[Defining daily doses and total doses for the measurement of antibiotic usage in Swiss pig production]

Contrasting Treatment- and Farm-Level Metrics of Antimicrobial Use Based on Used Daily Dose vs. Defined Daily Dose for the German Antibiotics Minimization Concept

The German Antibiotics Minimization Concept defines a farm-level benchmarking process based on half-yearly treatment frequencies that applies to six animal populations for fattening: calves (≤ 8 months), cattle (> 8 months), piglets (≤ 30 kg), pigs (> 30 kg), broiler chickens, and turkeys. The treatment frequency defined in the Minimization Concept takes into account the number of animals treated, the treatment duration, and the number of active antimicrobial ingredients, for each individual treatment, and is equivalent to a treatment frequency based on the used daily dose (UDD) and the actual weight of the animals at the time of treatment. With data from the German benchmarking system for the seven half-year periods from the second semester 2014 to the end of 2017, we compared UDD-based metrics of antimicrobial use (AMU) at the treatment and the farm level with metrics based on defined daily doses for animals (DDDvet) and standardized animal weights assumed at the time most likely for treatment. We show the extent to which DDDvet-based metrics would introduce errors into the measurement of AMU at the treatment level and consequently at the farm level. To that end, we introduce the average animal daily dose ratio, an aggregate measure that quantifies how choice of antimicrobial substances, deviations of used doses from recommended doses, of recommended doses from DDDvet values, and of treatment weights from standardized weights, affect a farm's AMU metrics. Our results show that in all animal populations considered benchmarking processes would become less successful at targeting high users. This would be especially true for broiler chickens and turkeys where the relative weight gain during fattening is the largest and overdosing appears to be common practice. Therefore, in AMU monitoring systems with the purpose of benchmarking farms UDD-based metrics are preferable to DDDvet-based metrics.

Antimicrobial usage in Swiss fattening pig farms: is there still potential for improvement?

OBJECTIVE

The aim of this study was to analyze antimicrobial usage (AMU) in fattening pig farms that took part in the SuisSano/Safety + Health Programme in Switzerland over the year 2020 and to discuss the potential for further improvement. Usage was examined according to the antimicrobial's class and indication for use, with emphasis on highest priority critically important antimicrobials (HPCIAs).

METHODS

Data on AMU from 1411 farms, reported in an electronic treatment journal, was used. AMU was quantified through treatment incidence (TI) based on Swiss Defined Daily Doses (DDDch). Indication of use for each antimicrobial class was analyzed with particular focus on HPCIAs.

RESULTS

The total TI of all antimicrobials used in the farms corresponds to 8.9 DDDch per 1000 pig-days at risk, of which HPCIAs represented 2.6 %. A total of 140 farms (9.9 %) partake in HPCIAs usage, with tylosin (73.8 % of total HPCIA TI) and colistin (22.8 % of total HPCIA TI) being the most frequently antimicrobials used. The most common indication for treatment with HPCIAs was gastrointestinal disorders (62.1 % of total HPCIA TI).

CONCLUSION AND CLINICAL RELEVANCE

This study shows that the efforts made in recent years to foster prudent use of antimicrobials and, especially HPCIAs in Swiss pig production, have been successful. Indeed, 90.1 % (1271 of 1411) of the farms did not use any HPCIAs over the year 2020. Of the recorded treatments, HPCIA's represented only 2.6 % of the total TIs used in fattening pigs. Since many farms do not use any HPCIAs, knowledge can be obtained from these farms to identify practices which can further reduce or even stop HPCIAs usage. Moreover, information concerning indications for HPCIAs usage provide input concerning where treatment options other than HPCIAs should be explored by both farmers and veterinarians.

Comparison of Antimicrobial Treatment Incidence Quantification Based on Detailed Field Data on Animal Level with the Standardized Methodology of the European Medicines Agency in Veal Calves, Switzerland, 2016-2018

Precise quantification of antimicrobial treatment incidence (TI) is crucial for benchmarking. Two widespread methods for treatment incidence quantification were compared for agreement. Field data were obtained from 38 veal farms from 2016 to 2018 (1905 calves, 1864 treatments). Calculation of TI_swiss for calves was based on detailed treatment records using pharmacokinetic values from the Swiss Veterinary Medicines Compendium. The method published by the European Medicines Agency was used to calculate TI in defined daily doses (TI_DDD). For each calf and treatment, TI_swiss and TI_DDD were calculated on level of the antimicrobial class, drug, application route, and farm. The quotient (Q) of TI_swiss and TI_DDD was calculated. Divergence in results between the two methods of ≤25% was arbitrarily set as good agreement. The agreement between TI_swiss and TI_DDD was mostly good. On class level, good agreement was observed for treatments representing 71.5% of the TI_DDD, and 74.5% of the total TI_DDD on drug level. Poor agreement was mainly observed for tylosin and sulfadimidine. The agreement was better for parenteral than for oral treatments (81.6% vs. 72.3%). For practically orientated calculation on farm level, good agreement was observed (77.5% of the TI_DDD). The TI_DDD method showed mostly good agreement, especially for parenteral treatments.

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.

Agreement of Benchmarking High Antimicrobial Usage Farms Based on Either Animal Treatment Index or Number of National Defined Daily Doses

Introduction: While treatment frequency as an indicator of antimicrobial consumption is often assessed using defined doses, it can also be calculated directly as an Animal Treatment Index (ATI). In this study, the correlation of calculating antimicrobial usage on Swiss pig farms using either national Defined Daily Doses (DDDch) or an ATI (number of treatments per animal per year) and the agreement between the different methods for the identification of high usage farms were investigated.

Material and Methods: The antimicrobial consumption of 893 Swiss pig herds was calculated separately for suckling piglets, weaned piglets, fattening pigs, lactating and gestating sows using the indicators nDDDch (number of DDDch) per animal per year and ATI. Correlations between the indicators were investigated by calculating Spearman's Rho coefficients. The 5, 10, and 25% highest usage farms were determined by applying both methods and the interrater reliability was described using Cohen's Kappa coefficients and visualized by Bland-Altman plots.

Results: The Spearman's Rho coefficients showed strong correlations (r > 0.5) between nDDDch/animal/year and ATI. The lowest coefficient was shown for the correlation of both indicators in gestating sows (r = 0.657) and the highest in weaned piglets (r = 0.910). Kappa coefficients identifying high usage farms were the highest in weaned piglets (k = 0.71, 0.85, and 0.91, respectively for 5, 10, and 25% most frequent users) and the lowest in gestating sows (k = 0.54, 0.58, and 0.55 for 5, 10, and 25% most frequent users).

Conclusions: In general, the investigated indicators showed strong correlations and a broad agreement in terms of the calculated levels of antimicrobial usage and the identification of high usage farms. Nevertheless, a certain proportion of the farms were defined differently depending on the indicator used. These differences varied by age category and were larger in all age categories except weaned piglets when a higher percentage benchmark was used to define high usage farms. These aspects should be considered when designing scientific studies or monitoring systems and considering which indicator to use.

Impact of the Suissano Health Programme on antimicrobial usage on 291 pig farms in Switzerland

BACKGROUND

In 2015, in Switzerland the Suissano Health Programme was implemented in pig production to improve transparency for antimicrobial usage (AMU) and to reduce the usage of fluoroquinolones (FQ), macrolides and cephalosporins, representing highest priority critically important antimicrobials.

METHODS

In the presented cohort study, the impact of the Suissano programme on the AMU of 291 pig farms between 2016 and 2017 was investigated. AMU was calculated in total numbers of defined course doses (nDCDch) for all farms in the programme. For each single farm the nDCDch/animal/year was determined for four different age categories (suckling piglets, weaned piglets, fattening pigs, sows) as well as each antimicrobial substance separately. Trends between 2016 and 2017 were investigated for all farms as well as the 25 per cent with the highest usage of antimicrobials (high users) separately.

RESULTS

Total AMU measured in nDCDch declined by 23 per cent between 2016 and 2017, but statistically significant differences could not be observed when comparing the data sets of the individual farms. A significantly reduced usage of FQ could be demonstrated in suckling piglets (P=0.003), weaned piglets (P=0.006) and sows (P=0.008) in 2017 compared with 2016. For high users, a significant reduction of total AMU could be shown in suckling piglets (P=0.02), weaned piglets (P=0.0004) and fattening pigs (P=0.01).

CONCLUSION

This study demonstrated a significant reduction in the usage of FQs in suckling piglets, weaned piglets and sows as well as total AMU in suckling piglets, weaned piglets and fattening pigs on high-usage farms.

Antimicrobial Drug Consumption on Swiss Pig Farms: A Comparison of Swiss and European Defined Daily and Course Doses in the Field

Defined Daily Doses (DDD) and Defined Course Doses (DCD) have been established in both human and veterinary medicine in order to standardize the measurement of treatments in a population. In 2016 the European Medicines Agency published average defined daily dose (DDDvet) and defined course dose (DCDvet) values for antimicrobial agents used in livestock production. Similarly, national defined doses (DDDch and DCDch) for the pig sector in Switzerland have recently been determined. The aim of this study was to compare the outcome of calculating antimicrobial consumption based on either DDDvet/DCDvet or DDDch/DCDch. Data from 227 Swiss pig farms describing antimicrobial use in 2015 was collected. The numbers of treatment days and treatments were calculated using DDDvet/DCDvet and DDDch/DCDch respectively, for each farm in total and for different antimicrobial classes. Associations between calculated numbers of DDDvet/DCDvet and DDDch/DCDch on farm level were investigated. In addition, differences concerning antimicrobial use were investigated between different production types of farms (piglet-producer, finishing farm or farrow-to-finishing farm). Using DDDch/DCDch values we calculated 1,805,494 treatment days and 433,678 treatments compared to 1,456,771 treatment days (19% ratio) and 303,913 treatments (30% ratio) based on DDDvet/DCDvet. Penicillins (21.4/26.6%), polypeptides (18.6/27.6%) and fluoroquinolones (9.5/8.8%) were the most frequently used classes of antimicrobials based on calculation using both DDDch and DDDvet. Similar findings were observed for complete treatments (DCDch/vet) (penicillins: 52.8/39.6%; polypeptides: 7.8/14.2%; fluoroquinolones: 13.2/12.9%). The number of treatment days or treatments per farm was higher for piglet-producers and farrow-to-finishing farms compared to finisher farms regardless of whether Swiss or European DDD or DCD values were used for the calculation (each P < 0.001). Similar results for antimicrobial use (AMU) obtained at farm level were observed when calculated either by Swiss or European definitions. Nevertheless, marked differences could be observed in the assessment of the use of specific antimicrobial classes in the field based on DDDvet/DCDvet compared to DDDch/DCDch.