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Moura P, Borck Høg B, Alban L, Sönksen UW, Ribeiro Duarte AS, Sandberg M. Evaluating the OH-EpiCap tool using the Danish integrated surveillance program for AMU and AMR as a case study. Front Public Health 2023; 11:1127701. [PMID: 38054067 PMCID: PMC10694429 DOI: 10.3389/fpubh.2023.1127701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is considered a One Health (OH) challenge, ideally demanding concerted efforts from the animal, human and environmental side. DANMAP, the Danish Integrated Antimicrobial Resistance Monitoring and Research Program, is monitoring AMR and antimicrobial use in animals and humans. OH-EpiCap is an evaluation tool, developed to address essential elements in OH surveillance systems, such as the dimensions of the organization, operational activities and the impact of the surveillance activities. We aimed to evaluate DANMAP using OH-EpiCap and hereby assessed the suitability of OH-EpiCap to evaluate integrated AMR surveillance systems. During the evaluation, the strengths and weaknesses of DANMAP concerning the "OH-ness" of the program were discussed. Furthermore, possible adaptations of the standard operating procedures and governance structure were addressed. Attention was paid to the ability and easiness of DANMAP to cope with current and future challenges connected to integrated AMR surveillance. It was concluded that DANMAP has a strong OH approach covering relevant aspects for humans and animals, whereas environmental aspects are missing. OH-EpiCap proved to be straightforward to use and provided valuable insights. The authors recommend OH-EpiCap to be used by health authorities and stakeholders. It is not suitable for the technical evaluation of a surveillance program.
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Affiliation(s)
- Pedro Moura
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Birgitte Borck Høg
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Lis Alban
- Department for Food Safety, Veterinary Issues and Risk Analysis, Danish Agriculture and Food Council, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | | | - Marianne Sandberg
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
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Moura P, Sandberg M, Høg BB, Niza-Ribeiro J, Nielsen EO, Alban L. Characterisation of antimicrobial usage in Danish pigs in 2020. Front Vet Sci 2023; 10:1155811. [PMID: 37180070 PMCID: PMC10167271 DOI: 10.3389/fvets.2023.1155811] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023] Open
Abstract
Introduction Denmark is one of the world's largest exporters of pigs and pig meat, so the sector plays an important role in the national antimicrobial use (AMU). The Danish government has run antimicrobial stewardship programs in collaboration with the pig industry for more than 25 years. These have resulted in substantial overall reductions in total AMU and limiting the use of fluoroquinolones, the 3rd and 4th generation cephalosporines and the polymyxin colistin. To understand where further reductions in AMU could take place, it is necessary to investigate which antimicrobials are being used, how, and for which reasons. Materials and methods We characterized the AMU in the Danish pig sector in 2020, providing new analytical insights based on data retrieved from the VetStat database. The AMU data were segmented into classes, routes of administration, treatment indications and age groups, and interpreted as an outcome of the interventions taken. We evaluated the current AMU regarding choice of antimicrobial class. Moreover, we discussed how to further improve the antimicrobial stewardship in Danish pig production to achieve additional reductions without jeopardizing animal welfare. Where relevant, two pig veterinary specialists were consulted. Results In 2020, 43.3 mg antimicrobials per population correction unit (PCU) were ascribed to the Danish pig sector. There was practically no use of fluoroquinolones, 3rd and 4th generation cephalosporins and polymyxins. Weaners related to 45% of the total AMU in pigs when measured in tonnes and 81% when measured in defined animal daily doses, of these 76% were ascribed to gastrointestinal indications and overall, 83% were administered perorally. Conclusion To enable further reductions in AMU, it should be investigated how and when to replace group treatments (e.g., all animals in section or a pen) with individual treatments. Moreover, prevention of disease and promotion of animal health should be prioritized, e.g., through focus on feed, vaccination, biosecurity, and disease eradication.
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Affiliation(s)
- Pedro Moura
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Marianne Sandberg
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Birgitte Borck Høg
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - João Niza-Ribeiro
- Departamento de Estudo de Populações, ICBAS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
| | | | - Lis Alban
- Department for Food Safety, Veterinary Issues and Risk Analysis, Danish Agriculture and Food Council, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
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Sanders P, Vanderhaeghen W, Fertner M, Fuchs K, Obritzhauser W, Agunos A, Carson C, Borck Høg B, Dalhoff Andersen V, Chauvin C, Hémonic A, Käsbohrer A, Merle R, Alborali GL, Scali F, Stärk KDC, Muentener C, van Geijlswijk I, Broadfoot F, Pokludová L, Firth CL, Carmo LP, Manzanilla EG, Jensen L, Sjölund M, Pinto Ferreira J, Brown S, Heederik D, Dewulf J. Monitoring of Farm-Level Antimicrobial Use to Guide Stewardship: Overview of Existing Systems and Analysis of Key Components and Processes. Front Vet Sci 2020; 7:540. [PMID: 33195490 PMCID: PMC7475698 DOI: 10.3389/fvets.2020.00540] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/10/2020] [Indexed: 01/11/2023] Open
Abstract
The acknowledgment of antimicrobial resistance (AMR) as a major health challenge in humans, animals and plants, has led to increased efforts to reduce antimicrobial use (AMU). To better understand factors influencing AMR and implement and evaluate stewardship measures for reducing AMU, it is important to have sufficiently detailed information on the quantity of AMU, preferably at the level of the user (farmer, veterinarian) and/or prescriber or provider (veterinarian, feed mill). Recently, several countries have established or are developing systems for monitoring AMU in animals. The aim of this publication is to provide an overview of known systems for monitoring AMU at farm-level, with a descriptive analysis of their key components and processes. As of March 2020, 38 active farm-level AMU monitoring systems from 16 countries were identified. These systems differ in many ways, including which data are collected, the type of analyses conducted and their respective output. At the same time, they share key components (data collection, analysis, benchmarking, and reporting), resulting in similar challenges to be faced with similar decisions to be made. Suggestions are provided with respect to the different components and important aspects of various data types and methods are discussed. This overview should provide support for establishing or working with such a system and could lead to a better implementation of stewardship actions and a more uniform communication about and understanding of AMU data at farm-level. Harmonization of methods and processes could lead to an improved comparability of outcomes and less confusion when interpreting results across systems. However, it is important to note that the development of systems also depends on specific local needs, resources and aims.
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Affiliation(s)
- Pim Sanders
- The Netherlands Veterinary Medicines Institute (SDa), Utrecht, Netherlands
| | - Wannes Vanderhaeghen
- Centre of Expertise on Antimicrobial Consumption and Resistance in Animals (AMCRA), Brussels, Belgium
| | - Mette Fertner
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Klemens Fuchs
- Department for Data, Statistics and Risk Assessment, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Walter Obritzhauser
- Unit of Veterinary Public Health and Epidemiology, Institute of Food Safety, Food Technology and Veterinary Public Health, University of Veterinary Medicine, Vienna, Austria
| | - Agnes Agunos
- Public Health Agency of Canada, Guelph, ON, Canada
| | | | - Birgitte Borck Høg
- Division for Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Vibe Dalhoff Andersen
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Claire Chauvin
- Epidemiology, Health and Welfare Unit, French Agency for Food, Environmental and Occupational Health & Safety, Ploufragan, France
| | - Anne Hémonic
- IFIP-Institut du Porc, Domaine de la Motte au Vicomte, Le Rheu, France
| | - Annemarie Käsbohrer
- Unit of Veterinary Public Health and Epidemiology, Institute of Food Safety, Food Technology and Veterinary Public Health, University of Veterinary Medicine, Vienna, Austria.,Unit for Epidemiology, Zoonoses and Antimicrobial Resistance, Federal Institute for Risk Assessment (BfR), Berlin, Germany
| | - Roswitha Merle
- Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Berlin, Germany
| | - Giovanni L Alborali
- Istituto Zooprofilattico Sperimentale della Lombardia e Dell'Emilia Romagna, Brescia, Italy
| | - Federico Scali
- Istituto Zooprofilattico Sperimentale della Lombardia e Dell'Emilia Romagna, Brescia, Italy
| | | | - Cedric Muentener
- Institute of Veterinary Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | | | | | - Lucie Pokludová
- Institute for State Control of Veterinary Biologicals and Medicines, Brno, Czechia
| | - Clair L Firth
- Unit of Veterinary Public Health and Epidemiology, Institute of Food Safety, Food Technology and Veterinary Public Health, University of Veterinary Medicine, Vienna, Austria
| | - Luís P Carmo
- Vetsuisse Faculty, Veterinary Public Health Institute, University of Bern, Bern, Switzerland
| | - Edgar Garcia Manzanilla
- Moorepark Animal and Grassland Research Center, Teagasc, Irish Agriculture and Food Development Authority, Cork, Ireland.,School Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Laura Jensen
- Danish Veterinary and Food Administration, Glostrup, Denmark
| | - Marie Sjölund
- Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute, Uppsala, Sweden
| | | | - Stacey Brown
- Veterinary Medicines Directorate, Addlestone, United Kingdom
| | - Dick Heederik
- The Netherlands Veterinary Medicines Institute (SDa), Utrecht, Netherlands
| | - Jeroen Dewulf
- Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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