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Acharya KR, Cohen A, Brankston G, Soucy JPR, Hulth A, Löfmark S, Brownstein JS, Davidovich N, Ellen ME, Fisman DN, Moran-Gilad J, Steinman A, MacFadden DR, Greer AL. An Evaluation of the Impact of an OPEN Stewardship Generated Feedback Intervention on Antibiotic Prescribing among Primary Care Veterinarians in Canada and Israel. Animals (Basel) 2024; 14:626. [PMID: 38396594 PMCID: PMC10885889 DOI: 10.3390/ani14040626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
An interrupted time-series study design was implemented to evaluate the impact of antibiotic stewardship interventions on antibiotic prescribing among veterinarians. A total of 41 veterinarians were enrolled in Canada and Israel and their prescribing data between 2019 and 2021 were obtained. As an intervention, veterinarians periodically received three feedback reports comprising feedback on the participants' antibiotic prescribing and prescribing guidelines. A change in the level and trend of antibiotic prescribing after the administration of the intervention was compared using a multi-level generalized linear mixed-effect negative-binomial model. After the receipt of the first (incidence rate ratios [IRR] = 0.88; 95% confidence interval (CI): 0.79, 0.98), and second (IRR = 0.85; 95% CI: 0.75, 0.97) feedback reports, there was a reduced prescribing rate of total antibiotic when other parameters were held constant. This decline was more pronounced among Israeli veterinarians compared to Canadian veterinarians. When other parameters were held constant, the prescribing of critical antibiotics by Canadian veterinarians decreased by a factor of 0.39 compared to that of Israeli veterinarians. Evidently, antibiotic stewardship interventions can improve antibiotic prescribing in a veterinary setting. The strategy to sustain the effect of feedback reports and the determinants of differences between the two cohorts should be further explored.
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Affiliation(s)
- Kamal R. Acharya
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Adar Cohen
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel; (A.C.); (A.S.)
| | - Gabrielle Brankston
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada;
| | - Jean-Paul R. Soucy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (J.-P.R.S.); (D.N.F.)
| | - Anette Hulth
- Public Health Agency of Sweden, 171 82 Stockholm, Sweden; (A.H.); (S.L.)
| | - Sonja Löfmark
- Public Health Agency of Sweden, 171 82 Stockholm, Sweden; (A.H.); (S.L.)
| | - John S. Brownstein
- Computational Epidemiology Lab, Boston Children’s Hospital, Boston, MA 02115, USA;
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Nadav Davidovich
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel; (N.D.); (J.M.-G.)
| | - Moriah E. Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - David N. Fisman
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (J.-P.R.S.); (D.N.F.)
| | - Jacob Moran-Gilad
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel; (N.D.); (J.M.-G.)
| | - Amir Steinman
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 7610001, Israel; (A.C.); (A.S.)
| | | | - Amy L. Greer
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada;
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Sanders P, van Geijlswijk I, Bonten M, Mughini-Gras L, van Hout J, Heederik D. Comparing human and animal antimicrobial usage: a critical appraisal of the indicators used is needed. JAC Antimicrob Resist 2024; 6:dlae005. [PMID: 38268966 PMCID: PMC10807996 DOI: 10.1093/jacamr/dlae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Comparisons between antimicrobial usage (AMU) in humans and food-producing animals are regularly made. The accuracy of such comparisons depends on the indicators used to quantify AMU. Indicators for AMU quantitatively relate use data (the numerator) to population data (the denominator). The denominator should be a proxy for the population at risk in a certain period when comparing the exposure of different populations to antimicrobials. Denominators based on numbers of animals slaughtered, such as the commonly used population correction unit, do not consider the time at risk of antimicrobial treatment. Production-based indicators underestimate animal AMU. Additionally, production-based indicators are fundamentally different from indicators used to quantify human AMU. Using such indicators to compare human and animal AMU therefore leads to biased results. More caution should be taken in selecting the indicator to quantify AMU when comparing AMU in food-producing animals and humans.
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Affiliation(s)
- Pim Sanders
- The Netherlands Veterinary Medicines Institute (SDa), Utrecht, The Netherlands
| | - Ingeborg van Geijlswijk
- The Netherlands Veterinary Medicines Institute (SDa), Utrecht, The Netherlands
- Pharmacy Department, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marc Bonten
- The Netherlands Veterinary Medicines Institute (SDa), Utrecht, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lapo Mughini-Gras
- The Netherlands Veterinary Medicines Institute (SDa), Utrecht, The Netherlands
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jobke van Hout
- The Netherlands Veterinary Medicines Institute (SDa), Utrecht, The Netherlands
- Royal GD, Deventer, The Netherlands
| | - Dick Heederik
- The Netherlands Veterinary Medicines Institute (SDa), Utrecht, The Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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Millar N, Dufour S, Lardé H, Roy JP, Belloc C, Francoz D, Paradis MÈ, Archambault M, Fairbrother JM, Aenishaenslin C. Barriers and facilitators to implementing a new regulation restricting antimicrobial use in dairy production in Québec, Canada: A qualitative study. Front Vet Sci 2023; 10:1025781. [PMID: 37008362 PMCID: PMC10060835 DOI: 10.3389/fvets.2023.1025781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
With the emergence of antimicrobial resistance (AMR), many countries are implementing restrictive regulations to reduce antimicrobial use (AMU) in animal production. Although these measures are effective at the national level, their implementation may generate challenges for producers and veterinarians. The objective of this study was to explore the barriers and facilitators of implementing a new regulation restricting the use of antimicrobials of very high importance for human health in the dairy production sector in the province of Québec, Canada. Individual interviews were conducted with fifteen veterinarians and twenty-seven dairy producers. Thematic analysis was performed based on the COM-B model of behavior change (capability-opportunity-motivation-behavior). Our results indicated that the lack of availability of alternative treatments, the long delays related to diagnostic tests and the fear of economic consequences were major barriers to the implementation of the regulation. A small number of producers also perceived that the regulation negatively impacted the health and wellbeing of their animals. Additionally, participants acknowledged the importance of early education and training to better understand the purpose of the regulation and increase its acceptability. Lastly, most participants reported that they had not only reduced their use of antimicrobials of very high importance for human health following the regulation, but they had also increased preventive practices on their farm. This study reveals that the implementation of restrictive regulations to reduce AMU in animal production can lead to multiple challenges in practice. Our results highlight the need for better communication and training of producers and veterinarians before and during the implementation of similar regulations in the future and underline the importance of measuring the direct and indirect impacts of those regulations on productivity and on animal health and wellbeing.
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Affiliation(s)
- Nikky Millar
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Centre de recherche en santé publique, Université de Montréal et Centre intégré de santé et de services sociaux du Québec du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
- Fond de recherche Nature et technologies du Québec (FRQNT)—Regroupement FRQNT Op+lait, Saint-Hyacinthe, QC, Canada
| | - Simon Dufour
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Fond de recherche Nature et technologies du Québec (FRQNT)—Regroupement FRQNT Op+lait, Saint-Hyacinthe, QC, Canada
| | - Hélène Lardé
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Fond de recherche Nature et technologies du Québec (FRQNT)—Regroupement FRQNT Op+lait, Saint-Hyacinthe, QC, Canada
- Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Jean-Philippe Roy
- Fond de recherche Nature et technologies du Québec (FRQNT)—Regroupement FRQNT Op+lait, Saint-Hyacinthe, QC, Canada
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Catherine Belloc
- Biologie, Épidémiologie et Analyses de risque en santé animale (BIOEPAR), ONIRIS-INRAE, Nantes, France
| | - David Francoz
- Fond de recherche Nature et technologies du Québec (FRQNT)—Regroupement FRQNT Op+lait, Saint-Hyacinthe, QC, Canada
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Marie-Ève Paradis
- Association des médecins vétérinaires praticiens du Québec, Saint-Hyacinthe, QC, Canada
| | - Marie Archambault
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Fond de recherche Nature et technologies du Québec (FRQNT)—Regroupement FRQNT Op+lait, Saint-Hyacinthe, QC, Canada
| | - John Morris Fairbrother
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Cécile Aenishaenslin
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
- Centre de recherche en santé publique, Université de Montréal et Centre intégré de santé et de services sociaux du Québec du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
- *Correspondence: Cécile Aenishaenslin
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Current Insights Regarding the Role of Farm Animals in the Spread of Antimicrobial Resistance from a One Health Perspective. Vet Sci 2022; 9:vetsci9090480. [PMID: 36136696 PMCID: PMC9503504 DOI: 10.3390/vetsci9090480] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial resistance (AMR) represents a global threat to both human and animal health and has received increasing attention over the years from different stakeholders. Certain AMR bacteria circulate between humans, animals, and the environment, while AMR genes can be found in all ecosystems. The aim of the present review was to provide an overview of antimicrobial use in food-producing animals and to document the current status of the role of farm animals in the spread of AMR to humans. The available body of scientific evidence supported the notion that restricted use of antimicrobials in farm animals was effective in reducing AMR in livestock and, in some cases, in humans. However, most recent studies have reported that livestock have little contribution to the acquisition of AMR bacteria and/or AMR genes by humans. Overall, strategies applied on farms that target the reduction of all antimicrobials are recommended, as these are apparently associated with notable reduction in AMR (avoiding co-resistance between antimicrobials). The interconnection between human and animal health as well as the environment requires the acceleration of the implementation of the ‘One Health’ approach to effectively fight AMR while preserving the effectiveness of antimicrobials.
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