Global Trends in Antimicrobial Use in Food Animals from 2017 to 2030

Demand for animal protein is rising globally and has been facilitated by the expansion of intensive farming. However, intensive animal production relies on the regular use of antimicrobials to maintain health and productivity on farms. The routine use of antimicrobials fuels the development of antimicrobial resistance, a growing threat for the health of humans and animals. Monitoring global trends in antimicrobial use is essential to track progress associated with antimicrobial stewardship efforts across regions. We collected antimicrobial sales data for chicken, cattle, and pig systems in 41 countries in 2017 and projected global antimicrobial consumption from 2017 to 2030. We used multivariate regression models and estimated global antimicrobial sales in 2017 at 93,309 tonnes (95% CI: 64,443, 149,886). Globally, sales are expected to rise by 11.5% in 2030 to 104,079 tonnes (95% CI: 69,062, 172,711). All continents are expected to increase their antimicrobial use. Our results show lower global antimicrobial sales in 2030 compared to previous estimates, owing to recent reports of decrease in antimicrobial use, in particular in China, the world’s largest consumer. Countries exporting a large proportion of their production are more likely to report their antimicrobial sales data than countries with small export markets.

Download Full-text

Global trends in antimicrobial use in aquaculture

Scientific Reports ◽

10.1038/s41598-020-78849-3 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Daniel Schar ◽

Eili Y. Klein ◽

Ramanan Laxminarayan ◽

Marius Gilbert ◽

Thomas P. Van Boeckel

Keyword(s):

Antimicrobial Stewardship ◽

Ecosystem Health ◽

Species Group ◽

Asia Pacific ◽

Current Evidence ◽

Antimicrobial Use ◽

Antimicrobial Consumption ◽

Global Trends ◽

Aquaculture Industry ◽

Species Groups

AbstractGlobally aquaculture contributes 8% of animal protein intake to the human diet, and per capita consumption is increasing faster than meat and dairy consumption. Reports have documented antimicrobial use in the rapidly expanding aquaculture industry, which may contribute to the rise of antimicrobial resistance, carrying potential consequences for animal-, human-, and ecosystem-health. However, quantitative antimicrobial use across a highly diversified aquaculture industry is not well characterized. Here, we estimate global trends in antimicrobial use in aquaculture in 2017 and 2030 to help target future surveillance efforts and antimicrobial stewardship policies. We estimate antimicrobial use intensity (mg kg−1) for six species groups though a systematic review of point prevalence surveys, which identified 146 species-specific antimicrobial use rates. We project antimicrobial use in each country by combining mean antimicrobial use coefficients per species group with OECD/FAO Agricultural Outlook and FAO FishStat production volumes. We estimate global antimicrobial consumption in 2017 at 10,259 tons (95% uncertainty interval [UI] 3163–44,727 tons), increasing 33% to 13,600 tons in 2030 (UI 4193–59,295). The Asia–Pacific region represents the largest share (93.8%) of global consumption, with China alone contributing 57.9% of global consumption in 2017. Antimicrobial consumption intensity per species group was: catfish, 157 mg kg−1 (UI 9–2751); trout, 103 mg kg−1 (UI 5–1951); tilapia, 59 mg kg−1 (UI 21–169); shrimp, 46 mg kg−1 (UI 10–224); salmon, 27 mg kg−1 (UI 17–41) and a pooled species group, 208 mg kg−1, (UI 70–622). All antimicrobial classes identified in the review are classified as medically important. We estimate aggregate global human, terrestrial and aquatic food animal antimicrobial use in 2030 at 236,757 tons (95% UI 145,525–421,426), of which aquaculture constitutes 5.7% but carries the highest use intensity per kilogram of biomass (164.8 mg kg−1). This analysis calls for a substantial scale-up of surveillance capacities to monitor global trends in antimicrobial use. Current evidence, while subject to considerable uncertainties, suggests that for some species groups antimicrobial use intensity surpasses consumption levels in terrestrial animals and humans. Acknowledging the fast-growing nature of aquaculture as an important source of animal nutrition globally, our findings highlight the urgent need for enhanced antimicrobial stewardship in a high-growth industry with broad links to water and ecosystem health.

Download Full-text

P32 An audit to assess the suitability of patients at a tertiary/quaternary paediatric hospital to switch from intravenous (IV) to oral (PO) antimicrobial therapy

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-nppg.41 ◽

2020 ◽

Vol 105 (9) ◽

pp. e23.1-e23

Author(s):

Orlagh McGarrity ◽

Aliya Pabani

Keyword(s):

High Risk ◽

Antimicrobial Resistance ◽

Blood Culture ◽

Antimicrobial Stewardship ◽

Antimicrobial Therapy ◽

Blood Cultures ◽

Antimicrobial Use ◽

List Type ◽

Paediatric Hospital ◽

Oral Agents

Introduction, Aims and ObjectivesIn 2011 the Start Smart then Focus campaign was launched by Public Health England (PHE) to combat antimicrobial resistance.1 The ‘focus’ element refers to the antimicrobial review at 48–72 hours, when a decision and documentation regarding infection management should be made. [OM1] At this tertiary/quaternary paediatric hospital we treat, immunocompromised, high risk patients. In a recent audit it was identified that 80% of antimicrobial use is IV, this may be due to several factors including good central access, centrally prepared IV therapy and oral agents being challenging to administer to children. The aim of the audit was to assess if patient have a blood culture prior to starting therapy, have a senior review at 48–72 hours, and thirdly if our high proportion of intravenous antimicrobial use is justified.MethodElectronic prescribing data from JAC was collected retrospectively over an 8 day period. IV antimicrobials for which there is a suitable oral alternative, this was defined as >80% bioavailability, were included. Patients were excluded in the ICU, cancer and transplant setting, those with absorption issues and with a high risk infection, such as endocarditis or bacteraemia. Patient were assessed against a set criteria to determine if they were eligible to switch from IV to PO therapy; afebrile, stable blood pressure, heart rate <90/min, respiratory rate < 20/min for 24 hours. Reducing CRP, reducing white cell count, blood cultures negative or sensitive to an antibiotic that can be given orally.Results100% of patients (11) had a blood cultures taken within 72 hours of starting therapy55% of patients had a positive blood culture82% of patients had a senior review at 48–72 hours46% of patients were eligible to switch from IV to PO therapy at 72 hours33% of eligible patients were switched from IV to PO therapy at 72 hoursConclusion and RecommendationsThis audit had a low sample size due to the complexity of the inclusion and exclusion criteria, and the difficulty in reviewing patient parameters on many different hospital interfaces. It is known that each patient is reviewed at least 24 hourly on most wards and therefore there is a need for improved documentation of prescribing decisions. Implementation of an IV to oral switch guideline is recommended to support prescribing decisions and educate and reassure clinicians on the bioavailability and benefits of PO antimicrobial therapy where appropriate. Having recently changed electronic patient management systems strategies to explore include hard stops on IV antimicrobial therapies, however this will require much consideration. Education of pharmacist and nurses is required to raise awareness about antimicrobial resistance and the benefits of IV to PO switches, despite the ease of this therapy at out Trust. This will promote a culture in which all healthcare professionals are active antimicrobial guardians, leading to better patient outcomes, less service pressures, and long term financial benefit.ReferenceGOV.UK. 2019. Antimicrobial stewardship: Start smart - then focus. [ONLINE]Available at: https://www.gov.uk/government/publications/antimicrobial-stewardship-start-smart-then-focus [Accessed 3 July 2019]

Download Full-text

Antimicrobial Stewardship in the Emergency Department

Journal of Pharmacy Practice ◽

10.1177/0897190015585762 ◽

2016 ◽

Vol 29 (6) ◽

pp. 556-563 ◽

Cited By ~ 21

Author(s):

Bryan M. Bishop

Keyword(s):

Emergency Department ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Health Concern ◽

Antimicrobial Use ◽

Upper Respiratory Infection ◽

Diagnostic Uncertainty ◽

National Public Health ◽

Inpatient Settings ◽

Tract Infections

Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance.

Download Full-text

Global trends in antimicrobial use in food animals

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1503141112 ◽

2015 ◽

Vol 112 (18) ◽

pp. 5649-5654 ◽

Cited By ~ 991

Author(s):

Thomas P. Van Boeckel ◽

Charles Brower ◽

Marius Gilbert ◽

Bryan T. Grenfell ◽

Simon A. Levin ◽

...

Keyword(s):

Large Scale ◽

Meat Products ◽

Farming Systems ◽

Human Consumption ◽

Antimicrobial Use ◽

Antimicrobial Consumption ◽

Middle Income ◽

Intensive Farming ◽

Production Practices ◽

Food Animals

Demand for animal protein for human consumption is rising globally at an unprecedented rate. Modern animal production practices are associated with regular use of antimicrobials, potentially increasing selection pressure on bacteria to become resistant. Despite the significant potential consequences for antimicrobial resistance, there has been no quantitative measurement of global antimicrobial consumption by livestock. We address this gap by using Bayesian statistical models combining maps of livestock densities, economic projections of demand for meat products, and current estimates of antimicrobial consumption in high-income countries to map antimicrobial use in food animals for 2010 and 2030. We estimate that the global average annual consumption of antimicrobials per kilogram of animal produced was 45 mg⋅kg−1, 148 mg⋅kg−1, and 172 mg⋅kg−1 for cattle, chicken, and pigs, respectively. Starting from this baseline, we estimate that between 2010 and 2030, the global consumption of antimicrobials will increase by 67%, from 63,151 ± 1,560 tons to 105,596 ± 3,605 tons. Up to a third of the increase in consumption in livestock between 2010 and 2030 is imputable to shifting production practices in middle-income countries where extensive farming systems will be replaced by large-scale intensive farming operations that routinely use antimicrobials in subtherapeutic doses. For Brazil, Russia, India, China, and South Africa, the increase in antimicrobial consumption will be 99%, up to seven times the projected population growth in this group of countries. Better understanding of the consequences of the uninhibited growth in veterinary antimicrobial consumption is needed to assess its potential effects on animal and human health.

Download Full-text

Comparison of Prior Authorization and Prospective Audit with Feedback for Antimicrobial Stewardship

Infection Control and Hospital Epidemiology ◽

10.1086/677624 ◽

2014 ◽

Vol 35 (9) ◽

pp. 1092-1099 ◽

Cited By ~ 39

Author(s):

Jimish M. Mehta ◽

Kevin Haynes ◽

E. Paul Wileyto ◽

Jeffrey S. Gerber ◽

Daniel R. Timko ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Academic Medical Center ◽

Antimicrobial Use ◽

Prior Authorization ◽

Antimicrobial Consumption ◽

Prospective Audit ◽

Gram Negative ◽

Stewardship Program ◽

Days Of Therapy

(See the commentary by Van Schooneveld and Rupp, on pages1100–1102.)ObjectiveAlthough prior authorization and prospective audit with feedback are both effective antimicrobial stewardship program (ASP) strategies, the relative impact of these approaches remains unclear. We compared these core ASP strategies at an academic medical center.DesignQuasi-experimental study.MethodsWe compared antimicrobial use during the 24 months before and after implementation of an ASP strategy change. The ASP used prior authorization alone during the preintervention period, June 2007 through May 2009. In June 2009, many antimicrobials were unrestricted and prospective audit was implemented for cefepime, piperacillin/tazobactam, and vancomycin, marking the start of the postintervention period, July 2009 through June 2011. All adult inpatients who received more than or equal to 1 dose of an antimicrobial were included. The primary end point was antimicrobial consumption in days of therapy per 1,000 patient-days (DOT/1,000-PD). Secondary end points included length of stay (LOS).ResultsIn total, 55,336 patients were included (29,660 preintervention and 25,676 postintervention). During the preintervention period, both total systemic antimicrobial use (−9.75 DOT/1,000-PD per month) and broad-spectrum anti-gram-negative antimicrobial use (−4.00 DOT/1,000-PD) declined. After the introduction of prospective audit with feedback, however, both total antimicrobial use (+9.65 DOT/1,000-PD per month; P < .001) and broad-spectrum anti-gram-negative antimicrobial use (+4.80 DOT/1,000-PD per month; P < .001) increased significantly. Use of cefepime and piperacillin/tazobactam both significantly increased after the intervention (P = .03). Hospital LOS and LOS after first antimicrobial dose also significantly increased after the intervention (P = .016 and .004, respectively).ConclusionsSignificant increases in antimicrobial consumption and LOS were observed after the change in ASP strategy.Infect Control Hosp Epidemiol 2014;35(9):1092-1099

Download Full-text

The Hospital Antimicrobial Use Process: From Beginning to End

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy098 ◽

2018 ◽

Vol 5 (6) ◽

Cited By ~ 2

Author(s):

William R Truong ◽

Jason Yamaki

Keyword(s):

Antimicrobial Resistance ◽

Patient Outcomes ◽

Adverse Drug Reactions ◽

Antimicrobial Stewardship ◽

Antimicrobial Use ◽

Drug Reactions ◽

Improve Patient ◽

Appropriate Antimicrobial Use

Abstract Hospital antimicrobial stewardship (AMS) programs are responsible for ensuring that all antimicrobials are utilized in the most appropriate and safe manner to improve patient outcomes, prevent adverse drug reactions, and prevent the development of antimicrobial resistance. This Perspectives article outlines the hospital antimicrobial use process (AUP), the foundational system that ensures that all antimicrobials are utilized in the most appropriate and safe manner. The AUP consists of the following steps: antimicrobial ordering, order verification, preparation and delivery, administration, monitoring, and discharge prescribing. AMS programs should determine how each step contributes to how an antimicrobial is used appropriately or inappropriately at their institution. Through this understanding, AMS programs can integrate stewardship activities at each step to ensure that every opportunity is taken to optimize antimicrobial use during a patient’s treatment course. Hence, approaching AMS through the framework of a hospital’s AUP is essential to improving appropriate antimicrobial use.

Download Full-text

Approaches for quantifying antimicrobial consumption per animal species based on national sales data: a Swiss example, 2006 to 2013

Eurosurveillance ◽

10.2807/1560-7917.es.2017.22.6.30458 ◽

2017 ◽

Vol 22 (6) ◽

Cited By ~ 24

Author(s):

Luís P Carmo ◽

Gertraud Schüpbach-Regula ◽

Cedric Müntener ◽

Anne Chevance ◽

Gérard Moulin ◽

...

Keyword(s):

Animal Species ◽

Alternative Methods ◽

Monitoring Systems ◽

Antimicrobial Use ◽

Total Biomass ◽

Prescription Data ◽

Antimicrobial Consumption ◽

Biomass Distribution ◽

Equal Distribution ◽

Sales Data

Antimicrobial use in animals is known to contribute to the global burden of antimicrobial resistance. Therefore, it is critical to monitor antimicrobial sales for livestock and pets. Despite the availability of veterinary antimicrobial sales data in most European countries, surveillance currently lacks consumption monitoring at the animal species level. In this study, alternative methods were investigated for stratifying antimicrobial sales per species using Swiss data (2006−2013). Three approaches were considered: (i) Equal Distribution (ED) allocated antimicrobial sales evenly across all species each product was licensed for; (ii) Biomass Distribution (BMD) stratified antimicrobial consumption, weighting the representativeness of each species' total biomass; and (iii) Longitudinal Study Extrapolation (LSE) assigned antimicrobial sales per species based on a field study describing prescription patterns in Switzerland. LSE is expected to provide the best estimates because it relies on field data. Given the Swiss example, BMD appears to be a reliable method when prescription data are not available, whereas ED seems to underestimate consumption in species with larger populations and higher treatment intensity. These methods represent a valuable tool for improving the monitoring systems of veterinary antimicrobial consumption across Europe.

Download Full-text

Targets for the reduction of antibiotic use in humans in the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) partner countries

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.28.1800339 ◽

2019 ◽

Vol 24 (28) ◽

Cited By ~ 3

Author(s):

Fabio D’Atri ◽

Jacqueline Arthur ◽

Hege Salvesen Blix ◽

Lauri A Hicks ◽

Diamantis Plachouras ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Action Plan ◽

Antibiotic Use ◽

The United States ◽

Human Medicine ◽

Antimicrobial Use ◽

Focal Points ◽

Antimicrobial Consumption ◽

Inappropriate Use ◽

And Control

Unnecessary and inappropriate use of antibiotics in human healthcare is a major driver for the development and spread of antimicrobial resistance; many countries are implementing measures to limit the overuse and misuse of antibiotics e.g. through the establishment of antimicrobial use reduction targets. We performed a review of antimicrobial use reduction goals in human medicine in Transatlantic Taskforce on Antimicrobial Resistance partner countries. On 31 March 2017, the European Centre for Disease Prevention and Control sent a questionnaire to National Focal Points for Antimicrobial Consumption and the National Focal Points for Antimicrobial Resistance in 28 European Union countries, Iceland and Norway. The same questionnaire was sent to the TATFAR implementers in Canada and the United States. Thirty of 32 countries replied. Only nine countries indicated that they have established targets to reduce antimicrobial use in humans. Twenty-one countries replied that no target had been established. However, 17 of these 21 countries indicated that work to establish such targets is currently underway, often in the context of developing a national action plan against antimicrobial resistance. The reported targets varied greatly between countries and can be a useful resource for countries willing to engage in the reduction of antibiotic use in humans.

Download Full-text

Knowledge of Antimicrobial Resistance among Veterinary Students and Their Personal Antibiotic Use Practices: A National Cross-Sectional Survey

Antibiotics ◽

10.3390/antibiotics8040243 ◽

2019 ◽

Vol 8 (4) ◽

pp. 243 ◽

Cited By ~ 6

Author(s):

Ismail A. Odetokun ◽

Uduak Akpabio ◽

Nma B. Alhaji ◽

Khalid T. Biobaku ◽

Nurudeen O. Oloso ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Antibiotic Usage ◽

Descriptive Statistics ◽

Antimicrobial Use ◽

Cross Sectional Survey ◽

Veterinary Students ◽

Cross Sectional ◽

Contributory Factors

The challenge of antimicrobial resistance (AMR) is grave in developing countries. Antimicrobials are misused yet stakeholders’ contribution to antimicrobial stewardship is low. Veterinary students are future prescribers and their knowledge could influence progress in combating AMR; hence, there is a need to assess their knowledge, attitude, and awareness of AMR. A multi-institutional questionnaire was administered to undergraduates in Nigerian veterinary schools. It comprised demographics, own personal antibiotic usage, and knowledge, attitude, and awareness of AMR in humans and animals. Descriptive statistics and logistic regression were used for analyses. Of the 426 respondents, 39.2% reported personal antimicrobial use in the previous six months. Over 60% received knowledge scores lower than average and >87% requested more education on clinical use and prescriptions pre-graduation, monitored dispensing of antimicrobials, conducting AMR research, and confirmed link among human, animal, and environmental health. Less than 25% of respondents were aware of antimicrobial stewardship and global efforts/organizations for AMR. Final year students have 9-fold and 14-fold more satisfactory knowledge on antimicrobials in humans and animals compared with other students, respectively (p = 0.001). Final year students also have more knowledge (13×) and awareness of contributory factors (3×) on AMR (p = 0.001) than other students. Unsatisfactory knowledge on AMR issues exists among veterinary students yet willingness to improve was observed. Identified knowledge, attitude, and gaps in AMR awareness should be targeted by veterinary schools in Nigeria.

Download Full-text