Antimicrobial Use and Antimicrobial Resistance in Food-Producing Animals: Cross-Sectional Study on Knowledge, Attitudes, and Practices Among Veterinarians and Operators of Establishments in the Republic of Cyprus

Background: Current evidence suggests that more than half of all antimicrobials are used in the sector of food-producing animals, thus constituting a major risk factor for development and spread of antimicrobial resistance (AMR). Methods: This cross-sectional study assessed the knowledge, attitudes, and practices regarding antimicrobial resistance (AMR) and antimicrobial use (AMU) among veterinarians (n = 26) working with food-producing animals and operators (n = 165) of establishments that keep food-producing animals, across all districts of Cyprus between October and December 2024. Results: Most veterinarians demonstrated sufficient knowledge regarding AMR and AMU; however, certain knowledge gaps were identified. There was a general trend toward desired responses aimed at reducing AMU. Despite this, the level of responses advocating for restrictions on the use of specific priority antimicrobials and broad-spectrum antibacterials was unsatisfactory. Over half of veterinarians prescribed Category B substances. Furthermore, there was no significant association between the use of "restricted" antibiotics and veterinarians' level of knowledge nor between antibiotic use and the practice of microbiological culture and susceptibility testing. Among operators, positive attitudes were significant predictors of implementing of good practices. Additionally, operators who had contracts with a veterinarians were more likely to follow good practices. Conclusions: There is a need for further education on AMR in the veterinary sector in the Republic of Cyprus. Raising awareness among animal producers, is also crucial, along with enforcing a policy on antimicrobial use. Comprehensive governance involving all stakeholders must be implemented to address AMR more effectively.

Knowledge, attitude and practice towards antibiotic use and resistance among the veterinarians in Bangladesh

BACKGROUND

The emergence of antimicrobial resistance is a growing human and animal health concern around the world. When a number of studies have emphasized the Knowledge, Attitude and Practice (KAP) regarding antibiotic use and resistance in humans, little attention has been paid to the veterinary sector. The aim of this study was to understand the KAP towards antibiotic use and resistance among veterinarians in Bangladesh.

METHODS

A cross-sectional online based questionnaire survey was conducted from August to September 2020 among the registered veterinary practitioners. A self-administered Google form questionnaire consisting of 45 questions on knowledge, attitude and practice regarding antibiotic use and resistance was used. For statistical significance test we used Chi-square or Fisher's Exact test and logistic regression for factor analysis.

RESULTS

A total of 208 registered veterinarians participated in this study. The study involved a majority of male participants, constituting 85.1%, while 54.8% of the participants held a Masters degree. Around 52% of the veterinarians were poultry practitioners. All respondents were familiar with antimicrobials. The participants (91.4%) knew that antibiotics cannot cure viral infections, while 97.6% believed that frequent antibiotic prescriptions rendered them less effective. Participants claimed that only they were eligible to prescribe drugs for the treatment of animals, and around 80% disagreed with adding antibiotics with feed/water as a growth promoter in livestock. Of the total participants, 87% believed that a local antimicrobial guideline would be more effective than an international one. A multivariable analysis revealed that male veterinarians have 2.37 times higher knowledge regarding antimicrobial use (AMU) and antimicrobial resistance (AMR) (OR = 2.37, CI = 1.01-5.59, p = 0.05). Veterinarians engaged in government services demonstrated a 2.59 times more favorable attitude towards AMU and AMR (OR = 2.59, CI = 0.99-6.73, p = 0.05). Additionally, respondents aged 31-35 were 0.45 times more likely to exhibit good practices (OR = 0.45, CI = 0.2-1.00, p = 0.05). However, gaps in practices were highlighted in our study, suggesting training deficiencies.

CONCLUSION

The present study, for the first time conducted in Bangladesh, dictates that future interventions like academic courses, workshops, and seminars on antibiotic usage and resistance are needed to facilitate the knowledge, behavior and practice of veterinarians with regard to the rational use of antibiotics.

Graduate Student Literature Review: Perceptions of biosecurity in a Canadian dairy context

The objective of this review was to outline current implementation of biosecurity, the impact of biosecurity on the industry, and producers' and veterinarians' perceptions of biosecurity, with a focus on the Canadian dairy industry. Biosecurity has an important role in farm safety by reducing the spread of pathogens and contaminants, improving animal health and production, and maintaining human safety. Implementation of biosecurity practices varies among farms and countries. Because Canada's supply management system is different than other countries, different barriers and perceptions of biosecurity may exist. Producers may have negative perspectives on biosecurity, such as it being expensive or time consuming. Producers are motivated or deterred from biosecurity implementation for many reasons, including perceived value, disease risk, and financial incentives or deterrents. In addition, because veterinarians are a trusted source of information, their approaches to discussions on biosecurity implementation are important to understand. Veterinarians and producers appear to have differing opinions on the importance of biosecurity and approaches to discussing biosecurity. Improving biosecurity implementation requires a multifactorial approach, such as individualized education and awareness for producers, further research into efficacy of and barriers to biosecurity, and development of strategies for effective communication between veterinarians and producers.

Comparison of Antibiotic Use and the Frequency of Diseases Depending on the Size of Herd and the Type of Cattle Breeding

Diseases are responsible for losses in livestock production by increasing animal mortality and reducing productivity. The administration of antibiotics can help mitigate these negative effects. However, inappropriate use can lead to severe complications, such as raising antibiotic resistance. The purpose of this study was to perform a comparative analysis of antibiotic use and disease frequency over four years, based on the size of dairy farms and the type of farm. The study covered a 4-year period and included medium dairy farms (20-50 cows, n = 13), large dairy farms (>250 cows, n = 8), and large beef farms (n = 8). The collected data involved antimicrobial use but also included farm demographics, animal health, disease frequency, and herd management practices. The criteria used to categorise antibiotics into groups A-D were based on the EMA guidelines. The carried-out study showed that the large dairy cattle farms had the highest antibiotic consumption (18.29 mg·PCU-1), due to the high frequency of diseases, and consequently, the treatment of calf (diarrhoea, lung inflammations) and cow diseases (general treatment and mastitis). Cattle on large beef farms suffer mainly from general diseases caused by maintenance and herd management conditions. The use of restrict antibiotics was, in some cases, unjustified (antibiotics for dry cow therapy). Future studies should consider a larger number of farms, taking into account the given direction of cattle production.

Effect of a dairy farmworker stewardship training program on antimicrobial drug usage in dairy cows

Antimicrobial use (AMU) is critical to preserving animal health and welfare. However, the development of antimicrobial resistance (AMR) represents a public health threat. Although most antimicrobials used on the farm require a veterinarian prescription, farmworkers make daily on-farm treatment decisions. Therefore, farmworker training is vital to promote responsible AMU. This research project aimed to evaluate the effect of farmworker antimicrobial stewardship (AMS) training on the quantity of AMU on dairy farms in Ohio and California. We hypothesized that farms receiving AMS training would have reduced AMU in dairy cattle compared with farms where training wasn't administered. We designed a quasiexperimental study with 18 conventional dairy farms enrolled in Ohio and California. Twelve farms received AMS training, and 6 farms did not. The AMS program included a 12-wk training focused on accurate identification of cows requiring antimicrobial treatment. We quantified AMU by collecting used drug containers, manually counted by researchers during farm visits. Treatment incidence (TI) was calculated using animal daily doses (ADD), and Poisson regression models were used to analyze the TI data. Disease incidence rate (DIR) in lactating cows was 2.2, 1.5, 1.0, 0.4, 0.3, 0.2, and 0.03/1,000 cow-days for mastitis, lameness, metritis, pneumonia, retained placenta, diarrheas, and other diseases (e.g., conjunctivitis, injuries), respectively. The highest TI by antimicrobial class (provided in ADD/1,000 cow-days) was cephalosporin (5.9), penicillin (5.2), tetracyclines (0.4), lincosamides (0.2), and sulfonamides (0.1). Among the trained farms using a within-treatment group analysis, no significant differences were observed in TI pre-intervention (10.9 ADD/1,000 cow-days) compared with TI postintervention (10.3 ADD/1,000 cow-days). Treatment incidence from the training group was 10.8 ADD/1,000 cow-days and although numerically lower, it was not significantly different compared with TI in the control groups at 13.9 ADD/1,000 cow-days (rate ratio = 0.77, CI = 0.25-2.38). Future research on AMS should incorporate farmworker training with social science approaches to overcome barriers and promote on-farm responsible use.

Antimicrobial stewardship in veterinary medicine: a review of online resources

Background

An awareness of antimicrobial resistance and stewardship is important for all prescribers from a One-Health perspective. Educational resources have been created to help veterinary practitioners and encourage an optimized approach to their antimicrobial use.

Objectives

To support veterinarians to select the most appropriate educational resource to meet their personal learning goals in relation to veterinary antimicrobial stewardship (AMS).

Methods

Modular online platforms, developed to promote AMS in veterinary practice (farm and companion animal), were reviewed and key features highlighted, including the required time commitment, resource type, focus and source as well as a subjective evaluation of resource accessibility (according to prior knowledge base).

Results

Five different online courses are described in this educational resource review: Antimicrobial stewardship in veterinary practice; Farm Vet Champions; Farmed Animal Antimicrobial Stewardship Initiative (FAAST); the Pathway of antimicrobial resistance (AMR) for a veterinary services professional; and the VetAMS online learning program. Each of these tools introduces users to key themes of veterinary AMS. Upon completion of any of the courses practitioners should feel confident to assume an active role as proponents of rational antimicrobial use. Significant differences between resources, relating to the focus (companion or farm animal), scope and depth of material covered, are recognized reflecting their respective target audiences.

Conclusions

Several informative and accessible resources, centred on the core principles of veterinary AMS, were reviewed. Key features have been highlighted to inform and guide resource-users towards the most appropriate tool for them. Greater engagement with these educational resources will hopefully contribute to improved antimicrobial prescribing among veterinarians and greater awareness of the importance of stewardship for the profession.

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.

Veterinary Practitioners' Standpoints and Comprehension towards Antimicrobial Use-Are There Opportunities for Antimicrobial Stewardship Improvement?

The main subject of the research is the assessment of the knowledge, attitudes and behaviors of veterinarians regarding the use of antibiotics (AMU) and antimicrobial resistance (AMR) through a questionnaire conducted among veterinarians in the northern region of Serbia. A total of 62 respondents completed the questionnaire, which represents a response rate of 44.3%. Male veterinarians are less likely to be in the group of veterinarians with insufficient knowledge (p < 0.05). Veterinarians engaged in mixed practice (small and large animals) (p < 0.001) and veterinarians who have over 100 patients per month (p < 0.005) are also less likely to be in the group with insufficient knowledge of antimicrobial resistance. The proportion of those with insufficient knowledge is growing among veterinarians whose source is the Internet (p < 0.01), while the proportion of those with insufficient knowledge about antimicrobial resistance is declining among veterinarians whose source of information is continuous education (p < 0.05). The majority of the respondents (n = 59, 95.2%) completely agreed that AMR is a very big issue in the global health sector right now. Unfortunately, there are crucial gaps in the knowledge and attitudes of the surveyed participants. They do not appear to be aware of the importance of AMU in veterinary medicine and its influence on overall AMR, or the crucial part that non-prescribed antibiotics have in all of it. Positively, many veterinarians use good practice AMU guidelines in their everyday practice and in line with the global trend of AMU reduction, respondents have also decreased their AMU compared to the previous year.

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.

Knowledge, Attitudes, and Common Practices of Livestock and Poultry Veterinary Practitioners Regarding the AMU and AMR in Bangladesh

Current evidence indicates that more than half of all antimicrobials are used in the animal food-producing sector, which is considered a significant risk factor for the development, spread, and existence of antimicrobial resistance (AMR) pathogens in animals, humans, and the environment. Among other factors, clinical etiology and the level of knowledge, attitudes, and practices (KAP) of veterinarians are thought to be responsible for inappropriate prescriptions in the animal-source protein production sector in lower-resource settings like Bangladesh. We performed this cross-sectional study to assess factors associated with veterinarians' antimicrobial prescription behavior and their KAP on antimicrobial use (AMU) and AMR in Bangladesh. Exploratory and multivariate logistic models were used to describe an association between knowledge, attitudes, and practices of AMU and AMR and demographic characteristics of veterinarians. The results demonstrated that when selecting an antimicrobial, there was no to minimal influence of culture and susceptibility tests and patients' AMU history but moderate to high influence of the farmer's economic condition and drug instructions among the veterinarians. The results also demonstrated that more than half of the veterinarians had correct KAP regarding AMU and AMR, while the rest had moderate or lower levels of KAP. The factor score analysis revealed that age, level of education, years of experience, gender, and previous training on AMU and AMR were the key influencing factors in their level of KAP. Adjusted logistic regression analysis showed that respondents' age, current workplace, and previous training on AMU and AMR had a positive association with increased KAP. Considering the results, it is imperative to include AMR issues on vet curricula, and to provide post-education training, awareness campaigns, easy access to, and dissemination of AMR resources. Increasing the veterinary services to the outreach areas of the country and motivating veterinarians to follow the national AMR guidelines could be some other potential solutions to tackle the over-prescriptions of antimicrobials.

Farm Animal Veterinarians' Knowledge and Attitudes toward Antimicrobial Resistance and Antimicrobial Use in the Republic of Serbia

Antimicrobial resistance (AMR) is considered one of the most prevalent global health issues in both veterinarian and human medicine. This complex problem requires a "One Health" approach with the cooperation of all healthcare sectors, as well as agriculture, finance, and consumers. We conducted a survey with the objective to assess the knowledge and attitudes of farm animal veterinarians toward AMR and antimicrobial use in the Republic of Serbia with a small focus on mastitis therapy. A total of 110 respondents completed the questionnaire, which represents a response rate of 27.3%. The majority of our respondents (n = 102, 92.7%) completely agreed that AMR currently represents severe concern in the health sector. Unfortunately, less than one-third (n = 34, 30.9%) of the respondents had only heard about antimicrobial stewardship. Participants showed a positive attitude toward prudent antimicrobial use and were open to solutions to the AMR crisis. We noticed a certain gap between farm veterinarians' desire to improve and perform better in daily practice, while at the same time feeling like they did not have enough guidance, help, and resources.

Narratives of veterinary drug use in northern Tanzania and consequences for drug stewardship strategies in low-income and middle-income countries

INTRODUCTION

Awareness-raising campaigns play a central role in efforts to combat drug resistance. These campaigns assume that knowledge deficits drive poor practices that increase resistance. Therefore, increasing awareness will promote prudent practices and reduce resistance. However, most awareness campaigns have been developed and evaluated in high-income and public health settings. Consequently, it is not clear whether these campaigns are effective in low-income and middle-income countries and/or within animal health settings.

METHODS

Focus group discussions and in-depth interviews were used to collect narratives of veterinary drug use among Maasai pastoralists (n=70), animal health professionals (n=10) and veterinary drug sellers (n=5). Thematic analysis was used to identify recurring themes across narratives and groups.

RESULTS

Narratives of Maasai and animal health professionals indicated that Maasai treated their livestock with limited input from the professional sector and that non-prudent treatment practices were observed (eg, using antimicrobials as 'energizers'). Professionals linked these practices to knowledge and attitudinal deficits among the Maasai, while Maasai narratives highlighted the importance of climatic uncertainties and cultural beliefs surrounding veterinary care.

CONCLUSION

Narratives of veterinary drug use from animal health professionals are consistent with the knowledge deficit assumption guiding awareness-raising efforts. In contrast, Maasai narratives highlight how animal health practices are patterned by cultural norms interacting with factors largely outside of Maasai control, including a constrained professional veterinary sector. If these cultural and structural contexts remain unconsidered in awareness-raising strategies, current campaigns are unlikely to motivate practices necessary to limit drug resistance, especially within low-income and middle-income settings.

Understanding Farmers' Behavior and Their Decision-Making Process in the Context of Cattle Diseases: A Review of Theories and Approaches

Understanding farmers' behavior regarding disease control is essential to successfully implement behavior change interventions that improve uptake of best practices. A literature review was conducted to identify theoretical underpinnings, analytical methodologies, and key behavioral determinants that have been described to understand farmers' behavior in disease control and prevention on cattle farms. Overall, 166 peer-reviewed manuscripts from studies conducted in 27 countries were identified. In the past decade, there were increasing reports on farmers' motivators and barriers, but no indication of application of appropriate social science methods. Furthermore, the majority (58%) of reviewed studies lacked a theoretical framework in their study design. However, when a theoretical underpinning was applied, the Theory of Planned Behavior was most commonly used (14% of total). The complexity of factors impacting farmers' behavior was illustrated when mapping all described key constructs of the reviewed papers in behavior change frameworks, such as the socioecological framework and the Capability, Opportunity and Motivation Behavior (COM-B) model. Constructs related to personal influences and relationships between farmers and veterinarians were overrepresented, whereas constructs related to other interpersonal and contextual environments were not extensively studied. There was a general lack of use of validated scales to measure constructs and empirically validated theoretical frameworks to understand and predict farmers' behavior. Furthermore, studies mainly focused on measurements of intention of stakeholder behavior rather than actual behavior, although the former is a poor predictor of the latter. Finally, there is still a lack of robust evidence of behavior change interventions or techniques that result in a successful change in farmers' behavior. We concluded that for a sustainable behavior change, studies should include wider constructs at individual, interpersonal, and contextual levels. Furthermore, the use of empirically validated constructs and theoretical frameworks is encouraged. By using coherent frameworks, researchers could link constructs to design interventions, and thereby take the first step toward theory-driven, evidence-based interventions to influence farmers' behavior for disease control.

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.

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.

Survey of perceptions and attitudes of an international group of veterinarians regarding antibiotic use and resistance on dairy cattle farms

Veterinarians are the main source of information for farmers regarding the responsible use of antibiotics in farm animals and how to reduce the risk of antibiotic resistance. Consequently, understanding how veterinarians perceive their clients' and colleagues' antibiotic use and their own beliefs about the development of antibiotic resistance is essential to determining areas in which antibiotic use practices can be improved to minimize the emergence of antibiotic resistance. An international cross-sectional study was carried out using a questionnaire designed to elucidate perceptions, attitudes, and concerns of dairy veterinarians regarding antibiotic use and the emergence of antibiotic resistance in dairy farming. The questionnaire was initially administered to veterinarians attending the International Bovine Mastitis Conference in Milano, Italy, 2018, followed by veterinarian members of the National Mastitis Council, and all conference registrants. A total of 71 participants from 21 countries participated in the survey, the majority were from the United States and member countries of the European Union. Logistic regression analysis was conducted to identify predictors of veterinarians' level of concern about the development of antibiotic resistance on their clients' farms. Associations were described with odds ratios (ORs) and the associated 95 % confidence intervals (95 % CIs). Free text responses where participants shared their views on the reason for overprescribing antibiotics by veterinarians were analyzed using thematic analysis. Participants perceived that nearly half of their clients overuse or inappropriately use antibiotics, and nearly half of their colleagues overprescribe or inappropriately prescribe antibiotics. After controlling for other factors, the odds of veterinarians being concerned about antibiotic resistance on dairy farms they served decreased by a factor of 0.91 for each additional year of participants' experience working with dairy cattle (OR = 0.91, 95 % CI = 0.84-0.99). Participants concerned about antibiotic resistance on clients' dairy farms were also more likely to consider better adherence to drug labelling as important for reducing farmers' antibiotic use (OR = 6.86, 95 % CI = 1.21-38.93). Thematic analysis revealed four themes surrounding the perceived reasons for veterinarians' overprescribing of antibiotics: (i) knowledge, (ii) attitudes, (iii) barriers, and (iv) rules and regulations. The study findings will aid in the development of strategies to improve antibiotic use in dairy farming and educational initiatives looking to enhance the communication between veterinarians and farmers about judicious use of antibiotics.

Alternative Medicines on the Farm: A Study of Dairy Farmers' Experiences in France

Despite being of debatable efficacy, alternative medicines are in regular use on both organic and conventional dairy farms as part of a strategy for limiting the on-farm use of antibiotics. The study presented here examined French dairy farmers' understanding of and experiences with these medicines, focusing on homeopathy, aromatherapy and phytotherapy. Adopting an interdisciplinary approach combining animal science and sociology, we considered how dairy farmers' use of alternative medicines fits into a holistic approach to herd health management, on the one hand, and into farmers' networks of professional relationships, on the other. Our findings show that farmers are interested in alternative medicines for reasons that are at once technical, ethical, and economic. In the absence of local veterinarians specializing in homeopathy and aromatherapy, farmers enroll in short-term training courses to learn how to use these medicines. Alternative medicines are not a substitute for conventional medicine for these farmers; rather, they constitute one part of a holistic approach to herd health that combines preventive measures with a variety of curative treatments, and which is grounded in close attention to the animals' state of health. Farmers make use of guidelines for observing livestock that are central to the veterinary alternative medicine approach. Interestingly, women farmers appear to play an important role in introducing these practices into the management of the farm operation. Finally, farmers' interest in alternative medicines is indicative of their broader expectations for advice and support in moving toward the integrated management of livestock health, a key element of the agroecological transition. Recognizing these expectations offers useful insights for rethinking the role of veterinarians in dairy farming.

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.

Survey of production animal veterinarians' prescription practices, factors influencing antimicrobial drug use, and perceptions of and attitudes toward antimicrobial resistance

OBJECTIVE

To assess production animal medicine veterinarians' prescription practices and identify factors influencing their use of antimicrobial drugs (AMDs) and their perceptions of and attitudes toward antimicrobial resistance (AMR).

SAMPLE

157 production animal veterinarians in the United States.

PROCEDURES

An online cross-sectional survey and digital diary were used to gather information regarding perceptions on AMD use and AMR and on treatment recommendations for production setting-specific disease scenarios. Results were compared across respondents grouped by their selected production setting scenarios and reported years as veterinarians.

RESULTS

The most commonly selected production setting disease scenarios were dairy cattle (96/157 [61.1%]), backgrounding cattle (32/157 [20.4%]), and feedlot cattle (20/157 [12.7%]). Because few respondents selected swine (5/157 [3.2%]) or poultry (4/157 [2.5%]) scenarios, those responses were excluded from statistical analysis of AMD prescription practices. Most remaining respondents (147/148 [99.3%]) reported that they would recommend AMD treatment for an individual ill animal; however, responses differed for respondents grouped by their selected production setting scenarios and reported years as veterinarians when asked about AMD treatment of an exposed group or high-risk disease-free group. Most respondents reported that government regulations influenced their AMD prescribing, that owner and producer compliance was a veterinary-related factor that contributed to AMR, and that environmental modifications to prevent disease could be effective to mitigate AMR.

CONCLUSIONS AND CLINICAL RELEVANCE

Results of the present study helped fill important knowledge gaps pertaining to prescription practices and influencing factors for AMD use in production animal medicine and provided baseline information for future assessments. This information could be used to inform future interventions and training tools to mitigate the public health threat of AMR.

Veterinary Herd Health Consultancy and Antimicrobial Use in Dairy Herds

The globally increasing level of antimicrobial resistance affects both human and animal health, why it is necessary to identify ways to change our current use of antimicrobials. The veterinary herd health collaboration between veterinarians and dairy farmers provides a useful setting for changing antimicrobial use in livestock. However, farmers and veterinarians work in a complex agricultural setting influenced by socio-economic factors, which complicates their choices regarding antimicrobial usage. It is therefore necessary to be aware of the range of potential influencing factors and to integrate this knowledge in the relevant local settings. This manuscript presents a literature review of relevant factors relating to antimicrobial use within the veterinary herd health consultancy setting, including knowledge gaps of relevance for changing the use of antimicrobials. An enriched version of the framework of the Theory of Planned Behaviour was used to organise the literature review. We identified diverging attitudes on correct treatment practices and perceptions of antimicrobial resistance among veterinarians and farmers, influenced by individual risk perception as well as social norms. Furthermore, disagreements in terms of goal setting and in the frequency of herd visits in relation to herd health consultancy can negatively influence the collaboration and the intention to change antimicrobial use. Farmers and veterinarians emphasise the importance of legislation and the role of the dairy industry in changing antimicrobial use, but the relevance of specific factors depends on the country-specific context. Overall, farmers and veterinarians must communicate better to understand each other's perspectives and establish common goals within the collaboration if they are to work efficiently to reduce antimicrobial use. Farmers and veterinarians both requested changes in individual behaviour; however, they also called for national and structural solutions in terms of balanced legislation and the availability of better diagnostics to facilitate a change in antimicrobial use practices. These various paths to achieving the desired changes in antimicrobial use illustrate the need to bridge methodological research approaches of veterinary science and social sciences for a better understanding of our potential to change antimicrobial use within the dairy farm animal sector.

How companion animal veterinarians in the United States perceive financial constraints on antibiotic decision-making

BACKGROUND

The misuse of antibiotics is a persistent problem in both human and veterinary medicine. While complex social and behavioural factors drive inappropriate use in human medicine, less is known about factors that impact antibiotic use in companion animal medicine.

OBJECTIVE

To identify the perceptions that veterinarians practicing companion animal medicine hold about the influence of financial considerations on antibiotic use.

METHODS

Semi-structured qualitative interviews were conducted with veterinarians practicing companion animal medicine in a major metropolitan area in the Eastern United States. Respondents were sampled purposefully, and data were analysed using a thematic analysis approach.

RESULTS

Interviews were conducted with 36 veterinarians from 19 practices. Veterinarians believed that their clients' willingness to pay for diagnostic testing or treatment interfered with their ability to make appropriate decisions about antibiotic use. Concerns over antibiotic expiration and subsequent financial losses limited which antibiotics veterinarians stocked. Some veterinarians feared that restricting antibiotic use to appropriate uses could harm their business and lead to economic euthanasia of their patients.

CONCLUSIONS

Veterinarians perceive that financial factors can impede their ability to appropriately prescribe antibiotics. Interventions that address the financial aspects of prescribing have the potential to improve antibiotic decision-making in veterinary medicine.

Raising awareness of antimicrobial resistance among the general public in the UK: the role of public engagement activities

In response to the accepted risk of emerging antimicrobial resistance, many organizations and institutions have developed and delivered events and activities designed to raise awareness of the issue and to change the behaviour of the intended audience. However, few of these events for a general public audience are documented or able to be sourced by those who might wish to repeat, adapt or modify, particularly those events that are successful. 'Insider knowledge' appears to be the best search tool. Moreover, evaluation of the success or impact of the event is rarely published. It would be useful if there were a 'hub' where descriptions of such activities could be deposited, enabling the building of a significant resource with real academic value.

Probiotics in Animal Husbandry: Applicability and Associated Risk Factors

Probiotics have been emerging as a safe and viable alternative to antibiotics for increasing performance in livestock. Literature was collated via retrieved information from online databases, viz, PubMed, MEDLINE, ScienceDirect, Scopus, Web of Science and Google Scholar. Besides improved immunomodulation and nutrient digestibility, in-feed probiotics have shown drastic reductions in gastrointestinal tract-invading pathogens. However, every novel probiotic strain cannot be assumed to share historical safety with conventional strains. Any strain not belonging to the wild-type distributions of relevant antimicrobials, or found to be harbouring virulence determinants, should not be developed further. Modes of identification and the transmigration potential of the strains across the gastrointestinal barrier must be scrutinized. Other potential risk factors include the possibility of promoting deleterious metabolic effects, excessive immune stimulation and genetic stability of the strains over time. Adverse effects of probiotics could be strain specific, depending on the prevailing immunological and physiological condition of the host. The most crucial concern is the stability of the strain. Probiotics stand a good chance of replacing antibiotics in animal husbandry. The possibility of the probiotics used in animal feed cross-contaminating the human food chain cannot be downplayed. Thus, the established safety measures in probiotic development must be adhered to for a successful global campaign on food safety and security.

Estimating Factors Related to Fluoroquinolone Resistance Based on One Health Perspective: Static and Dynamic Panel Data Analyses From Europe

Objectives: Antimicrobial resistance (AMR) has become a One Health problem in which fluoroquinolone resistance has caused great concern. The aim of this study is to estimate factors related to fluoroquinolone resistance involving the professionals and antimicrobial consumption (AMC) in human and animal fields. Methods: A country-level panel data set in Europe from 2005 to 2016 was constructed. The dependent variables were measured by Escherichia coli ( E. coli ) and Pseudomonasaeruginosa ( P. aeruginosa ) resistance rates to fluoroquinolones. Both the static and dynamic panel data models were employed to estimate the above factors associated with the resistance rates. Results: The 10% increase in the number of medical staff and veterinary professionals per 100,000 population were significantly correlated with the 32.44% decrease of P. aeruginosa and 0.57% decrease of E. coli resistance rates to fluoroquinolones (Coef. = -3.244, -0.057; p = 0.000, 0.030, respectively). The 10% increase in the human AMC was correlated with 10.06% and 8.04% increase of P. aeruginosa resistance rates to fluoroquinolones in static and dynamic models (Coef. = 1.006, 0.804; p = 0.006, 0.001, respectively). The 10% increase in veterinary AMC was related to a 1.65% decrease of P. aeruginosa resistance rates to fluoroquinolones (Coef. = -0.165, p = 0.019). Conclusions: The increases in medical and veterinary professionals are respectively associated with the decrease of P. aeruginosa and E. coli resistance rates to fluoroquinolones. The increase in human AMC is also associated with increase of P. aeruginosa resistance rates, while the increase in veterinary AMC was found to be associated with a decrease in resistance rate for P. aeruginosa.

Knowledge, attitudes, and practices among veterinarians during an outbreak of canine leptospirosis-Maricopa County, Arizona, 2017

Leptospirosis, caused by Leptospira spp., is a zoonotic bacterial disease important to both human and animal health. Six pathogenic serovars are currently known to commonly infect and cause disease in dogs in the United States. While canine leptospirosis infection is historically rare in Arizona (≤5 cases reported annually) (ADHS unpublished data) several clusters were reported in Maricopa County (MC) during February 2016-January 2017. Public health initiated an outbreak response and developed a knowledge, attitudes, and practices survey for veterinarians. The goals were to determine awareness and general attitudes about canine leptospirosis and to identify gaps in veterinarians' knowledge in treatment and prevention. We distributed a 40-question self-administered online survey to 1058 Arizona Veterinary Medical Association members, made available during February 9-May 15, 2017. We analyzed the results using Pearson's Chi-squared or Fisher's exact test; a P-value <0.05 was considered statistically significant. We analyzed 202 complete responses. Veterinarians from 10 (66%) of 15 Arizona counties were represented. MC practices were more likely to stock leptospirosis vaccine (80%) than other counties combined (58%) (P = 0.004). The average composite knowledge score was 24.4 out of 38 (range 12-37, median 24); 49% of respondents demonstrated higher knowledge as defined by authors, largely in identification of leptospirosis risk factors (86%) and routes of exposure (73%). Fewer than half (45%) of respondents correctly identified the length of time bacteria can be shed in dogs' urine. Eighty-one percent of respondents demonstrated lower knowledge about clinical signs associated with leptospirosis; only 47% of respondents identified eight clinical signs commonly associated with leptospirosis. Sixty-one percent of MC respondents agreed that leptospirosis is an important canine disease in their geographic area, while only 40% of other county respondents agreed (P=0.03). Seventy percent of respondents identified diagnostic testing options. The majority correctly selected infection-control practices in line with recommendations from 2 national clinical guidelines. More respondents would recommend leptospirosis vaccination if dogs traveled or lived in rural areas (87-96%) than if dogs attended day care or were boarded (63%). We identified opportunities for education, including the local epidemiology of leptospirosis, transmission prevention strategies, vaccine safety, testing, clinical identification, and emerging risk factors. Our findings will help guide the design of educational materials for small animal veterinarians in Arizona regarding recommendations for prevention of animal and human leptospirosis infections; these efforts could also shift the culture of reporting companion animal diseases to improve future One Health collaborations.

Monitoring Antibiotic Usage in German Dairy and Beef Cattle Farms-A Longitudinal Analysis

It is well-established that antimicrobial use is a major factor for the development of antimicrobial resistance. To analyze the associations between antimicrobial resistance and usage of antimicrobial agents, data from monitoring and surveillance systems are crucial. Within the project VetCAb (Veterinary Consumption of Antibiotics), antibiotic usage data in German livestock is regularly collected and evaluated. Based on a cross-sectional study in 2011, the project was continued as the longitudinal study VetCAb-Sentinel with ongoing participant recruitment and data collection from 2013. The data collection is based on official German application and delivery forms (ADF), voluntarily provided by veterinarians and farmers. In this study the results of antibiotic usage data of dairy cows, dairy calves and beef cattle were described, using a semi-annual treatment frequency, and 95,944 ADF issued between 2011 and 2015 were analyzed. Results show that the median of the treatment frequency in dairy calf and beef cattle holdings slightly decreased from 0.4 to 0.3 and from 0.2 to 0 days, respectively, whereas the median in dairy cow holdings ranged between 1.9 and 2.3 during the observed period. Temporal changes and the effect of the factors "farm size" and "region" on the treatment frequency were investigated, using multiple linear mixed and logistic regression models. Generally, the factor "time" has a statistically significant impact on the treatment frequency in all production types. In addition, a temporal trend test over the first six half-years shows that an increasing linear trend can be stated in dairy cows and dairy calves (p = 0.017; p = 0.004, respectively). If the time-period is extended to all eight half-years under study, this turns into a quadratic effect (dairy cows: p = 0.006; dairy calves: p < 0.001). In dairy calves and beef cattle the factor "farm size" also has a statistically significant impact. The factor "region," in contrast, shows no statistically significant impact at all. Compared to other livestock populations in Germany, the use of antimicrobials in dairy cows, dairy calves, and beef cattle appears to be low, but varies across several associated factors. Considering these effects, it is recommended that the size of dairy calf and beef cattle holdings is regularly considered in the evaluation of antimicrobial usage data over time.

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.

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.

Antimicrobial use in food-producing animals: a rapid evidence assessment of stakeholder practices and beliefs

Food-producing animals throughout the world are likely to be exposed to antimicrobial (AM) treatment. The crossover in AM use between human and veterinary medicine raises concerns that antimicrobial resistance (AMR) may spread from food-producing animals to humans, driving the need for further understanding of how AMs are used in livestock practice as well as stakeholder beliefs relating to their use. A rapid evidence assessment (REA) was used to collate research on AM use published in peer-reviewed journals between 2000 and 2016. Forty-eight papers were identified and reviewed. The summary of findings highlights a number of issues regarding current knowledge of the use of AMs in food-producing animals and explores the attitudes of interested parties regarding the reduction of AM use in livestock. Variation between and within countries, production types and individual farms demonstrates the complexity of the challenge involved in monitoring and regulating AM use in animal agriculture. Many factors that could influence the prevalence of AMR in livestock are of concern across all sections of the livestock industry. This REA highlights the potential role of farmers and veterinarians and of other advisors, public pressure and legislation to influence change in the use of AMs in livestock.

Factors influencing antimicrobial prescribing by veterinarians and usage by dairy farmers in New Zealand

AIMS

To determine the factors associated with the selection of antimicrobials by dairy veterinarians, and the attitudes of those veterinarians and dairy farmers to antimicrobial usage and resistance.

METHODS

Facilitated focus groups of dairy farmers (n=22) and an anonymous online survey of dairy cattle veterinarians (n=206 respondents) were used to determine prescribing behaviour, factors affecting prescribing of antimicrobials, and the attitudes of veterinarians and farmers to the use of antimicrobials and the risk of antimicrobial resistance (AMR).

RESULTS

Amongst the 22 farmers, the most common primary reason for choosing an antimicrobial was veterinary advice (87%) followed by personal experience (68%). Farmers had limited knowledge or concern about the risk of AMR, particularly outside their farm, with only 47% and 26% agreeing or strongly agreeing that use of antimicrobials on their farm would increase the risk of resistance in their herd and in humans, respectively. Prescribing of antimicrobials by veterinarians was predominantly based on diagnosis (168/206; 82%), and response to previous therapy (134/206; 65%), while duration above the minimum inhibitory concentration (43/206; 21%) was also considered important. Non-clinical factors such as withholding period (52/206; 25%) and farmers' preferences (45/206; 22%) also influenced prescribing. Antimicrobial culture and susceptibility testing was not widely used, with 126/166 (76%) having culture results for less than four of the last 10 clinical mastitis cases for which they prescribed antimicrobials. Attitudes about prescribing and AMR varied with years of practice, gender and employment status.

CONCLUSIONS

Veterinarians primarily considered technical reasons when prescribing antimicrobials. However non-technical factors did influence prescribing, in particular client feedback about perceived efficacy and perceptions of cost/benefit. Farmers stated that veterinarians were the most credible source of advice for selection of antimicrobials, but that personal experience on their farm was also important.

CLINICAL RELEVANCE

Farmers' perception of efficacy of antimicrobials, based on clinical outcomes, is an important determinant of their preferred choice of product. Hence, where changes in on-farm use patterns are required, clear communication by veterinarians about prudent antimicrobial choice and usage will require initial education around classes of antimicrobials and risk of resistance, as well as information around assessing efficacy of antimicrobial usage. Many veterinarians are in businesses that do not have practice prescribing policies. Such policies would likely lead to more consistent and judicious use of antimicrobials.

Understanding the culture of antimicrobial prescribing in agriculture: a qualitative study of UK pig veterinary surgeons

OBJECTIVES

The use of antimicrobials in food-producing animals has been linked with the emergence of antimicrobial resistance in bacterial populations, with consequences for animal and public health. This study explored the underpinning drivers, motivators and reasoning behind prescribing decisions made by veterinary surgeons working in the UK pig industry.

METHODS

A qualitative interview study was conducted with 21 veterinary surgeons purposively selected from all UK pig veterinary surgeons. Thematic analysis was used to analyse transcripts.

RESULTS

Ensuring optimum pig health and welfare was described as a driver for antimicrobial use by many veterinary surgeons and was considered a professional and moral obligation. Veterinary surgeons also exhibited a strong sense of social responsibility over the need to ensure that antimicrobial use was responsible. A close relationship between management practices, health and economics was evident, with improvements in management commonly identified as being potential routes to reduce antimicrobial usage; however, these were not always considered economically viable. The relationship with clients was identified as being a source of professional stress for practitioners due to pressure from farmers requesting antimicrobial prescriptions, and concern over poor compliance of antimicrobial administration by some farmers.

CONCLUSIONS

The drivers behind prescribing decisions by veterinary surgeons were complex and diverse. A combination of education, improving communication between veterinary surgeons and farmers, and changes in regulations, in farm management and in consumer/retailer demands may all be needed to ensure that antimicrobial prescribing is optimal and to achieve significant reductions in use.

Recent government regulations in the United States seek to ensure the effectiveness of antibiotics by limiting their agricultural use

The development of bacteria resistant to antibiotics is viewed as a medical health threat. Because thousands of people die every year due to antibiotic-resistant bacteria, efforts are underway to reduce antibiotic usage which in turn will reduce the development of antibiotic-resistant bacteria. In the United States, the use of antibiotics in the production of food animals to enhance animal growth has been identified as contributing to resistance. In 2015, a veterinary feed directive was adopted by the U.S. federal government prohibiting nontherapeutic uses of antibiotics in food animals that should reduce usage. The continued usage of antibiotics by producers for preventing disease may mean the directive is insufficient to reduce nontherapeutic antibiotic administration. This may lead some consumers to seek meat products from animals raised without antibiotics. A governmentally-sponsored labeling program could encourage reduction in antibiotic usage.

Fresh-cow handling practices and methods for identification of health disorders on 45 dairy farms in California

The aim of the present study was to describe fresh-cow handling practices and techniques used during fresh cow evaluations to identify postpartum health disorders on 45 dairy farms in California ranging from 450 to 9,500 cows. Fresh cow practices were surveyed regarding (a) grouping and housing, (b) scheduling and work organization, (c) screening for health disorders, and (d) physical examination methods. Information was collected based on cow-side observations and responses from fresh cow evaluators. Cows were housed in the fresh cow pen for 3 to 14 (20%), 15 to 30 (49%), or >31 (31%) d in milk. Fresh cow evaluations were performed daily (78%), 6 times a week (11%), 2 to 5 times a week (9%), or were not routinely performed (2%). There was significant correlation between the duration of fresh cow evaluations and the number of cows housed in the fresh pen. Across all farms, the duration of evaluations ranged from 5 to 240 min, with an average of 16 s spent per cow. During fresh cow checks, evaluators always looked for abnormal vaginal discharge, retained fetal membranes, and down cows. Dairies evaluated appetite based on rumen fill (11%), reduction of feed in the feed bunk (20%), rumination sensors (2%), or a combination of these (29%). Milk yield was evaluated based on udder fill at fresh cow checks (40%), milk flow during milking (11%), milk yield records collected by milk meters (2%), or a combination of udder fill and milk meters (5%). Depressed attitude was evaluated on 64% of the dairies. Health-monitoring exams for early detection of metritis were implemented on 42% of the dairies based on rectal examination (13%), rectal temperature (22%), or both (7%). Dairies implementing health-monitoring exams took longer to perform fresh cow evaluations. Physical examination methods such as rectal examination, auscultation, rectal temperature evaluation, and cow-side ketosis tests were used on 76, 67, 38, and 9% of dairies, respectively. Across dairies, we found large variation in signs of health disorders screened and how those signs were evaluated. Fresh cows were primarily evaluated based on nonspecific and subjective observations during screening. Future research efforts should focus on developing and validating scoring systems to more objectively identify health disorders in postpartum cows.

Attitudes and perceptions of Dutch veterinarians on their role in the reduction of antimicrobial use in farm animals

Little is known about attitudes of veterinarians towards antibiotic use and reduction opportunities, and their interaction with farmers herein. Therefore, a questionnaire was developed and sent out to Dutch farm animal veterinarians. The response rate was 40%. Categorical Principal Component Analysis (CATPCA) was conducted on statements measuring attitudes towards the use of antibiotics and reduction opportunities in farm animals, the veterinary pharmacy and the interaction of veterinarians with farmers in improving animal health. This resulted in 3 underlying dimensions. Additionally, possible explanatory variables (main farm animal species working with, years of experience in practice) were added to the CATPCA to identify differences between veterinarians. Veterinarians working with different animal species were comparable in their opinions towards the necessity to reduce veterinary antibiotic use and the current policy to halve veterinary antibiotic consumption. Veterinarians working with ruminants - "ruminant specialists" - and veterinarians working with several different animal species - "generalists" - reported to feel more uncertainty in acting independently from farmers' and significant others' (other advisors, colleagues) demands for antibiotics or opinions than veterinarians mainly working with intensively raised animals (pigs, poultry, veal calves) - "intensive specialists". Years of experience in practice was negatively related to feelings of uncertainty in acting independently. At the other hand, years of experience was associated with being less concerned about the possible contribution of veterinary antibiotic use to antimicrobial resistance, considering it more important to keep the right to prescribe and sell antibiotics, and being less hesitant to apply antibiotics to prevent (further dissemination of) animal diseases. Intensive specialists expected most from improving feed quality and benchmarking of antibiotic prescribing and use in reducing veterinary antibiotic use; ruminant specialists and generalists preferred improving housing and climate conditions and benchmarking. The by veterinarians perceived main reasons for farmers not to comply to veterinary advices to improve animal health were related to financial and time restrictions, although intensive specialists stressed the importance of conflicting advices from other advisors as a cause for non-compliance. The results showed that younger veterinarians might require additional support to act independently from farmers' and significant others'. Additionally, experienced veterinarians could be educated about possible risks related to veterinary overuse of antibiotics. Alternative approaches should be identified for veterinarians to preserve a decent income without pharmacy incomes. Especially in intensive farming, ways should be found to prevent contradictory advices as a barrier not to implement veterinary advices to improve animal health.

Pharmacokinetics of enrofloxacin and ceftiofur in plasma, interstitial fluid, and gastrointestinal tract of calves after subcutaneous injection, and bactericidal impacts on representative enteric bacteria

This study's objectives were to determine intestinal antimicrobial concentrations in calves administered enrofloxacin or ceftiofur sodium subcutaneously, and their impact on representative enteric bacteria. Ultrafiltration devices were implanted in the ileum and colon of 12 steers, which received either enrofloxacin or ceftiofur sodium. Samples were collected over 48 h after drug administration for pharmacokinetic/pharmacodynamic analysis. Enterococcus faecalis or Salmonella enterica (5 × 10(5) CFU/mL of each) were exposed in vitro to peak and tail (48 h postadministration) concentrations of both drugs at each location for 24 h to determine inhibition of growth and change in MIC. Enrofloxacin had tissue penetration factors of 1.6 and 2.5 in the ileum and colon, while ciprofloxacin, an active metabolite of enrofloxacin, was less able to cross into the intestine (tissue penetration factors of 0.7 and 1.7). Ceftiofur was rapidly eliminated leading to tissue penetration factors of 0.39 and 0.25. All concentrations of enrofloxacin were bactericidal for S. enterica and significantly reduced E. faecalis. Peak ceftiofur concentration was bactericidal for S. enterica, and tail concentrations significantly reduced growth. E. faecalis experienced growth at all ceftiofur concentrations. The MICs for both organisms exposed to peak and tail concentrations of antimicrobials were unchanged at the end of the study. Enrofloxacin and ceftiofur achieved intestinal concentrations capable of reducing intestinal bacteria, yet the short exposure of ceftiofur in the intestine may select for resistant organisms.

Factors associated with the inappropriate use of antimicrobials

Antimicrobial resistance continues to grow and antimicrobial use in food animal production and to a lesser extent in human patients is under fire. Much of the criticism has to do with the misapplication of these drugs in both settings. Research indicates that patients, food animal producers, physicians and veterinarians have all played a part in misusing antimicrobials, often because of mistaken beliefs. This paper reviews this research and introduces a theoretical perspective, the Theory of Planned Behavior (TPB), which broadens our understanding of the motivations for misuse. In particular this approach shows that individuals making decisions about antimicrobial use take into account social pressures from and a sense of obligation to significant others in their social networks. Our own work summarized in this paper indicates that both feedlot veterinarians and feedlot managers' antimicrobial decisions are influenced by both expectations from and obligations to a variety of actors in the feedlot network (other veterinarians, feedlot clients, consumers, pharmaceutical companies, and regulatory bodies). Generally across 4 circumstances of antimicrobial use (for acutely sick cattle, chronically-sick cattle, at-risk cattle, high-risk cattle), it is largely the perception that peers and clients expect feedlot veterinarians to use antimicrobials and feedlot veterinarians sense of obligation to these groups that have the most influence on their decisions to recommend antimicrobials. Based on these findings, the question of engaging in changing the choices made by those working with food animals must start with those who influence the decision to proscribe or use antimicrobials. As our data come from the United States and may be unique relative to other countries, these efforts should begin by ascertaining who influences these decisions. The next step is to then change the beliefs of these significant others.