prevalence and AMR, accessibility of the full-length article, and publication dates between 2015 and 2022 were the eligibility criteria for inclusion in the review. Original research reports written in English were considered. The heterogeneities of the studies were examined, and a meta-analysis was performed to estimate the pooled prevalence and AMR using a random effects model.

Results

The pooled prevalence of Shigella species in East Africa was 6.2% (95% CI -0.20-12.60), according to an analysis of 22 studies. Shigella species prevalence was 4.0% in Ethiopia, 14.6% in Kenya, 0.7% in Sudan, 5.2% in South Sudan, and 20.6% in Somalia. The association of Shigella infection significantly varied among the countries (p = 0.01). Among the antibiotics tested, most Shigella isolates were susceptible to ciprofloxacin, norfloxacin, nalidixic acid, and ceftriaxone. Despite the fact that the reports varied in study sites and time, Shigella species were resistant to tetracycline, ampicillin, amoxicillin, chloramphenicol, and co-trimoxazole.

Conclusion

The pooled estimate indicates high burden of Shigella infection in East Africa, as well as a high proportion of drug resistance pattern to tetracycline, ampicillin, chloramphenicol, and amoxicillin. Therefore, initiating and scale-up of performing drug susceptibility test for each shigellosis case need to be considered and strengthened.

PRRSV-1 Stabilization Programs in French Farrow-to-Finish Farms: A Way to Reduce Antibiotic Usage

Infection with the porcine reproductive and respiratory syndrome virus type 1 (PRRSV-1) has serious economic consequences for the pig industry. Swine practitioners and other agricultural advisors often describe an increase in antibiotic use when PRRSV-1 is circulating. Our objective was to assess the impact of PRRSV-1 stabilization programs on reducing antibiotic use in 19 French farrow-to-finish farms that successfully implemented such a protocol between 2007 and 2019. For each farm, we compared the global antibiotic consumption, including all physiological stages (expressed in mg/PCU and ALEA) one year before (P1) and one year after (P2) the implementation of the protocol, and the change between P1 and P2 was calculated in percentages. The data were also analyzed by level of consumption. We showed that antibiotic use decreased significantly between P1 and P2 if expressed in mg/PCU and showed a decreased tendency in terms of exposure (ALEA) after PRRSV-1 stabilization. Concerning the change from P1 to P2, depending on the level of consumption in P1, our results showed that the higher the consumption levels were in P1, the greater the antibiotic reduction in P2. This study highlights the ability of a stabilization protocol against PRRSV-1 to reduce antibiotic use, especially on farms that have high consumption rates. These hopeful results show that further investigations about the relationship between PRRSV-1 and antibiotic usage could be beneficial.

Determinants of farms' antibiotic consumption - A longitudinal study of pig fattening farms in Germany

As high consumption of antibiotics in livestock production poses risks to public health, Germany has implemented a monitoring system to decrease their administration to farm animals. Data from 1,984 German pig farms are used to describe prescription trends for different antibiotic subclasses between Autumn 2017 and Autumn 2019. A panel Tobit model with control function approach is implemented to identify determinants of antibiotic consumption, where variables studied include farm, farmer, and county characteristics as well as weather variables. The overall quantity of prescribed antibiotics has been stable but with seasonal fluctuations and a shift away from critically important antibiotics used. Biosecurity factors such as livestock farm density in a county and pigs per farm are shown to be important drivers of antibiotic consumption. In addition, the number of cold days within a season increases antibiotic consumption but precipitation and the number of hot days have no significant effect.

Determinants of antimicrobial resistance occurrence in animal‐based food, perceived by livestock farmers: A qualitative phenomenological study

Background and Purpose of the Study

The determinants of antimicrobial resistance in human medicine have been copiously explored. On the other hand, the existing research in veterinary medicine and animal husbandry is in its infancy. The present qualitative study used the one‐health approach to explore farmers’ attitudes toward antimicrobial use and antimicrobial stewardship.

Methodology

The present qualitative study was phenomenological in type. It was conducted in 2022 in the two cities of Kerman and Bandar Abbas in Iran. The data were collected through in‐depth interviews by semistructured interviews with 17 livestock, poultry, and aquatic animal breeders selected through purposive sampling. The interviews lasted between 35 and 65 min in the Farsi language. The data were analyzed using conventional qualitative content analysis and Colaizzi's seven‐step analysis technique.

Results

The open coding was done in MAXQDA 10 and the results of data analysis were classified into five main themes and 17 subthemes subcategories. The main categories include personal determinants, contextual determinants, legal and regulatory determinants, social determinants, and economic determinants.

Conclusion

Considering the increasing use of antibiotics among livestock farmers and breeders of animals used as human food, different measures such as educational, regulatory, social, and even cultural interventions may be able to control and prevent antimicrobial resistance.

Understanding Vaccine Hesitancy in Vietnamese Fish Farmers

(1) Background: Antibiotic (AB) usage in food animals is a significant contributor to antimicrobial resistance (AMR). Vaccination can reduce the over-use of AB treatment. Little is known about farmers’ attitudes and beliefs about AB and vaccine usage in developing countries, especially in aquaculture. (2) Methods: We used the necessity/concerns framework to guide our research, where vaccine hesitancy is viewed as a function of the perceived necessity versus the perceived concerns about treatment. We measured disease and treatment perceptions in 400 Vietnamese farmers of Pangasius catfish, specifically regarding (a) chemical treatment of water, (b) antibiotic usage, and (c) vaccination of fish. (3) Results: Although farmers’ concerns about AB usage outweighed necessity beliefs, 86.5% reported having used ABs on their farm. Knowledge and attitudes towards vaccination were positive, with views of its necessity outweighing concerns. However, if available, only 67.6% said they would definitely use vaccines in the future. Farmers were more likely to use vaccines if they reported having fewer problems with fish disease, felt that any concerns about vaccines were outweighed by their perceived benefits, had less mistrust of vaccination, and had fewer concerns about commercial profiteering. (4) Conclusion: Interventions that highlight concerns about continued antibiotic use, reduce concerns, and mistrust and increase the perceived necessity of vaccines combined with greater availability of vaccines may be the most effective way of overcoming vaccine hesitancy and increase appropriate use of vaccines by Vietnamese fish farmers.

Evidence of a decrease in sales of antimicrobials of very high importance for humans in dairy herds after a new regulation restricting their use in Quebec, Canada

In the province of Quebec, Canada, a new regulation restricting usage of antimicrobials of very high importance for human health (Health Canada: category 1 antimicrobials) in production animals is effective since February 2019. The objective of this study was to estimate changes in AM sales in dairy herds after the implementation of the regulation. Therefore, invoice data were extracted from veterinary software, Vet-Expert, used by most dairy veterinarians in the province of Quebec, and antimicrobial quantities were transformed in Canadian defined course doses for cattle (DCDbovCA). The sum of antimicrobials sales monthly in each herd was estimated in DCDbovCA from June 2016 to May 2020. To evaluate the herd-level change in AM sales and the impact of different factors, the number of DCDbovCA by herd from June 2017 to May 2018 (pre-regulation period) were compared with those of June 2019 to May 2020 (post-regulation period). Total category 1 AM sales of 3,569 Quebec's herds went from a range of 14,258 to 21,528 DCDbovCA/month to a range of 1,494 to 4,707 DCDbovCA/month after the implementation of the new regulation. Moreover, using data from 3,337 herds, we estimated a mean (95% confidence interval) reduction in 19 DCDbovCA/herd-year (14.8, 24.2), while the pre-regulation herd-level category 1 AM sales was 26 DCDbovCA/herd-year. This reduction was achieved without evidence of an increase in other antimicrobials. Finally, the veterinary facility associated with the herd was an important determinant of the herd-level reduction in category 1 antimicrobials. This study was the first to quantify a significant reduction in category 1 AM sales following the implementation of a restrictive regulation in dairy production in Canada. These results demonstrate that such an approach is effective to reduce the sales of a specific category of antimicrobial in animal production.

Assessing Knowledge, Beliefs, and Behaviors around Antibiotic Usage and Antibiotic Resistance among UK Veterinary Students: A Multi-Site, Cross-Sectional Survey

Antimicrobial resistance (AMR) is a profound threat to human and animal health. Antimicrobial prescribing behaviours are influenced by psychological factors such as knowledge, beliefs, and emotions. As future antimicrobial prescribers, it is important to understand beliefs about AMR and stewardship among veterinary (vet) students. This cross-sectional online survey assessed vet students’ self-reported behavior, knowledge, and beliefs in specific relation to antibiotic resistance (ABR) and antibiotic usage. Participants were early years (first- and second-year; n = 460) and later-years (third- and fourth-year; n = 113) undergraduate vet students from three UK universities. Self-reported antibiotic-related behaviors were responsible among most students. Knowledge about ABR and stewardship was moderate among early years students and good among later years students. Vet students typically believed that vets had less responsibility for both causing and preventing ABR than other groups (animal owners, human medics, and the public). This study offers evidence that vet students (along with other groups) tend to lay greater responsibility for ABR/AMR outside of their own profession, which may impact their future prescribing behaviors. It is vital that AMR and antimicrobial stewardship are embedded across veterinary curricula, and that the One Health nature of the challenge posed by AMR is emphasized to encourage shared responsibility across all stakeholder groups, thereby helping to reduce ‘other-blaming’ for AMR.

Antibiotic Use in Relation with Psychological Profiles of Farmers of a French Pig Cooperative

(1) Background: We focus on the psychological factors that influence pig farmers’ antibiotic use, which is not exclusively determined by the technical, health and structural factors of livestock farming. (2) Methods: We visited farming sites and asked 91 pig farmers about various psychosocial dimensions that could be considered relevant in explaining antibiotic use. (3) Results: The results indicate the existence of three livestock-farmer sub-profiles, each of which is associated with distinct psychological characteristics and antibiotic use levels. (4) Conclusions: We discuss the implications of antibiotic use for livestock in terms of communication and support.

Antimicrobial use in agriculture: critical review of the factors influencing behaviour

Antimicrobial resistance (AMR) is a global health emergency affecting humans and animals, diminishing the effectiveness of medication used to treat illness. The agri-food sector has attracted increased attention for imprudent antimicrobial use (AMU) and its contribution to AMR. Thus, ascertaining farmers' and veterinarians' behaviours surrounding AMU is essential to address imprudent AMU and generate behaviour change within the agri-food sector. Therefore, the aim of this critical review is to investigate, assess and collate the current body of evidence to identify psychosocial factors including knowledge, understanding, perceptions, attitudes and behaviours surrounding AMU. Database searches were limited to articles utilizing qualitative and quantitative methodologies, available in English with no restriction on publication year. Of the 1156 articles identified, 103 were retained for this review. Findings on the psychosocial aspects were thematically analysed. Five key themes emerged from the data: (i) knowledge and awareness of antimicrobials; (ii) attitudes towards antimicrobials; (iii) influential relationships; (iv) resources; and (v) factors influencing AMU. Results indicated that to overcome barriers experienced by key stakeholders, a carefully considered, evidence-based approach, incorporating behaviour change theory, is required when designing intricate interventions/strategies, in order to elicit successful and sustained AMU behaviour change.

Risk Factors for Antimicrobial Use on Irish Pig Farms

Simple Summary

Antimicrobial resistance (AMR) is a major threat to public health. There are concerns that antimicrobial use (AMU) in agriculture has a role in the development of AMR. Pigs are one of the main consumers of veterinary antimicrobials and a better understanding of the drivers for AMU in this sector will help in efforts to reduce use. The aim of this study was to investigate the associations between antimicrobial use, farm characteristics, biosecurity, the presence of respiratory disease on the farm and health management practices on Irish pig farms. Farms that manufactured their feed on-site had lower total AMU than farms that purchased their feed from a feed mill. Higher levels of lung abscesses and pericarditis (inflammation of the lining around the heart), both indicators of respiratory disease, were associated with increased AMU. Higher levels of pericarditis were also associated with increased use of critically important antimicrobials. Farms vaccinating against swine influenza also had higher AMU. Farms that administered prophylactic antimicrobial treatments to piglets had higher use of individual treatments and critically important antimicrobials. The results from this study show that prophylaxis and respiratory disease are the main drivers of AMU on Irish pig farms. These findings highlight areas of farm management where interventions may aid in reducing AMU on Irish pig farms.

Abstract

The threat to public health posed by antimicrobial resistance in livestock production means that the pig sector is a particular focus for efforts to reduce antimicrobial use (AMU). This study sought to investigate the risk factors for AMU in Irish pig production. Antimicrobial use data were collected from 52 farrow-to-finish farms. The risk factors investigated were farm characteristics and performance, biosecurity practices, prevalence of pluck lesions at slaughter and serological status for four common respiratory pathogens and vaccination and prophylactic AMU practices. Linear regression models were used for quantitative AMU analysis and risk factors for specific AMU practices were investigated using logistic regression. Farms that milled their own feed had lower total AMU (p < 0.001), whereas higher finisher mortality (p = 0.043) and vaccinating for swine influenza (p < 0.001) increased AMU. Farms with higher prevalence of pericarditis (p = 0.037) and lung abscesses (p = 0.046) used more group treatments. Farms with higher prevalence of liver milk spot lesions (p = 0.018) and farms practising prophylactic AMU in piglets (p = 0.03) had higher numbers of individual treatments. Farms practising prophylactic AMU in piglets (p = 0.002) or sows (p = 0.062) had higher use of cephalosporins and fluoroquinolones. This study identified prophylactic use and respiratory disease as the main drivers for AMU in Irish pig production. These findings highlight areas of farm management where interventions may aid in reducing AMU on Irish pig farms.

The use of item response theory models to evaluate scales designed to measure knowledge of, and attitudes toward, antibiotic use and resistance in Swedish dairy producers

Scales are frequently used to quantify latent traits that can not be measured directly (eg knowledge of a subject, attitude toward an issue, severity of a clinical condition). Historically, little attention has been paid within veterinary medical sciences to evaluating how well these scales perform. In this study methods that can be used in this evaluation were reviewed and applied to scales quantifying two unmeasurable traits: knowledge of, and attitudes toward, antibiotic use and resistance in Swedish dairy farms. Items (questionnaire questions) that did not fit well with the assumed unmeasurable trait were identified and removed. Item response theory models were applied to the remaining items to determine how well they contributed to the scale using item characteristic curves and a variety of information functions. A graphical evaluation of the fit of the models to the data was then carried out. For the knowledge scale, the evaluation identified a number of items which did not fit well with the scale. It subsequently demonstrated that the scale did a good job of discriminating among producers with below average knowledge, but had very little ability to separate average producers from those with a high level of knowledge. Similarly, the attitude scale did well at discriminating among producers with an average or poor attitude toward reducing their own antibiotic use, but had little ability to distinguish among those with above average attitudes. Item response theory models are valuable for determining how well items contribute to predicting an individual's value of the latent variable and whether or not there are "gaps" in the scale which are not measured well. Guidelines for the use of these methods in the development or refinement of scales are presented. Their post-hoc use to verify the performance of scales in preparation for subsequent analyses is also discussed.

Antimicrobial use, biosecurity, herd characteristics, and antimicrobial resistance in indicator Escherichia coli in ten Finnish pig farms

We investigated connections between antimicrobial use (AMU), biosecurity, and the numbers of pigs and staff in ten Finnish farrow-to-finish herds. Data on AMU in each herd were collected for 12 months. AMU was quantified as treatment incidences per 1000 days at risk (TI) using the consensus defined daily dose calculation. Biosecurity was scored using the Biocheck.UGent™ system. We also examined antimicrobial resistance patterns of indicator E. coli isolated from faeces of selected pigs. In each herd, two groups of five pigs were formed: 1) antimicrobial treatment group (ANT: at least one pig in the litter was identified as sick and treated with antimicrobials) and 2) non-antimicrobial treatment group (NON: the litter was not medicated). Faecal samples were taken from these pigs at 5 and 22 weeks of age, cultured, and indicator E. coli isolates were tested for antimicrobial susceptibilities. The AMU varied considerably between the herds. Altogether, most of the antimicrobial treatment courses were assigned to weaned piglets. When AMU was quantified as TIs, suckling piglets had the highest TI (mean 46.6), which was significantly higher (P < 0.05) than TIs in fatteners and breeders (9.3 and 7.3, respectively). The difference between TI in suckling and TI in weaned piglets (19.1) was not statistically significant. There was a tendency for a negative correlation between the TI in breeders and the number of sows (r = -0.56, P = 0.09). Larger herds had higher external biosecurity scores than smaller herds (LS-means; 72 vs. 66, P < 0.05). The proportions of E. coli isolates resistant to at least one antimicrobial were higher in pigs at 5 weeks than in pigs at 22 weeks of age (Binomial proportion means; 40.5 % vs. 15.5 %, P < 0.05); as well as proportions of isolates resistant to at least three antimicrobial classes (23.0 % vs. 3.7 %, P < 0.01). These proportions did not differ between the ANT and NON groups at either 5 or 22 weeks of age (P> 0.05). We found few connections: enhanced external biosecurity levels found in the large herds co-occurred with lower use of antimicrobials and herds with low biosecurity scores - especially in the internal subcategories - appeared to have higher proportions of resistant isolates. Conclusively, we suggest that enhancing internal biosecurity might contribute to a reduction in the spreading of antimicrobial resistance in pig herds.

Coaching Belgian and Dutch Broiler Farmers Aimed at Antimicrobial Stewardship and Disease Prevention

A reduction in antimicrobial use (AMU) is needed to curb the increase in antimicrobial resistance in broiler production. Improvements in biosecurity can contribute to a lower incidence of disease and thereby lower the need for AMU. However, veterinary advice related to AMU reduction or biosecurity is often not complied with, and this has been linked to the attitudes of farmers. Behavior change promoted by coaching may facilitate uptake and compliance regarding veterinary advice. Thirty broiler farms in Belgium and the Netherlands with high AMU were included in this study for 13 months. For each farmer, the attitude towards AMU reduction was quantified using an adjusted Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR^®) change management model, and farm biosecurity was assessed with the Biocheck.UGent^™ tool. Subsequently, farmers were coached to improve disease prevention and antimicrobial stewardship. After the individual coaching of farmers, there was a change in their attitudes regarding AMU, reflected by an increase in ADKAR^® scores. Biosecurity levels improved by around 6% on average, and AMU was reduced by 7% on average without negative effects on performance parameters. Despite these improvements, no significant association could be found between higher ADKAR^® scores and lower AMU. Further investigation into sociological models is needed as a tool to reduce AMU in livestock production.

Income compensation options and partial budget analysis following a reduction of antimicrobial sales at the veterinary practice level

Over the years, the excessive consumption of antimicrobials (AM) by animals and humans has become a major concern at the global level, and several studies have highlighted the link between antimicrobial use (AMU) and antimicrobial resistance. Previous studies showed that, in Switzerland, every calf in the fattening process received in average seven days of AM treatment, and mainly oral group treatments. Therefore, policies to reduce the consumption of AM among veal calves should be implemented and promoted to decrease AM pressure on the microbiome. This study aimed to assess how a potential loss of income due to a reduction of AM prescriptions and sales in the Swiss veal calves sector could potentially be compensated. Partial budget models at the veterinary practice level were built to evaluate the effect on the net profit of veterinary practices, following four different national policy interventions that aim to reduce AM prescriptions for veal calves. The best-case scenarios resulted in a positive net profit. The scenarios assuming complete loss of profit from AM sales resulted in very low or negative net profit. Therefore, without financial support (e.g. through the government or other entities), veterinarians are likely to find it difficult to fully compensate the economic losses. At the practice level, income compensation mechanisms require a fundamental change of the business model. New model should be largely independent of pharmaceutical sales and should promote paid counselling on herd health management.

Why do Irish pig farmers use medications? Barriers for effective reduction of antimicrobials in Irish pig production

Background

In addressing the threat of antimicrobial resistance, it is critical to understand the barriers to the uptake of strategies for the reduction of antimicrobial use (AMU) in the pig industry. In several EU countries, factors such as education level, habits and social pressures are recognised as affecting farmers’ decision-making process in relation to AMU. However, there is a lack of information on the Irish scenario. The aim of this study was to investigate pig farmers’ perspectives and their behaviour towards AMU to identify potential barriers to effectively reduce AMU in Irish pig production. We conducted face-to-face semi-structured interviews with 30 pig farmers, 5 pig veterinarians and 4 focus groups of pig farm personnel. We employed qualitative analyses to explore the objective of the study.

Results

Qualitative analysis revealed six convergent themes as potential barriers: perceptions about the need for AMU on farm, concept of animal welfare and associated management practices, legislation, culture, economics and standards of communication/type of advice-network. Overall, pig farmers believed that there is poor communication between stakeholders (i.e. farmers, vets and advisors) and a lack of reliable people to approach for advice. They considered themselves as operating responsibly in terms of AMU compared to their national and international colleagues and expressed the importance of a so-called ‘Irish solution’ to the problem of AMU because it was associated with what ‘has always been done’ and was therefore considered reliable and safe.

Conclusions

Barriers and challenges were in line with those identified in other EU countries highlighting similarities in behavioural and attitudinal patterns among pig farmers. Overall, farmers appeared to be more likely to rely on previous experiences or to wait for an imposed change (e.g. legislation) instead of taking personal action. Thus, considerable behavioural and attitudinal changes are needed to adopt a more responsible AMU in Irish pig production and to develop effective intervention strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13620-021-00193-3.

Examining the Effect of Context, Beliefs, and Values on UK Farm Veterinarians' Antimicrobial Prescribing: A Randomized Experimental Vignette and Cross-Sectional Survey

Antimicrobial resistance (AMR) is a pressing threat to public and animal health. There is evidence that antimicrobial prescribing and stewardship behaviors by veterinarians (vets) are influenced by non-clinical factors, such as psychological, social, and environmental factors. This study explored the role of context, beliefs, and values on vets' antimicrobial prescribing decisions. UK-based practicing farm vets (n = 97) were recruited to an online study. Using an experimental vignette methodology, vets were randomly assigned across four conditions, to examine the effects of different contexts (pressure on farm economics, the farmer, or the vet-farmer relationship, compared to a control condition) on vets' likelihood of prescribing antibiotics. Vets' beliefs about different groups' responsibility for causing and preventing AMR and vets' values were also measured. Key findings were that context alone, values, and beliefs about groups' responsibilities for causing AMR were not predictive of vets' likelihood of prescribing antibiotics. However, vets' beliefs about groups' responsibilities for preventing AMR were predictive of an increased likelihood of prescribing antibiotics, when vets were exposed to the experimental condition of the vignette in which the vet-farmer relationship was under pressure. Farm vets also believed that different groups have different levels of responsibility for causing and preventing AMR. Results should be interpreted cautiously, given the smaller than planned for sample size, and the possibility for both false negatives and false positives. Further research is needed to explore how these findings could inform antimicrobial stewardship interventions in veterinary medicine.

Exploring Farmers' Reasons for Antibiotic Use and Misuse in Pig Farms in Brazil

Stressful management that makes farmed pigs susceptible to infections is associated with high antibiotic use (AMU) and resistance (AMR). Pig farmers are key stakeholders to support the international agenda pushing AMU restrictions. We interviewed 58 pig farmers on AMU/AMR, biosecurity, veterinary assistance, disease prevention and treatment, aiming to understand practices and attitudes towards the AMU/AMR problem. Farmers described a reliance on antibiotics to prevent and treat disease while neglecting biosecurity measures. We identified inappropriate AMU practices (high use of broad-spectrum antibiotics, incorrect dosage or treatment length) and unrestricted access to antibiotics, which encouraged imprudent AMU. Nevertheless, most farmers considered this AMU legitimate to guarantee herd productivity and showed unpreparedness and resistance to changing AMU practices, perceiving limitations (economic, sanitary and inspection) more easily than alternatives to reduce AMU. Agro-industries and foreign markets were mentioned, and internal consumers dismissed as potential motivators for behavioral changes. Importantly, farmers' economic, technical and social factors may limit their autonomy to change practices. We conclude that the observed distancing of pig farmers from the AMU/AMR problem limits the efficiency of policies aiming for a prudent AMU. Our study indicates a need for education, training and behavior change nudging that should include other stakeholders beyond farmers.

Understanding farmers' and veterinarians' behavior in relation to antimicrobial use and resistance in dairy cattle: A systematic review

To tackle antimicrobial resistance, it is vital that farmers' and veterinarians' antimicrobial use behaviors and attitudes toward resistance are understood so that we can identify how beliefs and motives influence practices. Current literature details qualitative and quantitative research that explores the knowledge, attitudes and perceptions of dairy farmers and veterinarians with respect to antimicrobial resistance and antimicrobial practices, and the reported findings are varied and conflicting. Our objective was to conduct a systematic review to assess the evidence and knowledge gaps in the published literature. We identified articles via database searches of Embase, Medline, PubMed, Scopus, and Web of Science; we limited findings to published articles available in English with no publication year restrictions. Article screening was conducted at 3 levels: title, abstract, and full text. Of the 349 articles identified, 35 were retained for systematic review. Transparency of reporting was assessed for each study using the Consolidated Criteria for Reporting Qualitative Research (COREQ) framework. Quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings relating to dairy farmers' and veterinarians' knowledge, attitudes, and perceptions on antimicrobial resistance and practices were thematically analyzed. The comprehensiveness of reporting was variable: studies reported 5 to 26 of the 32 COREQ checklist items. Five key themes emerged from the data: knowledge and awareness of antimicrobial resistance; factors influencing farmer and veterinarian decision-making; perceived barriers and facilitators to reduced antimicrobial use; perceived responsibility for antimicrobial resistance; and the role of the farmer and veterinarian relationship in reducing antimicrobial use. Awareness of prudent antimicrobial use was not uniform between studies. Many factors influence farmers' and veterinarians' decisions to use antimicrobials, including animal welfare and available resources. The farmer-veterinarian relationship is a potential barrier or facilitator of reduced antimicrobial use, depending on the perceived relationship dynamic. Encouraging collaboration between farmers and veterinarians could lead to shared responsibility for reducing antimicrobial use. This review provided a coherent picture of what is currently known and identified gaps in the current knowledge to inform future behavioral intervention research. Increased knowledge, skill development, resources, engagement, and further research to address the gaps we identified are the main recommendations to effectively overcome barriers, elicit appropriate behavior change, and achieve reduced antimicrobial use in dairy cattle.

The Effectiveness of an Educational Intervention on Knowledge, Attitudes and Reported Practices on Antibiotic Use in Humans and Pigs: A Quasi-Experimental Study in Twelve Villages in Shandong Province, China

Our aim was to evaluate the effectiveness of an intervention for residents in rural China on knowledge, attitudes and reported practices (KAP) on antibiotic use in humans and pigs. A quasi-experimental study was conducted in 12 villages in rural Shandong province, divided into intervention and control groups, covering a two-year period from July 2015 to June 2017. A package of health education-based interventions including training sessions, speakerphone messages, posters and handbooks for residents was developed and implemented over a one-year period to improve the use of antibiotics in humans and pigs. The intervention net effects were evaluated by Difference-in-Difference (DID) analysis based on responses to a questionnaire concerning KAP towards antibiotic use in humans and pigs. A total of 629 participants completed both baseline and post-trial questionnaires, including 127 participants with backyard pig farms. Significant improvements were found in KAP towards antibiotic use in humans, but changes related to antibiotic use for pigs were not significant. Participants who were in the intervention group (p < 0.001) were more likely to have improved their knowledge on antibiotic use in humans. Participants who had higher attitude scores were less likely to report self-medicating with stored antibiotics in the previous year (p < 0.001). Our results suggest that our health education-based intervention was effective in improving KAP on human antibiotic use, but it had little effect regarding antibiotic use for pigs.

In-Water Antibiotic Dosing Practices on Pig Farms

Pigs reared on many farms are mass-medicated for short periods with antibiotics through their drinking water to control bacterial pathogen loads and, if a disease outbreak occurs, to treat pigs until clinical signs are eliminated. Farm managers are responsible for conducting in-water antibiotic dosing events, but little is known about their dosing practices. We surveyed managers of 25 medium to large single-site and multi-site pig farming enterprises across eastern and southern Australia, using a mixed methods approach (online questionnaire followed by a one-on-one semi-structured interview). We found wide variation in the antibiotics administered, the choice and use of dosing equipment, the methods for performing dosing calculations and preparing antibiotic stock solutions, the commencement time and duration of each daily dosing event, and the frequency of administration of metaphylaxis. Farm managers lacked data on pigs’ daily water usage patterns and wastage and the understanding of pharmacology and population pharmacometrics necessary to optimize in-water dosing calculations and regimens and control major sources of between-animal variability in systemic exposure of pigs to antibiotics. There is considerable scope to increase the effectiveness of in-water dosing and reduce antibiotic use (and cost) on pig farms by providing farm managers with measurement systems, technical guidelines, and training programs.

Antimicrobial Usage Factors and Resistance Profiles of Shiga Toxin-Producing Escherichia coli in Backyard Production Systems From Central Chile

Shiga toxin-producing Escherichia coli (STEC) is a zoonotic pathogen and important cause of foodborne disease worldwide. Many animal species in backyard production systems (BPS) harbor STEC, systems characterized by low biosecurity and technification. No information is reported on STEC circulation, antimicrobial resistance (AMR) and potential drivers of antimicrobial usage in Chilean BPS, increasing the risk of maintenance and transmission of zoonotic pathogens and AMR generation. Thus, the aim of this study was to characterize phenotypic and genotypic AMR and to study the epidemiology of STEC isolated in BPS from Metropolitana region, Chile. A total of 85 BPS were sampled. Minimal inhibitory concentration and whole genome sequencing was assessed in 10 STEC strain isolated from BPS. All strains were cephalexin-resistant (100%, n = 10), and five strains were resistant to chloramphenicol (50%). The most frequent serotype was O113:H21 (40%), followed by O76:H19 (40%), O91:H14 (10%), and O130:H11 (10%). The stx1 type was detected in all isolated strains, while stx2 was only detected in two strains. The Stx subtype most frequently detected was stx1c (80%), followed by stx1a (20%), stx2b (10%), and stx2d (10%). All strains harbored chromosomal bla_AmpC. Principal component analysis shows that BPS size, number of cattle, pet and horse, and elevation act as driver of antimicrobial usage. Logistic multivariable regression shows that recognition of diseases in animals (p = 0.038; OR = 9.382; 95% CI: 1.138–77.345), neighboring poultry and/or swine BPS (p = 0.006; OR = 10.564; 95% CI: 1.996–55.894), visit of Veterinary Officials (p = 0.010; OR = 76.178; 95% CI: 2.860–2029.315) and close contact between animal species in the BPS (p = 0.021; OR = 9.030; 95% CI: 1.385–58.888) increase significantly the risk of antimicrobial use in BPS. This is the first evidence of STEC strains circulating in BPS in Chile, exhibiting phenotypic AMR, representing a threat for animal and public health. Additionally, we identified factors acting as drivers for antimicrobial usage in BPS, highlighting the importance of integration of these populations into surveillance and education programs to tackle the potential development of antimicrobial resistance and therefore the risk for ecosystemic health.

Understanding antibiotic use for pig farming in Thailand: a qualitative study

BACKGROUND

Antimicrobial resistance (AMR), recognised as a serious and growing threat to global health, is promoted by multiple drivers, including antibiotic use in the livestock sector. Thus, understanding factors influencing antibiotic use in livestock production is essential to the design and implementation of effective interventions to reduce AMR. This qualitative study aimed to explore the experiences and views of the key actors associated with the use of antibiotics for pig farming in Thailand, from local farmers to officers in central government institutions.

METHODS

A total of 31 in-depth interviews were conducted with different categories of actors: pig farmers (n = 13), drug retailers (n = 5), veterinarians (n = 7), government officers (n = 3) and representatives of animal and human health associations (n = 2). Themes emerging from the interviews were identified and explored using thematic analysis. In addition, direct observations were conducted in the pig farms.

RESULTS

The findings highlight the multi-faceted nature of the views and practices that may contribute to misuse or overuse of antibiotics in the study locations, including misconceptions about the nature of antibiotics and AMR (particularly among smallholders), lack of facilities and financial means to establish an antibiotic-free farm, lack of sufficient training on AMR and antibiotic prescribing for veterinarians, the profit motive of pharmaceutical companies and their ties to farm consultants, and lack of sufficient regulatory oversight.

CONCLUSIONS

Our study indicates a clear need to improve antibiotic use for pig production in Thailand. Farmers need better access to veterinary services and reliable information about animal health needs and antibiotics. Innovative investments in biosecurity could improve farm management and decrease reliance on antibiotics, although the cost of these interventions should be low to ensure wide uptake in the livestock sector. Lastly, further development of professional training and clinical guidelines, and the establishment of a code of conduct, would help improve antibiotic dispensing practices.

Antimicrobial Usage Among Different Age Categories and Herd Sizes in Swiss Farrow-to-Finish Farms

In the Swiss pig sector, the usage of antimicrobials has been recorded, evaluated and systematically reduced on a voluntary basis since 2015. This monitoring has been carried out using various methods thereby enabling continuous national scrutiny as well as international comparisons. To gain a better understanding of the dynamics of the antimicrobial usage on Swiss farms, consumption data of farrow-to-finish farms were analyzed for (i) the within-herd relationships among different age categories and (ii) the influence of the herd size. The data were collected on 71 farms for the year 2017, encompassing the amount of active ingredients and number of defined daily doses Switzerland (nDDDch) in total, and stratified for the different age categories of piglets, weaners, fattening pigs, and sows. The differences in nDDDch per animal among the age categories were determined by a Wilcoxon test and subsequent post-hoc analysis according to Bonferroni. The within-herd relationship among the individual age categories as well as the influence of the herd size on nDDDch per animal measured as kept sows were analyzed by simple linear regression. The evaluation of the treatment days showed that 50% of the nDDDch were used in piglets, 44% for weaners, and 3% each for fattening pigs and sows. Compared to the other age categories, the examination of the number of nDDDch per animal showed a significantly higher number for sows, whereas for fattening pigs the number was significantly lower (P < 0.01). The farm-based analysis using linear regression showed a relationship between antimicrobial usage in sows and piglets (P < 0.001; adj. R² = 0.19). Similarly, a significant relationship between larger herd size and increased antimicrobial usage was observed (P = 0.02; adj. R² = 0.06). The present study provides an insight into the antimicrobial treatment dynamics of farrow-to-finish farms. In particular, the age categories piglets and sows—with their higher number of treatment days in total or per animal—are of interest regarding the potential reduction in antimicrobial usage. Likewise, larger farms with higher management requirements were found to be of particular importance for the reduction of antimicrobial usage. Monitoring programs should therefore evaluate different age categories separately to identify problems for individual farms.

Veterinary Diagnostic Practice and the Use of Rapid Tests in Antimicrobial Stewardship on UK Livestock Farms

In this paper we consider the shifting role, practice and context of veterinary diagnosis in addressing concerns over what is, in the context of the growing threat of antimicrobial resistance, considered unnecessary or excessive antimicrobial medicine use in UK livestock farms. With increasing policy and regulatory interest in diagnostic practices and technologies, coupled with an expanding focus on the development and deployment of new rapid and point-of-care on-farm diagnostic testing, this paper investigates current diagnostic practices amongst veterinarians working on dairy, pig and poultry farms in Great Britain (England, Wales, and Scotland) and, more specifically, veterinarians' use and perceptions of new and emerging rapid and point-of-care diagnostic tests. Drawing on a series of 30 semi-structured interviews with farm animal veterinary professionals across the three sectors, this paper examines the manner in which such tests are both used and anticipated in clinical farm animal veterinary practice and the possible impact rapid test technologies might have on broader farm animal health management and disease control. Analysis of the transcribed interviews reveals a number of complexities around the use of rapid and point-of-care diagnostic tests. The relative rapidity and simplification of such tests, facilitating immediate treatment responses, is held in balance against both the accuracy and the more detailed and documented procedures of established laboratory testing routes. In situations of multifaceted on-farm etiologies, respondents maintained that rapid tests may offer restricted diagnostic capabilities, though in other situations they were found to offer ready confirmation of disease presence. A third complexity arising from the growth of rapid and point-of-care testing and revealed in this study relates to the shifting distribution of responsibilities in animal health care within contemporary food chains. The growing availability of rapid and point-of-care tests effectively diversifies the range of diagnostic actors with consequences for the flow of diagnostic and disease information. The veterinarians in this study identified areas where new rapid and point-of-care tests would be of particular value to them in their clinical practice particularly in addressing concerns over inappropriate antimicrobial use in animal treatment. However, despite the considerable policy advocacy on rapid and point-of-care tests as key tools in shifting diagnostic practice and reducing unnecessary antimicrobial use, veterinarians in this study, while recognizing the potential future role of such tools and technologies, nonetheless viewed diagnostic practice as a far more complex process for which rapid tests might constitute only a part.

Transition Pathways Toward the Prudent Use of Antimicrobials: The Case of Free-Range Broiler Farmers in France

Reducing antimicrobial use (AMU) on farms is key for controlling the rise of resistant bacteria that have the potential capacity to infect humans via direct animal contact or via the food chain or the environment. To reduce AMU, antimicrobials must be used in a prudent and rational manner. Extensive efforts have been made recently to identify the cognitive and behavioral barriers to the appropriate use of antimicrobials by various livestock sector stakeholders. However, most studies carried out thus far have only partly captured the dynamic and systemic dimension of the processes involved in changes of practices related to AMU on farms. To shed light on the transition pathways implemented to reduce AMU, a qualitative study was conducted in France based on 28 semi-structured interviews with farmers, technicians and veterinarians from the free-range broiler production sector. Based on the thematic analysis of verbatims, we identified technical improvements which are key contributors to reduced AMU. We also highlighted some gaps in knowledge regarding AMU and antimicrobial resistance. We found that, rather than individual motivations alone, the extent to which farmers are embedded in collective organizations is decisive for changes in practices, and downstream operators (distributors and slaughterers) play a key role in the beginning of AMU transition pathways. As a result, we show that change in AMU requires a global rethinking of the overall socio-technical system rather than modifications of a single element in a farming system. Our results also highlight that transition pathways toward reduced AMU cannot just rely on trigger events, but also involves medium or long-term processes, with actors' experiences and practices being modified on an incremental basis over time. Our study sheds light on the need for multi and trans-disciplinary research involving the social sciences to analyze interactions between stakeholders and the collective actions implemented to tackle the challenge of AMU reduction.

Decision-Making of Swiss Farmers and the Role of the Veterinarian in Reducing Antimicrobial Use on Dairy Farms

The reduction of antimicrobials on dairy farms is a topical issue and confronts both veterinarians and farmers with major challenges. The aim of this study was to investigate dairy farmers' motivation to reduce antimicrobial use on their farms. Factors influencing dairy farmers' decision-making regarding dairy cow health were identified and the role of the veterinarian in these processes was characterized. A customized structured questionnaire was sent to all participants (n = 59) of an ongoing antimicrobial reduction project among dairy farmers in the Canton of Fribourg, Switzerland, by mail. Fifty-eight completed questionnaires were returned and evaluated (response rate 98.3%). The majority of respondents were men (56/58, 96.6%) and farm managers (55/57, 96.5%) managing their farms as their main occupation (56/57, 98.2%). Using a 5-point-Likert-scale (1 = not a reason, 5 = very important reason), respondents ranked “My veterinarian is putting pressure on us to use less antimicrobials” (median=2.5, interquartile range = 1–3) and “Other farmers also reduce antimicrobial use” (2.0, 1–3) as the least important factors affecting their motivation to reduce the use of antimicrobials in dairy cows (P < 0.001). Respondents ranked their veterinarian's opinion (4.0, 4–5) and their own feelings and knowledge (4.0, 3–4) as the two factors having significantly more importance on their decisions regarding dairy cow management (P < 0.001). The farmers indicated they were satisfied with the quality of the consultancy given by their veterinarians (4.0, 4–5) and with the quality of communication with veterinarians (4.0, 3–4). They indicated that they understood recommendations made by the veterinarian (4.0, 3.75–4) and also felt understood by the veterinarian (4.0, 3–4). However, only 25.9% (14/54) indicated they were willing to pay for good quality, farm-adapted consulting by their veterinarian. Based on these findings, veterinarians play an important role in influencing Swiss dairy farmers in decision-making concerning animal health and treatment. However, veterinarians were not viewed by farmers as important motivators for reducing antimicrobial use. Swiss veterinarians are encouraged to be aware of their influence on farmers' decisions and to use that influence to more clearly promote antimicrobial reduction on dairy farms.

Perception of Drug Vendors and Pig and Poultry Farmers of Imerintsiatosika, in Madagascar, Toward Risks Related to Antibiotic Usage: A Q-Method Approach

Antimicrobial resistance is a One Health issue that must be tackled worldwide. In order to implement effective communication strategies in Madagascar, a better understanding must be gained of practices and perceptions related to antimicrobial use at the smallholder farm level. Our study used a semi-qualitative approach, called Q methodology, to identify patterns of opinion on antimicrobial use, or its alternatives, among pig and poultry smallholders and drug vendors in the commune of Imerintsiatosika, in Madagascar. Twenty-nine breeders and 23 drug vendors were asked to rank, respectively, 38 and 45 statements, produced from semi-structured interviews and secondary data, through a 7 grade scale from -3 (totally disagree) to +3 (totally agree) about antimicrobial use, related risks and alternatives. The interview ended with a discussion around extreme statements. The Q-sortings were analyzed by factor analysis and Principal Component Analysis. Regarding antimicrobial use, antimicrobial resistance and alternatives, the breeders and drug vendors were divided according to three discourses: "A: confidence in antibiotics" (respectively, 13 and 6 individuals), "B: belief in alternatives" (7 and 7 individuals), and "C: moderate approach to antibiotic use" (6 and 6 individuals), explaining, respectively, 57 and 60% of total variance. Group A was associated with the use of antibiotics as a preventive measure, poor knowledge of resistance and low trust in alternatives. Group B considered the preventive use of antibiotics to be a major problem for antimicrobial resistance and believed that alternatives, such as vaccines, were useful preventive methods. Group C seemed to have a hazy opinion. The presence of three main points of view offers the possibility to adapt awareness messages. Group B might also be used as a showcase to reduce the amounts of antibiotics used by the two other groups. This study revealed different practices and risk perceptions related to antimicrobial use that must be better characterized and accurately quantified.

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

OBJECTIVES

Farm-level quantification of antimicrobial usage (AMU) in pig farms.

METHODS

In a cross-sectional study, AMU data on group treatments administered to a single batch of fattening pigs from birth to slaughter (group treatment data) and antimicrobials purchased during 1 year (purchase data) were collected at 180 pig farms in nine European countries. AMU was quantified using treatment incidence (TI) based on defined (DDDvet) and used (UDDvet) daily doses and defined (DCDvet) and used (UCDvet) course doses.

RESULTS

The majority of antimicrobial group treatments were administered to weaners (69.5% of total TIDDDvet) followed by sucklers (22.5% of total TIDDDvet). AMU varied considerably between farms with a median TIDDDvet of 9.2 and 7.1 for a standardized rearing period of 200 days based on group treatment and purchase data, respectively. In general, UDDvet and UCDvet were higher than DDDvet and DCDvet, respectively, suggesting that either the defined doses were set too low or that group treatments were often dosed too high and/or administered for too long. Extended-spectrum penicillins (31.2%) and polymyxins (24.7%) were the active substances most often used in group treatments, with the majority administered through feed or water (82%). Higher AMU at a young age was associated with higher use in older pigs.

CONCLUSIONS

Collecting farm-level AMU data of good quality is challenging and results differ based on how data are collected (group treatment data versus purchase data) and reported (defined versus used daily and course doses).

Antimicrobial Resistance in Humans and Animals: Rapid Review of Psychological and Behavioral Determinants

A rapid review of current evidence examining psychological issues regarding the use of antibiotics and antimicrobials and resistance to these in both human and animal populations was conducted. Specific areas of interest were studies examining psychological determinants of AMR and interventions which attempt to change behavior with regard to AMR in the general population; animals; and fish, in particular. Although there is some evidence of the effectiveness of behavior change in general human populations, there is limited evidence in farmed animals, with a particular dearth in fish farming. We conclude there is an urgent need for more psychological research to identify major barriers and facilitators to change and evaluate the effectiveness of theory-based interventions aimed at reducing AM use in food production animals, including the promotion of alternatives to AMs, such as vaccination.

Farmers' Perceptions and Drivers of Antimicrobial Use and Abuse in Commercial Pig Production, Ogun State, Nigeria

Antimicrobial resistance (AMR) in humans has been linked to non-judicious antimicrobial use (AMU) in food animals. To develop antimicrobial stewardship plans (AMSPs) for pig farmers, there is the need to understand the current status of AMU and the driving factors in the industry. Data on AMU, farmers' perceptions of associated drivers, and biosecurity were collected through a mixed-method study design with focus group discussions (FGDs) and questionnaire-based interviews. Antimicrobials (AMs) were mainly used for therapeutic and prophylactic purposes. Common AMs used were tetracycline (78.8%), gentamycin (53.8%), and tylosin (52.5%). Perceived drivers of AMU were linked to economic benefits, farmers' previous experiences, sick animals, expensive veterinary services, easy accessibility to over-the-counter drugs, poor farm practices, and poor disease prevention strategies. AMU was poor (average 40.2%), while knowledge on AMs and implications for animal and human health was considered averagely satisfactory (56.4%). The biosecurity level was also satisfactory (53.0%) and significantly associated with having a written farm health plan (p = 0.035). Good AMU was found to be strongly associated with farmers' use of veterinary services (p = 0.001). Diverse factors drive antimicrobial use among pig farmers in Ogun State, and these could be addressed by providing continuing education on antimicrobial stewardship and best farm practices.

The technical and economic impact of veterinary interventions aimed at reducing antimicrobial use on broiler farms

Antimicrobial resistance is a global threat for both human and animal health. One of the main drivers of antimicrobial resistance is inappropriate antimicrobial use in livestock production. The aim of this study was to examine the technical and economic impact of tailor-made interventions, aimed at reducing antimicrobial use in broiler production. Historical (i.e., before intervention) and observational (i.e., after intervention) data were collected at 20 broiler farms. Results indicate that average daily gain and mortality generally increased after intervention, whereas feed conversion and antimicrobial use decreased. Economic performance after interventions was generally higher than before the interventions. Sensitivity analyses on price changes confirm the robustness of the findings.

Knowledge, attitudes and practices relating to antibiotic use and antibiotic resistance among backyard pig farmers in rural Shandong province, China

China is among the world's largest consumers of antibiotics for livestock, and the demand for meat protein continues to rise. Pig production takes place at a range of facilities, including backyard pig farms. The aim of this study was to describe the knowledge, attitudes and practices of backyard pig farmers concerning antibiotic use and resistance, and to observe household storage of antibiotics for use in pigs. We conducted a cross-sectional questionnaire survey among 271 rural residents with backyard pig farms in 12 villages in one town in Shandong province. The median number of pigs per backyard farm was 14, and 82 % (222/271) of participants reported not having had any training about raising pigs. Eighteen percent of participants (48/271) reported always or often adding antibiotics to feed to keep pigs healthy and prevent diseases, and a third (88/271) of participants believed that pigs should be given antibiotics when they stop eating. Thirty percent (82/271) reported having bought antibiotics in the previous year without having first spoken with a veterinarian. Antibiotics accounted for over half of all medicines stored (55 %, 197/358), and were observed in 31 % of all households (83/271). Less than half of participants (45 %, 37/83) from households in which antibiotics for pig use were found knew that they were storing antibiotics. The most common class of antibiotics stored for use in pigs was (Q)J01C beta-lactam antibiotics, penicillins (19 %, 37/197), followed by (Q)J01F macrolides, lincosamides and streptogramins (14 %, 28/197), and (Q)J01M quinolones (12 %, 25/197). These results provide important insights into how backyard pig farmers are using antibiotics in rural China and suggest potential targets for interventions to reduce unnecessary and inappropriate use.

Antibiotic use in people and pigs: a One Health survey of rural residents' knowledge, attitudes and practices in Shandong province, China

Objectives

To evaluate rural residents' knowledge, attitudes and practices (KAP) towards antibiotic use in humans and pigs, among individuals with and without backyard pig farms living in Shandong province, China.

Methods

We conducted a cross-sectional questionnaire study among residents in 12 villages, and directly observed medicines stored in households for humans and pigs.

Results

In total, 769 residents participated, including 330 backyard pig farmers. Respondents had low levels of knowledge about antibiotics. A quarter of participants had bought one or more antibiotics from a pharmacy without a prescription in the previous year, and this was more common among pig farmers who had bought antibiotics for their pigs without consulting a vet (49% versus 25%, P < 0.001). Stored antibiotics for human use were found in 42% of households, and 70% of participants from these households did not know they were storing antibiotics. Thirty-one percent of backyard pig farmers were storing antibiotics for pig use. Farmers who thought it was good to store leftover antibiotics for their pigs were more likely to have stored antibiotics for pigs (41% versus 20%) and for humans (47% versus 32%; both P < 0.01). A fifth of participants thought their own actions were important for controlling antibiotic resistance.

Conclusions

We found differences in the KAP of backyard pig farmers and non-pig farmers to antibiotics, and parallels between pig farmers' attitudes and behaviours towards antibiotic use in pigs and in humans. Our findings reinforce the need for context-adapted multifaceted interventions to improve antibiotic use and provide suggestions for targeting educational approaches.

Exploring Perspectives on Antimicrobial Use in Livestock: A Mixed-Methods Study of UK Pig Farmers

Increasing levels of antimicrobial resistance in human and veterinary medicine have raised concerns over the irresponsible use of antimicrobials. The role of administering antimicrobials in food producing animals most frequently falls to the farmer, therefore it is essential that their use of antimicrobials is both optimal and responsible. This study sought in-depth information on the drivers behind antimicrobial use behaviors and farmer attitudes to responsible use using a mixed-methodological approach. Initially, in-depth semi-structured interviews were conducted with a purposively selected sample of farmers (n = 22). A thematic analysis approach was taken to identify key themes from these qualitative data. The generalizability and variation of these themes was then tested on a larger randomly selected sample of pig farmers through a questionnaire study (n = 261). The influences behind antimicrobial use were complex with multiple drivers motivating decisions. There was no consensual opinion on what farming systems resulted in either a low or high antimicrobial requirement however, farmers reported that good management practices, low stocking densities, and a high health status were associated with low antimicrobial use. Farmers expressed desire to avoid the long-term use of in-feed antimicrobials, but identified barriers to discontinuing such behaviors, such as pig morbidity, mortality, and economic losses. The high cost of antimicrobials was described as a motivation toward seeking alternative methods of controlling disease to prophylactic use; however, this expense was balanced against the losses from an increased burden of disease. The high financial costs involved in pig production alongside the economic uncertainty of production and pressure from retailers, were identified as limiting the scope for improvements in pig accommodation and facilities which could reduce the antimicrobial requirements on farm. Long-term, sustainable and economically stable relationships between retailers and farmers may allow farmers to make necessary investments in improving management and housing in order to reduce antimicrobial use. Greater use and more widespread deployment of effective vaccinations were highlighted by farmers as being a feasible alternative to antimicrobial use in preventing disease.

Prevalence of Shigella species and its drug resistance pattern in Ethiopia: a systematic review and meta-analysis

Background

Shigella species are a major cause of dysentery and may attribute for death worldwide. Currently antibiotic resistance became the critical challenges for management of infectious disease. The aim was to conduct a systematic review and meta-analysis of Shigella species and its drug resistance pattern in Ethiopia.

Methods

A comprehensive literature search was conducted through internet searches using database of MEDLINE, PubMed, Google scholar, EMBASE, HINARI, Cochrane Library and reference lists of previous prevalence studies from January 1999 to November 2018. Results were presented in forest plot, tables and figures with 95% CI. The Cochrane Q test and I² test statistic were used to test heterogeneity across studies. The Pooled estimate of Shigella species and its drug resistance pattern was computed by a random effects model.

Results

The pooled prevalence of Shigella species in Ethiopia was 6.6% (95% CI 4.7–8.8). In the subgroup analysis, the highest prevalence was observed among patients in Health facility (8.5%, 95% CI 6.2–11.5) whereas the lowest prevalence was observed in Community based studies (1.6%, 95% CI 0.8–3.4). In addition, Shigella species were highly resistant to ampicillin, amoxicillin, erythromycin and multi-drug resistant (MDR) with the pooled resistance proportions of 83.1% (95% CI 75.7–88.6), 84.1% (95% CI 75.6–90.1), 86.5% (95% CI 70.9–94.4) and 83.2% (95% CI 77.1–87.9), respectively. On the other hand, comparably low resistance pattern was reported for ciprofloxacin 8.9% (95% CI 6.0–12.8), ceftriaxone 9.3% (95% CI 3.9–20.5), and norfloxacin 8.2% (95% CI 3.8–16.6) and gentamycin 17.3% (95% CI 11.2–25.9). Subgroup analyses indicated that study years were associated with a decreasing Shigella prevalence over time (p = 0.002).

Conclusion

The pooled estimate showed high burden of Shigella infection and its high proportion of drug resistance pattern to ampicillin, amoxicillin and erythromycin in Ethiopia. Therefore, initiating and scale up of performing drug susceptibility test for each shigellosis case, educate the community and health care providers on appropriate use of antibiotics need to be considered and strengthened.

Electronic supplementary material

The online version of this article (10.1186/s12941-019-0321-1) contains supplementary material, which is available to authorized users.

Epidemiological assessment of the factors associated with antimicrobial use in French free-range broilers

Background

Although the poultry sector accounts for a major portion of global antimicrobial consumption, few studies have explored the factors which influence antimicrobial use (AMU) in poultry farms in Europe. We performed a matched case-control study in traditional free-range broiler farms in France during 2016 to evaluate the effect of technical factors and farmers’ perceptions of health problems on the probability of AMU. In total, 52 cases (defined as flocks treated with antimicrobials when chickens were between 1 and 42 days old), were included. Another 208 controls (untreated flocks the same ages as the case flocks), were randomly selected and paired with a matching case (same farmer organization and placement date). On-farm questionnaires were administered. Multivariable logistic regression modeling was conducted; seven variables were significant in the final model.

Results

Two factors were associated with a lower probability of AMU: the use of chicken paper topped with starter feed (OR = 0.3; 95% CI = [0.1; 0.9]) and the use of herbal drugs as a prophylaxis (OR = 0.1; 95% CI = [0.01; 0.5]). A higher probability of AMU was associated with farmers perceiving the cumulative mortality of chicks between 1 and 10 days old as normal (OR = 10.1; 95% CI = [1.7; 59]) or high (OR = 58.7; 95% CI = [9.6; 372.3]). A higher probability of AMU also was associated with farmers detecting a health problem (OR = 12.5, 95% CI = [4.2; 36.9]) and phone calls between farmers and their technicians (OR = 5.9; 95% CI = [2.3; 14.8]) when chicks are between 11 to 42 days old. Two additional factors (litter thickness and cleaning/disinfecting) were significant and highlighted the importance of technical factors such as biosecurity.

Conclusions

Our results suggest that to reduce AMU, technical training should be provided to farmers to improve how farms are monitored and to reinforce preventive health measures. Training also should address how farmers assess warning criteria like daily mortality rates, which when overestimated often lead to antimicrobial treatment.

Electronic supplementary material

The online version of this article (10.1186/s12917-019-1970-1) contains supplementary material, which is available to authorized users.

Shared Goals, Different Barriers: A Qualitative Study of UK Veterinarians' and Farmers' Beliefs About Antimicrobial Resistance and Stewardship

Although much research has investigated the drivers of inappropriate antimicrobial prescribing in human medicine, equivalent research in veterinary medicine is in its infancy. This qualitative study used a critical incident approach to explore farm veterinarians' (vets) and farmers' beliefs about antimicrobial use and antimicrobial stewardship. Semi-structured interviews were conducted with 13 vets and 12 farmers in the UK, who worked mostly with beef cattle, dairy cattle and sheep, but a minority also worked with pigs or poultry. An inductive thematic analysis was conducted to explore how vets and farmers understood their responsibilities toward stewardship and antimicrobial resistance (AMR) and to identify key similarities and differences between the professions. The analysis generated four themes: "A shared conflict between ideals and behaviour," "Barriers to stewardship: the vets' perspective," "Barriers to stewardship: the farmers' perspective," and "A shared ambivalence: ownership vs. other-blaming." Vets and farmers demonstrated good understanding of stewardship but their treatment decisions are not always aligned to stewardship principles. Various barriers to improving antimicrobial stewardship were discussed by vets and farmers, but they placed differing emphasis on specific barriers. Faced with these barriers and an awareness that antimicrobial usage is not always aligned to stewardship principles, vets and farmers expressed frustration and a sense of ambivalence toward stewardship, and also engaged in other-blaming for the problem of AMR. In conclusion, vets and farmers in this study seem motivated to be antimicrobial stewards but feel challenged by the day-to-day reality of their jobs; they experience ambivalence toward their responsibilities for AMR, which may negatively impact their motivation to always act as antimicrobial stewards. Successfully tackling AMR will require change at the individual-, group-, and societal-level. Future interventions to improve antimicrobial usage in livestock farming could be situated within a social ecological framework, where other-blaming between professions is seen as a result of the interplay between psychological and contextual factors. Other-blaming could be reduced using a social identity approach; a common ingroup identity could be created by encouraging vets and farmers to focus on their common goal, namely a shared desire to promote animal welfare through optimal antimicrobial stewardship.

Patterns of antibiotic use in global pig production: A systematic review

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Many classes of antibiotic used for humans are also used in food animals, including the highest priority of the critically important antimicrobials for human medicine in the World Health Organisation's list.

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Penicillins and Tetracyclines classes were the most commonly used antibiotics in many countries.

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Improve understanding of the use of antibiotics and factors influencing antibiotic use will help promoting prudent use of antimicrobials in livestock.

This review assesses the evidence for patterns of antibiotic use in pig on the basis of papers published in peer-reviewed journals in English between 2000 and 2017. Thirty-six articles were identified and reviewed, of which more than 85% of studies were conducted in Europe and North America. Penicillins and Tetracyclines groups were the most commonly used antibiotics in many countries. Oral medication in suckling and post-weaning periods were the most common applications of antibiotic administration in pig production. Antibiotic use is driven by age-specific diseases and the common pathogens causing these conditions where epidemiological profiles varied greatly across countries. In addition, the type and size of farm were associated with antibiotic use with finisher and larger farms using more antibiotics than farrow-to-finish and smaller farms. There is variation in the use of the highest priority critically important antimicrobials in humans across studies. However, this review indicates that they are still commonly used in pig production, for treatment and prevention of infection. This evidence calls for global efforts on the prudent use of antibiotics in response to the emergence of antimicrobial resistance (AMR) in the agricultural sector.

Assessment of Drivers of Antimicrobial Usage in Poultry Farms in the Mekong Delta of Vietnam: A Combined Participatory Epidemiology and Q-Sorting Approach

In the Mekong Delta of Vietnam, poultry farmers use high amounts of antimicrobials, but little is known about the drivers that influence this usage. We aimed to identify these drivers using a novel approach that combined participatory epidemiology (PE) and Q-sorting (a methodology that allows the analysis of the subjectivity of individuals facing a common phenomenon). A total of 26 semi-structured collective interviews were conducted with 125 farmers representative of the most common farming systems in the area (chickens, meat ducks, and mobile grazing ducks), as well as with 73 farmers' advisors [veterinarians, veterinary drug shop owners, and government veterinarians/commune animal health workers (CAHWs)] in five districts of Dong Thap province (Mekong Delta). Through these interviews, 46 statements related to the antimicrobials' perceived reliability, costs, and impact on flock health were created. These statements were then investigated on 54 individuals (28 farmers and 26 farmers' advisors) using Q-sorting interviews. Farmers generally indicated a higher propensity for antimicrobial usage (AMU) should their flocks encounter bacterial infections (75.0-78.6%) compared with viral infections (8.3-66.7%). The most trusted sources of advice to farmers were, in decreasing order: government veterinarian/CAHWs, their own knowledge/experience, veterinary drug shop owners, and sales persons from pharmaceutical and feed companies. The highest peak of AMU took place in the early phase of the production cycle. Farmers and their advisors showed considerable heterogeneity of attitudes with regards to AMU, with, respectively, four and three discourses representing their views on AMU. Overall, farmers regarded the cost of AMU cheaper than other disease management practices implemented on their farms. However, they also believed that even though these measures were more expensive, they would also lead to more effective disease prevention. A key recommendation from this finding would be for the veterinary authorities to implement long-term sustainable training programs aiming at reducing farmers' reliance on antimicrobials.

A register-based study on associations between vaccination, antimicrobial use and productivity in conventional Danish finisher pig herds during 2011 to 2014

Reduction of antimicrobial use (AMU) in pigs is a priority to counteract development of antimicrobial resistance in animal and human pathogens. However, there is concern that Danish pig producers complying with official AMU restrictions might experience reduced herd health and productivity in the future, if alternative strategies are not available. Vaccination has been suggested as a strategy to prevent disease and minimise the need for antimicrobial treatments. The aim of this register-based study was to assess the associations between data on vaccination, productivity and AMU in Danish finisher herds over a 4-year period following initiation of the Yellow Card, which is a restrictive AMU control scheme. For each of the years 2011 to 2014, sow herds were grouped according to purchase patterns regarding Porcine Circovirus Type 2 (PCV2) (use/no use). For the sow herds (N = 179-433), additional information of purchases of vaccines against Mycoplasma hyopneumoniae (MYC), Actinobacillus pleuropneumoniae (APP), Porcine Reproductive and Respiratory Syndrome virus (PRRS) and Lawsonia intracellularis (LAW) was included. By use of movement data, finisher herds receiving pigs from the sow herds were tracked and included in the analyses. Finisher herds (N = 40-62) with register data on productivity (i.e. average daily weight gain, feed conversion rate, mortality and lean meat percentage) and data on prescriptions of antimicrobials measured in Animal Daily Doses/100 finishers/day as well as the proportion of parenteral AMU treatments out of all treatments (AMU-ratio) were included. Univariable combinations were tested for statistically significant associations (P < 0.05) and included in multivariable linear mixed-effects model for each of the six outcome variables representing productivity (N=4) or AMU (N=2). Herd number was included as a random effect to account for the herds appearing more than once. The variables representing PCV2, enrolment in the Danish Specific Pathogen Free (SPF) system, year, herd type and herd size were included as potential confounders. Vaccination against PRRS and higher AMU for finishers were associated with increased lean meat percentage, potentially due to disease outbreaks resulting in reduced growth of the pigs and lower carcass weight at slaughter in herds with PRRS. None of the other types of vaccines was associated with any of the productivity outcomes. Vaccination against PCV2, PRRS and APP were associated with higher levels of AMU, and vaccination against LAW with a higher AMU-ratio. This may be explained as some farmers preferring to take action soon after observing disease problems. No association was found between vaccination against MYC and AMU. Herds enrolled in SPF had significantly higher average daily weight gain than non-SPF herds.

A randomized controlled trial to evaluate performance of pigs raised in antibiotic-free or conventional production systems following challenge with porcine reproductive and respiratory syndrome virus

The trial objective was to compare the performance and animal health parameters of pigs raised according to one of 3 antibiotic (AB) protocols: standard AB medication consisting of mass treatment on days 4 and 21 and judicious AB therapy given therapeutically thereafter as group medication in water and feed or by individual injection (group T1, N = 702); modified AB medication identical to group T1 but with mass treatment only on day 4 and without subsequent therapeutic feed medication (group T2, N = 675); or an antibiotic-free (ABF) regimen (group T3, N = 702). All pigs were vaccinated with a modified-live porcine reproductive and respiratory syndrome virus (PRRSV) vaccine 3 days after weaning. Using a seeder pig model to mimic endemic field infection dynamics, pigs were contact-challenged with virulent PRRSV lineage 1 strain 174 four weeks after vaccination. At finishing, average daily gain (ADG) and mean feed conversion ratio (FCR) were significantly better (p ≤ 0.05) for the T1 and T2 groups compared to the T3 group. There were no significant differences in post-weaning ADG and FCR between the T1 and T2 groups. Mortality and removals significantly favored (p ≤0.05) the T1 and T2 groups (20.94% and 24.89%, respectively) versus the T3 group (57.98%). Net revenue per pig was $105.43, $98.79, and $33.81 for the T1, T2 and T3 groups, respectively. Under the conditions of this study, these results indicate that in a PRRSV-endemic setting involving bacterial co-infections, an ABF production strategy may leave pigs at considerable risk of exposure to severe clinical disease and that judicious use of antibiotics can significantly improve animal health.

Antimicrobial use practices, attitudes and responsibilities in UK farm animal veterinary surgeons

Increasing levels of antimicrobial resistance in human and veterinary medicine have raised concerns around the issue of overprescribing and the indiscriminate use of antimicrobials. Their use in food producing animals is under scrutiny due to the perceived risk from the zoonotic transfer of resistant pathogens from animals to humans. This study aimed to explore UK veterinary surgeons antimicrobial prescribing behaviours, their attitudes to antimicrobial resistance and their perceptions of responsibility of antimicrobial use in pigs through a questionnaire study on a census sample of 261 veterinary surgeons in England, Wales and Scotland who had a clinical caseload which included commercial pigs. The questionnaire had a useable response rate of 34.1% (n = 61/179) in eligible veterinary surgeons. Overall, veterinary surgeons reported personal confidence that their prescribing decisions were responsible however, there was concern that the prescribing behaviours of other veterinary surgeons and physicians in human medicine may be less responsible; a sociological concept known as 'othering'. In parallel, veterinary surgeons seldom identified that treatment failure was a consequence of antimicrobial resistance in their own clinical caseload, however they considered it an issue for other veterinary surgeons and for human prescribers. Veterinary surgeons consulted a wide spectrum of resources on antimicrobial use in pigs which, on occasion, contained conflicting guidance on what was defined as responsible prescribing. The decision over whether or not to prescribe an antimicrobial was influenced by numerous factors relating to the veterinary surgeons' experience and the clinical situation presented, but maintaining pig welfare was a high priority. There was a shared desire to seek alternative methods to prevent disease to antimicrobial use, however the use of diagnostics to support prescribing decisions was an infrequently reported behaviour and could play a more significant role in prescriber decisions if more cost effective and rapid tests were available. Future interventions to optimise antimicrobial use in pigs needs to focus on the evolution of antimicrobial use practices in a changing political and scientific landscape whilst also considering individual motivations and justifications for use.