July 19, 2019

Surveillance of Antimicrobial Use in Food-Producing Animals

Society is facing a problem of increasingly alarming proportions: Antimicrobial-resistant infections are becoming more common and difficult to treat. Experts agree that the major driver for the development of antimicrobial resistance (AMR) is the widespread use, and overuse, of antimicrobials in human and animal populations. 

 

Canada’s Action Plan to Combat Antimicrobial Resistance

The health of humans, animals, and the environment is inextricably interconnected – it’s one health. Preserving one health depends on the collaborative and cross-disciplinary interaction between leaders in the public and private sectors across disciplines and geographic borders. This “One Health” approach is the foundation upon which Canada has built its action plan to combat AMR.

This action plan has 4 key components, namely:

• Surveillance
• Infection prevention and control
• Stewardship
• Research and innovation

Surveillance includes systems to collect and track data on both AMR and antimicrobial use (AMU) across the human health, animal health, and agricultural sectors. The focus of this white paper is on the importance of AMU surveillance.   

 

What’s in a Name: Surveillance

Surveillance is a process that involves the collection, management, analysis, interpretation, and reporting on information regarding a disease or health concern within a population. The implication is that there will be some type of directed and specific action taken if the data indicates the health concern is above a predetermined threshold. Therefore, surveillance is comprised of three key components: 

• A monitoring system with a defined set of outcomes/performance indicators 
• Outcome/performance indicator threshold(s)
• Predefined intervention strategy – directed action 

A fully robust surveillance initiative is dependant upon routine and accurate monitoring. And when it comes to monitoring AMU, it is ultimately the responsibility of those that use and prescribe the drugs to ensure that an accurate account is being consistently recorded. 

 

Why Should We Surveil AMU in Livestock?

Surveillance of AMU in livestock is of vital importance for several reasons: 

• Establish a baseline understanding of: 

• • Who – species, production stage 
  • What – class of antimicrobial
  • When – treatment occurrence in time
  • Where – geography 
  • Why – condition treated
  • How much – overall treatment volumes and levels in livestock
• Set targets for optimizing AMU that are evidence-based and rooted in data
• Monitor trends in AMU over time, including progress in attaining targets
• Comparison of AMU across countries, provinces, species, and farms
• Establishes a platform for evaluating the association between AMU and AMR surveillance data
• Quality assurance and transparency – shows consumers that actions are being taken and progress is being made

 

AMU Surveillance in Canadian Livestock

The Public Health Agency of Canada, through the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS), monitors AMU in animals, as well as AMR in Salmonella samples from humans, animals, animal feed, and retail meat. AMU surveillance is accomplished through the voluntary (mandatory on December 1, 2018) reporting of antimicrobial sales data from members of the Canadian Animal Health Institute (CAHI), the trade association representing manufacturers and distributors of veterinary pharmaceuticals in Canada. CIPARS also collects AMU in animals through surveillance of volunteer sentinel swine, broiler, and turkey farms. 

 

What Does the Data Look Like?

We know that roughly 80% of all medically important antibiotics (by weight) sold in Canada are used in food producing animals, with the overwhelming majority (76%) of these compounds being used in-feed5.  In addition, in sentinel herds used for AMU surveillance under the CIPARS project (including grower-finisher, broiler, and turkey farms), the leading reason for antimicrobial use is disease prevention. 

 

A Global Perspective

There are many countries around the world taking an active role in the monitoring and surveillance of AMU in animal populations. For example, both Holland and Denmark have established national AMU monitoring programs with the expressed desire to:

• Reduce (specific, measurable targets set)
• Refine (use of justificatory antibiograms, especially when it comes to using Category I antimicrobials)
• Ensure responsibility (benchmarking producers and vets against one another)
• Review (routine reports to track progress in AMU)

That’s 4/5 R’s of Antimicrobial Stewardship.

 

Where Does Canada Rank?

Relative to European countries, Canada ranks 13th and 27th (out of 31) for AMU in humans and animals, respectively. Clearly there is room for progress.  

Monitoring systems currently in place in Canada are:

• At the aggregate country-wide sales data level
• Do not discriminate between target species 
• Do not allow for quantification of dosages used
• Do not allow for qualification of indication or conditions treated
• Do not ensure accountability or responsibility for those who prescribe, dispense, and/or use antimicrobials

For these reasons, use of ecological-level antimicrobial sales data, while informative to a certain degree, is not leading to the necessary understanding needed to fully embrace the 5 R approach to antimicrobial stewardship. Carte-blanche efforts to reduce total usage might do so at the peril of animal health and welfare. With a fuller understanding of who, what, when, where, why, and how antibiotics are being used, we can develop data-driven, situationally-specific strategies to reduce, refine, and replace AMU.  

 

What do Veterinarians Need to Do?

Antimicrobial stewardship is the foundation of any effort to stem the development and dissemination of AMR. Antimicrobial stewardship is founded on the 5 R’s of AMU.

AMU surveillance is an essential component to effective antimicrobial stewardship. The best way to ensure this is occurring is for clinicians to lead the charge in effective monitoring. Here are some of the steps you can take: 

• Leadership by example 

• • Keep excellent records of all prescriptions issued
    • Ensuring compliance with the College of Veterinarians of Ontario’s prescribing and dispensing standard (as outlined by the Veterinarians Act)
  • Ensure a system is in place that enables an accurate accounting of all medically important antimicrobials dispensed;
  • Ensure you establish and maintain a valid Veterinarian-Client-Patient relationship with all the clients with whom you consult and dispense prescription medications
  • Continuous critical evaluation of clinic-level and vet-level prescribing practices to ensure alignment with antimicrobial stewardship principles.
• Empowering and motivating producers to monitor AMU

• • Educate producers on pertinent issues surrounding AMR and the importance of practicing sound antimicrobial stewardship principles to limit the development of AMR in animals 
  • Establish clear disease definitions and educate producers on proper disease identification and diagnostic practices
  • Collaboratively develop evidence-based standard operating procedures, including clear directions on antimicrobial choice, dosing, and withdrawal recommendations 
  • Establish disease recording practices, including antimicrobial usage, in formats that facilitate monitoring
  • Through prescription, sales, and disease records, routinely evaluate AMU in your clients operations and discuss strategies to reduce, refine, and replace use wherever possible

The design and maintenance of a robust, specific, and actionable AMU surveillance initiative is a vital component to ensuring excellent antimicrobial stewardship practices that will ultimately help limit the development and dissemination of AMR without compromising animal health and food safety. As both producers and veterinarians are at the forefront of AMU in agriculture, any effort to track, benchmark, and affect usage needs cooperation and leadership at this grassroots level.

 

References

1. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. Rev Antimicrob Resist. 2016;(May):84. doi:10.1016/j.jpha.2015.11.005.
2. Public Health Agency of Canada. Tackling Antimicrobial Resistance and Antimicrobial Use A Pan-Canadian.; 2017.
3. Christensen J. Epidemiological concepts regarding disease monitoring and surveillance. Acta Vet Scand. 2001;42(SUPPL. 1):11-16. doi:10.1186/1751-0147-42-S1-S11.
4. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Lippincott Williams & Wilkins; 2008.
5. Public Health Agency of Canada. Canadian Antimicrobial Resistance Surveillance System Report 2017.; 2017.
6. Levy S. Reduced antibiotic use in livestock: how Denmark tackled resistance. Env Heal Perspect. 2014;122(6):A160-5. doi:10.1289/ehp.122-A160.
7. Ministry of Economic Affairs G of the N. Reduced and responsible: policy on the use of antibiotics in food-producing animals in the Netherlands. Gov Netherlands. 2014:8.
8. Page S, Prescott J, Weese S. Antimicrobial resistance: The 5Rs approach to antimicrobial stewardship. Vet Rec. 2014;175(8):207-208. doi:10.1136/vr.g5327.
9. CVO. Professional practice standard: prescribing a drug. https://cvo.org/getmedia/1166ddd7-008d-4564-a2ea-62ac59510971/PPSPrescribing.pdf.aspx. Published 2018.

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