Antimicrobial residues in meat from chickens in Northeast Vietnam: analytical validation and pilot study for sampling optimisation

Imprudent administration of antimicrobial drugs in food-producing animals can facilitate the development and spread of antimicrobial-resistant organisms and also enhance the occurrence of antimicrobial residue in animal products. This study was undertaken to assess antimicrobial drug administration to food animals in livestock farms in Enugu State and determine livestock farmers' awareness on the consequences of imprudent antimicrobial administration to food animals and finally the prevalence of antimicrobial drug residues in edible tissues of cattle and pigs in the state. Structured questionnaire was used to extract information on antimicrobial drug administration and consequences of irresponsible use of antimicrobials in food animals from 109 livestock farms/farmers randomly selected using multi-stage sampling technique. Premi® test technology (R-Biopharm, Germany) was used to screen for antimicrobial residues in edible tissues from 300 carcasses consisting of 165 cattle and 135 pigs slaughtered for human consumption in two major slaughterhouses in Enugu State. Tetracyclines (90.8%), penicillins and beta-lactams (89.9%), and aminoglycoside (57.8%) were the classes of antimicrobials most frequently administered to food animals in the farms surveyed. Withdrawal period was not observed in 65% of the farms. About 30% of cattle and 23% of pig carcasses screened contained detectable amounts of antimicrobial residues. There is widespread indiscriminate administration of antimicrobial drugs in food animals in Enugu State. This underscores the need for public enlightenment on prudent use of antimicrobial drugs in food-producing animals in order to preserve the therapeutic efficacy for sustainable livestock production and to safeguard human health.

The vast literature on antimicrobial drug use in animals has expanded considerably recently as the antimicrobial resistance (AMR) crisis in human medicine leads to questions about all usage of antimicrobial drugs, including long-term usage in intensively managed food animals for growth promotion and disease prevention. Attention is also increasingly focusing on antimicrobial use and on bacterial resistance in companion animals, which are in intimate contact with the human population. They may share resistant bacteria with their owners, amplify resistant bacteria acquired from their owners, and act as a reservoir for human infection. Considerable effort is being made to describe the basis of AMR in bacterial pathogens of animals. Documentation of many aspects of use of antimicrobials in animals is, however, generally less developed and only a few countries can describe quantities of drugs used in animals to kg levels annually. In recent years, many national veterinary associations have produced 'prudent use guidelines' to try to improve antimicrobial drug use and decrease resistance, but the impact of guidelines is unknown. Within the evolving global movement for 'antimicrobial stewardship', there is considerable scope to improve many aspects of antimicrobial use in animals, including infection control and reduction of use, with a view to reducing resistance and its spread, and to preserving antimicrobial drugs for the future.

Background: Healthcare big data has become an important strategic resource, and the study of applying it to the rational application of antimicrobial drugs is of great significance in improving and optimizing the various tasks of medicine and health and promoting the development of social health. Based on its own characteristics, the issue of data quality has important research value in promoting data output and application. Objective: To optimize the status quo of antimicrobial drug use in medical institutions, to explore the value of healthcare big data, and to explore the data governance methods in the era of digital intelligence in order to build a good ecosystem for the application of healthcare big data. Methods: This paper constructs a set of intelligent full-closed-loop antimicrobial rational application management platform integrated with data quality, adopts PDCA cycle management mode, analyzes the problems in the process of applying healthcare big data and gives the corresponding solutions, authorizes according to the personnel's duties, and guarantees the data security. Results: Since the platform went online in January 2021, the antimicrobial drug use intensity indicator of a hospital has decreased year by year from 38 to 34.4 as of June 2023, effectively standardizing the use of antimicrobial drugs. The time consumed for the statistics of antimicrobial use intensity related data has decreased from an average of 30min to 2min, which has significantly improved the work efficiency.Healthcare professionals are able to monitor indicator data in real time, with or without abnormal cases, and fully grasp the trend of indicators. At the same time, the patient's medication can be viewed at any time, and the condition can be grasped in a timely manner. Conclusions: The platform not only effectively solves the problem of information barriers, but also accurately determines the data source and statistical logic of indicator collection, reflecting the actual clinical diagnosis and treatment, and at the same time greatly reduces labor costs and optimizes the workflow.The practical experience of platform construction has important reference significance for the governance and application of healthcare big data, which provides data support and technical guarantee for the scientific, standardized and refined management of hospitals.

Sources of variation of antimicrobial use in Charolaise and Limousine beef breeds in Veneto region (Italy)

Background The role of antimicrobial drugs in end-of-life (EOL) care is uncertain, with the potential palliative benefit of antimicrobials in some settings being outweighed by potential limited benefit and added toxicity. In this study, we aimed to analyze the roles of palliative care consultation and code status change on antimicrobial prescribing practices at the EOL. We hypothesized that palliative medicine consultation (PMC) reduces antimicrobial use in patients receiving EOL care. Methods This was a retrospective cohort study conducted on adult patients who were admitted to Wake Forest Baptist Health facilities between January-December 2019 and who were either transitioned to comfort care or discharged to hospice. Patients were stratified based on the presence or absence of PMC during their hospitalization. The primary outcome was the mean days of therapy (DOT) per patient before and after EOL care. DOTs were defined as a calendar day when a single systemic antimicrobial was administered. Antimicrobials given topically or prescribed solely for Pneumocystis or herpesvirus prophylaxis were excluded. Results A total of 2242 patients were identified, of whom 621 received PM consultation during their hospitalization. Among those receiving PMC, there were a total of 3301 days of hospitalization and 4560 DOTs prior to the transition to EOL care, for a mean DOT/hospital day of 1.38 (95% CI 1.34-1.42). There were 6,563 hospital days and 11,466 DOTs among the non-PMC group, for a mean DOT/hospital day of 1.75 (1.72-1.78). Following transition to EOL care, antimicrobial use decreased rapidly, with 0.087 DOTs/hospital day in the PMC group (0.077-0.097) and 0.051 DOTs/hospital day (0.044-0.056) in the non-PMC group. Conclusion In this observational study, antimicrobial drug use decreased markedly in patients transitioning to EOL care. However, the rate of antimicrobial use in EOL patients was not reduced by PMC and was greater than in those patients not receiving PMC, although this difference was not clinically substantial. Antimicrobial use was infrequent in EOL patients in our cohort. Future studies should evaluate the palliative benefit of antimicrobials in specific subgroups of patients receiving EOL care. Disclosures Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support

Background and Aim:Antibiotics are used to improve growth, reduce disease, and decrease mortality in animals grown for food. The government regulates and prohibits the use of antibiotics, in particular, the use of antibiotic growth promoter (AGP) in livestock; however, it is not yet known whether the use of antibiotics is in accordance with regulations so that there are no antibiotic residues in food of animal origin. To ensure food safety of animal origin and to raise awareness of food safety, it is necessary to detect antibiotic residues in fish, eggs, and chicken meat from Yogyakarta Special Province through monitoring and monitoring. To ensure food safety and regulatory compliance in food samples, antibiotic residue screening techniques are essential. A number of methods, such as time-consuming and costly chromatographic and spectroscopic methods, have been developed for the detection of antibiotic residues in food samples; however, not all laboratories have these facilities. Therefore, a rapid diagnosis of food of animal origin is required. The purpose of this study was to rapidly test antibiotic residues by using Premi®test kits (R-Biopharm AG, Germany) to increase awareness of food safety of animal origin.Materials and Methods:We tested 345 animal-based food samples from traditional markets, supermarkets, and central markets in five districts of Yogyakarta Special Province for antibiotic residues using rapid test kits and observation questionnaires to identify risk factors.Results:The presence of antibiotic residues in food-animal origin samples from the Yogyakarta region had an antibiotic residue level of 9.28% (32/345), consisting of fish samples 11.3% (18/97), eggs 15.65% (1/114), and chicken meat samples 0.87% (13/102). The highest percentage of samples positive for residual antibiotics was 21.9% (7/32) from supermarket meat samples. The highest amounts of antibiotic residues were found in fish samples collected from Sleman Regency, up to 25% (8/32), whereas in supermarket fish samples, there were as high as 18.8% (6/32).Conclusion:Antibiotic residues in animal-based food can be attributed to various factors, including product source, transportation conditions, and environmental conditions. The widespread distribution of antibiotic residues in fish comes from environmental conditions during maintenance, distribution, and retailing. Monitoring antibiotic residue prevalence in food-animal origins, particularly chicken meat, eggs, and fish, is crucial for improving animal food quality and safety.

An antimicrobial drug use monitoring program which also provides clinical pharmacy services in a 635-bed hospital is described. The program includes culture sensitivity monitoring, antimicrobial use monitoring, aminoglycoside monitoring, physician consultation and reporting of results to the medical staff. It requires 34 hours of pharmacist time per month, at an estimated annual cost of #4,100.

Antibiotics are used in animal feeds as growth promoters or for disease prevention and treatment. Drugs and their metabolites accumulate into body cells and constitute the so-called drug residues. Residual antimicrobials in food are an increasing risk for human health. Antibiotic residues in meat and other foods are suspected to be responsible for drug allergies and emergence of antimicrobial-resistant bacteria.In Madagascar, bacterial resistance against several antibiotics has been regularly observed in pathogens isolated from humans and pigs. Suspicion of drug misuse in farms has been frequently recorded by animal health professionals but no guidelines are available on the good usage of antibiotics in livestock. Since scarce information is available on antimicrobial residues in ani­mal products in Madagascar, this study aimed at determining the prevalence of pork meat contaminated by such residues and sold in Antananarivo markets.A total of 967 meat samples (diaphragm muscle) were collected during 2010 and 2011 in the four main abattoirs of Antananarivo, and in three additional regional abattoirs, i.e. Antsirabe, Mahitsy (Central Madagascar) and Tsiroamandidy (Western Madagascar). Analysis for antimicrobial detection in meat was performed with the commercial Premi®-test kit (DSM, Urmond, Netherlands) at the National Veterinary Diagnostic Laboratory in Antananarivo. Premi®-test is a broad spectrum microbial screening test for the detection of antibiotic and sulfonamide residues in meat or meat products at, or below maximum residue limit (MRL) levels. MRL is the maximum concentration of residues following administration of a veterinary medicine which is legally permit­ted or acceptable in food under European Union legislation. The Premi®-test kit contains a standardized number of spores of Bacillus stearothermophilus, very sensitive to many antibiotics and sulfa compounds, in agar medium with selected nutrients together with an indicator. Premi®-test is based on the inhibi­tion of the growth of B. stearothermophilus. When meat juice is added to the Premi®-test ampoule and heated at 64°C, spores germinate. The germinated spores multiply and form an acid when no inhibitory substances are present, leading to an indica­tor color change from purple to yellow. When antimicrobial mol­ecules are present above the detection level, no growth occurs and the color remains purple.Table I presents the results of the percentage of positive samples in the various regions of Madagascar. On average 37.2% sam­ples were contaminated by antimicrobial residues. A significant increase from 32 to 39% was observed between 2010 and 2011, respectively. No significant differences were found between samples according to sex, breed or age class in individual ani­mals. No differences between pig farm origins were found either (Figure 1). However, Amoron’i Mania Region, and particularly suburban Ambositra, was the most contaminated area in 2010 (67%; n = 9) and Melaky region (Western Madagascar) in 2011. Pork meat samples originating from the same production area were less contaminated by drug residues when the animals were slaughtered in urban abattoirs compared to provincial abat­toirs. In this first step toward a national surveillance system, we confirm that drug residues in animal products are a serious public health concern for Madagascar.

Acute respiratory tract infections account for the majority of outpatient antimicrobial use, and physicians continue to prescribe these drugs inappropriately for cough, cold and flu symptoms despite lack of efficacy for viral illness. There have been modest reductions in antimicrobial prescribing for respiratory illness in recent years, but inappropriate use of broad-spectrum antimicrobials has increased. Multiple factors contribute to excessive and inappropriate antimicrobial prescribing, including patient expectations, time pressure and diagnostic uncertainty. Physicians perceive that patients will be more satisfied with an antimicrobial prescription, despite evidence that satisfaction with the physician and the office visit is largely determined by other factors. Market forces also contribute to excessive antimicrobial use in primary care. Changing physician behavior is challenging, and traditional approaches, such as continuing medical education conferences and materials, have little impact. Evidence suggests that multifaceted interventions are more effective than single interventions, particularly if they involve personal or small group educational sessions (‘academic detailing’). In general, it appears to be easier to influence decisions regarding the type of antimicrobial and duration of treatment as opposed to withholding antimicrobials entirely. Focusing patient communication on symptom alleviation can reduce patient opposition to non-antibiotic treatment recommendations and improve satisfaction. A contingency plan is helpful for patients who question non-antimicrobial treatment plans. Appropriate antimicrobial use is increasingly viewed as a quality improvement issue, and performance measures have been established for pediatric upper respiratory infection and adult bronchitis. There is growing interest in pay for performance, but little is known regarding the relationship between physician reimbursement and appropriate antimicrobial prescribing. Clinical decision support tools are also promising but require further investigation. Over the next decade, we must acquire a better understanding of macro-level factors that contribute to inappropriate antimicrobial use, including social/cultural health beliefs and practices, physician reimbursement practices, pharmaceutical marketing, and organizational policies regarding return-to-work or child care following illness. Health care systems, pharmaceutical companies, medical schools, residency programs and managed care organizations must all take responsibility and work collaboratively to produce lasting change in antimicrobial prescribing habits.

Introduction: Antimicrobial Resistance (AMR) has become a global emergency threatening to once again make infectious diseases the number one killer of mankind. Antimicrobial Stewardship (AMS) programs require baseline antimicrobial use and microbial drug resistance patterns to formulate rational antimicrobial use policies. However, information about the pattern of antimicrobial drug use among inpatients of government medical colleges in Kerala is scarce. Aim: To describe the antimicrobial use pattern among inpatients of a government medical College Hospital in Kerala. Materials and Methods: A medical-record-based crosssectional study of antimicrobial use among inpatients admitted to Government Medical College Hospital, Alappuzha, Kerala, India was conducted on a single calendar day (16th January 2019). Data was collected in a structured case record form and expressed as counts (%) or median (25th percentile, 75th percentile). Summary statistics were prepared using Microsoft Excel® spreadsheets. Results: Among 210 (107 female) inpatients admitted on 16th January 2019, 137 (65.2%) received at least one empiric antimicrobial despite being indicated in 118 (56.2%) only. Among inpatients prescribed antimicrobials, each received a median of 1 drug for treatment over a median of 3 (0,8) days of therapy. A total of 55 (40%) of antimicrobial use was for surgical prophylaxis in different specialties, but for much longer than recommended by guidelines. Details of culture and sensitivity tests were available in only 10 (4.3%) inpatient records, precluding any change in empiric to definitive antimicrobial therapy in virtually all cases. Third-generation cephalosporins, belonging to the watch group of World Health Organisation (WHO) Access, Watch and Reserve (AWaRe) classification, were the most widely used class of antimicrobials. Topical moxifloxacin was the most common antimicrobial prescribed for ocular disorders. Antimicrobial use from the access category was achieved in roughly 50% of cases, which was much below the target of 60% set by WHO for the period of 2019-23. Conclusion: The present study found unindicated use as well as prophylactic overuse of antimicrobials, especially from the WHO watch category of drugs, among inpatients at a Medical College Hospital. Defensive clinical practice and lack of faith in infection control systems may be contributing factors to this phenomenon. Regular, prospective and collaborative monitoring of antimicrobial use patterns in all tertiary care hospitals may help in strengthening AMS and combating AMR.

we evaluated the effect of implementation of an electronic medical record (EMR) on the use of antimicrobial agents and on the rates of infections with Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA). this was a retrospective, observational study conducted between 1 January 2005 and 31 December 2009. Antimicrobial drug use, rates of nosocomial C. difficile infection (CDI) and MRSA infection, the number of medical charts reviewed and number of antimicrobial recommendations made and accepted were compared before and after implementing the EMR utilizing interrupted time-series analysis. compared with the 10 quarters prior to implementing the EMR, there was a 36.6% increase in the number of charts reviewed (P < 0.0001), a 98.1% increase in the number of antimicrobial recommendations made (P < 0.0001) and a 124% increase in the number of recommendations accepted (P < 0.0001). There was a 28.8% decrease in the use of 41 commonly used antibacterial agents (P < 0.0001). Nosocomial CDI decreased by 18.7% (P = 0.07) and nosocomial MRSA infections decreased by 45.2% (P < 0.0001) following implementation of the EMR. adoption of an EMR facilitated a significant increase in chart reviews and antimicrobial recommendations, which resulted in a sustained decrease in antimicrobial use. There were decreased nosocomial infections with MRSA and a trend towards decreasing CDIs following implementation of the EMR.

The administration of antibiotics to farm animals is an important contemporary topic. Veterinarians, pig producers, politicians, retailers and consumers all have a vested interest in reducing antimicrobial use on farm,...

The increasing use of antimicrobiaL drugs is resulting in enormous hospital expenditures. Careful assessment of inappropriate prescribing and a search for more cost-effective treatment strategies are urgently required. Comparisons between hospitals should help identify areas of inappropriate prescribing as well as effective drug use programs, but such analyses may be severely biased if the impact of different case-mixes is not recognized. We studied antimicrobial usage and expenditures at four state university hospitals in southwestern Germany and assessed the significance of differences between hospital services after adjustment for patient variables. A prevalence survey was done with review of 2,254 charts of patients admitted to the surgical, medical and pediatric services to obtain information on antimicrobial drug prescription and expenditures in the week preceding the survey. According to pharmacy data for the year 1994, maximal differences between these hospitals in the antibiotic costs per patient-day were 1.9-fold (surgical services), 1.5-fold (medical services), and 1.6-fold (pediatric services). In a multivariate analysis, adjusted antibiotic prescription prevalence rates did not differ for medical and pediatric service patients, but did differ for surgical service patients (p = 0.03). Similarly, adjusted expenditures per patient-week differed significantly between hospitals for surgical service patients (p = 0.001), but only marginally for medical (p = 0.14) and pediatric (p = 0.05) service patients. The adjusted difference in expenditures between surgical departments was as large as 2.8-fold (95% CI 1.8 to 4.3) and was primarily related to preferential use of expensive iv antimicrobial drugs. In two hospitals, lowest expenditures in either surgery or medicine were associated with active antimicrobial drug use programs suggesting an impact of these programs on drug use and expenditures limited to these services. The identification of such large patient-mix unrelated differences in antimicrobial usage and expenditures offers opportunities for quality improvements and cost reduction.

BackgroundCombatting antimicrobial resistance requires a One Health approach to antimicrobial stewardship including antimicrobial drug (AMD) use evaluation. Current veterinary AMD prescribing data are limited.ObjectivesTo quantify companion animal AMD prescribing in primary care and specialty practice across 3 academic veterinary hospitals with particular focus on third‐generation cephalosporins, fluoroquinolones, and carbapenems.AnimalsDogs and cats presented to 3 academic veterinary hospitals from 2012 to 2017.MethodsIn this retrospective study, AMD prescribing data from 2012 to 2017 were extracted from electronic medical records at each hospital and prescriptions classified by service type: primary care, specialty practice or Emergency/Critical Care (ECC). Hospital‐level AMD prescribing data were summarized by species, service type, AMD class, and drug. Multivariable logistic full‐factorial regression models were used to estimate hospital, year, species, and service‐type effects on AMD prescribing. Estimated marginal means and confidence intervals were plotted over time.ResultsThe probability of systemic AMD prescribing for any indication ranged between 0.15 and 0.28 and was higher for dogs than cats (P < .05) apart from 2017 at hospital 1. Animals presented to primary care were least likely to receive AMDs (dogs 0.03‐0.15, cats 0.03‐0.18). The most commonly prescribed AMD classes were aminopenicillins/β‐lactamase inhibitors (0.02‐0.15), first‐generation cephalosporins (0.00‐0.09), fluoroquinolones (0.00‐0.04), nitroimidazoles (0.01‐0.06), and tetracyclines (0.00‐0.03). Among the highest priority classes, fluoroquinolones (dogs 0.00‐0.09, cats 0.00‐0.08) and third‐generation cephalosporins (dogs 0.00‐0.04, cats 0.00‐0.05) were most frequently prescribed.Conclusions and Clinical ImportanceAntimicrobial drug prescribing frequencies were comparable to previous studies. Additional stewardship efforts might focus on fluoroquinolones and third‐generation cephalosporins.

BackgroundUnderstanding potential risks of multi-drug resistant (MDR) pathogens from the booming poultry sector is a crucial public health concern. Campylobacter spp. are among the most important zoonotic pathogens associated with MDR infections in poultry and human. This study systematically examined potential risks and associated socio-environmental factors of MDR Campylobacter spp. in poultry farms and live bird markets (LBMs) of Bangladesh.MethodsMicrobial culture and PCR-based methods were applied to examine the occurrence and MDR patterns of Campylobacter spp. in potential sources (n = 224) at 7 hatcheries, 9 broiler farms and 4 LBMs in three sub-districts. Antimicrobial residues in broiler meat and liver samples (n = 50) were detected by advanced chromatographic techniques. A questionnaire based cross-sectional survey was conducted on socio-environmental factors.ResultsOverall, 32% (71/ 224) samples were found contaminated with Campylobacter spp. In poultry farms, Campylobacter spp. was primarily found in cloacal swab (21/49, 43%), followed by drinking water (8/24, 33%), and meat (8/28, 29%) samples of broilers. Remarkably, at LBMs, Campylobacter spp. was detected in higher prevalence (p < 0.05) in broiler meat (14/26, 54%), which could be related (p < 0.01) to bacterial contamination of drinking water (11/21, 52%) and floor (9/21, 43%). Campylobacter isolates, one from each of 71 positive samples, were differentiated into Campylobacter jejuni (66%) and Campylobacter coli (34%). Alarmingly, 49 and 42% strains of C. jejuni and C. coli, respectively, were observed as MDR, i.e., resistant to three or more antimicrobials, including, tetracycline, amoxicillin, streptomycin, fluoroquinolones, and macrolides. Residual antimicrobials (oxytetracycline, ciprofloxacin and enrofloxacin) were detected in majority of broiler liver (79%) and meat (62%) samples, among which 33 and 19%, respectively, had concentration above acceptable limit. Inadequate personal and environmental hygiene, unscrupulously use of antimicrobials, improper waste disposal, and lack of health surveillance were distinguishable risk factors, with local diversity and compound influences on MDR pathogens.ConclusionPotential contamination sources and anthropogenic factors associated with the alarming occurrence of MDR Campylobacter, noted in this study, would aid in developing interventions to minimize the increasing risks of poultry-associated MDR pathogens under ‘One Health’ banner that includes poultry, human and environment perspectives.