Informing Stewardship Measures in Canadian Food Animal Species through Integrated Reporting of Antimicrobial Use and Antimicrobial Resistance Surveillance Data—Part II, Application

Using the methodology developed for integrated analysis and reporting of antimicrobial use (AMU) and antimicrobial resistance (AMR) data, farm-level surveillance data were synthesized and integrated to assess trends and explore potential AMU and AMR associations. Data from broiler chicken flocks (n = 656), grower–finisher pig herds (n = 462) and turkey flocks (n = 339) surveyed by the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) at the farm-level (2015–2019) were used. The analyses showed a reduction in mean flock/herd level number of defined daily doses using Canadian standards (nDDDvetCA) adjusted for kg animal biomass that coincided with the decline in % resistance in the three species. This was noted in most AMU-AMR pairs studied except for ciprofloxacin resistant Campylobacter where resistance continued to be detected (moderate to high levels) despite limited fluoroquinolone use. Noteworthy was the significantly negative association between the nDDDvetCA/kg animal biomass and susceptible Escherichia coli (multispecies data), an early indication that AMU stewardship actions are having an impact. However, an increase in the reporting of diseases in recent years was observed. This study highlighted the value of collecting high-resolution AMU surveillance data with animal health context at the farm-level to understand AMR trends, enable data integration and measure the impact of AMU stewardship actions.

Informing Stewardship Measures in Canadian Food Animal Species through Integrated Reporting of Antimicrobial Use and Antimicrobial Resistance Surveillance Data—Part I, Methodology Development

This study explores methodologies for the data integration of antimicrobial use (AMU) and antimicrobial resistance (AMR) results within and across three food animal species, surveyed at the farm-level by the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). The approach builds upon existing CIPARS methodology and principles from other AMU and AMR surveillance systems. Species level data integration involved: (1) standard CIPARS descriptive and temporal analysis of AMU/AMR, (2) synthesis of results, (3) selection of AMU and AMR outcomes for integration, (4) selection of candidate AMU indicators to enable comparisons of AMU levels between species and simultaneous assessment of AMU and AMR trends, (5) exploration of analytic options for studying associations between AMU and AMR, and (6) interpretation and visualization. The multi-species integration was also completed using the above approach. In addition, summarized reporting of internationally-recognized indicators of AMR (i.e., AMR adjusted for animal biomass) and AMU (mg/population correction unit, mg/kg animal biomass) is explored. It is envisaged that this approach for species and multi-species AMU–AMR data integration will be applied to the annual CIPARS farm-level data and progressively developed over time to inform AMU–AMR integrated surveillance best practices for further enhancement of AMU stewardship actions.

The findings of Antimicrobial Resistance Surveillance in Bangladesh (2016-2020)

Antimicrobial resistance is a global problem. Surveillance is one of the effective tools to address this multifaceted problem. In Bangladesh a countrywide antimicrobial resistance surveillance is ongoing since 2016-2020. The main objective of the surveillance is to know the sensitivity pattern of some common bacteria which will eventually help to formulate a standard treatment guideline for the clinician and to know the gravity of the AMR problem in Bangladesh. It is a case based surveillance conducted by Institute of Epidemiology, Disease Control & Research (IEDCR) in nine sentinel sites where five types of clinical cases were selected according to case definition, tested in the microbiological department of the sites and ten types of bacteria were identified from six types of preselected specimens and their sensitivity test were done. All the laboratory works were done following the same standard operative procedure supplied by the AMR surveillance Reference laboratory at IEDCR. Total 19,263 samples were processed during the period of March 2017- March 2020 among which wound swab yielded highest growth (57%). E.coli was the highest (1717) isolated organism among the ten priority pathogens which showed highest sensitivity (91%) to Imipenem. Imipenem also showed higher sensitivity to other organisms like K. pneumoniae (77%), Salmonella species (100%), P. aeruginosa (53%) and Acb complex (29%). Third generation cephalosporin like ceftriaxone was found less than 50% sensitive to E.coli (37%) and K.pneumoniae (28%) although Salmonella spp. showed higher sensitivity (97%) to it. ACB complex, mostly isolated from ICU patients showed alarming resistance to all of the antibiotics and was less than 50% sensitive to even the highest sensitive antibiotic Imipenem (29%). Salmonella spp. isolated from blood showed higher susceptibility to most of the antibiotics except ciprofloxacin (7%). The result of the surveillance representing whole country is surely alarming as most of the bacteria are highly resistant to the commonly used as well some of the reserve group of antibiotics. So concerted effort should be taken from all concerned to curb the problem immediately.