Farmers’ attitudes towards antimicrobial use and awareness of antimicrobial resistance: a comparative study among turkey and rabbit farmers

Rabbits as a Reservoir of Multidrug-Resistant Escherichia coli: Clonal Lineages and Public Health Impact

Escherichia coli, including extended-spectrum β-lactamases (ESBL)-producing strains, poses a global health threat due to multidrug resistance, compromising food safety and environmental integrity. In industrial settings, rabbits raised for meat have the highest consumption of antimicrobial agents compared to other food-producing animals. The European Union is facing challenges in rabbit farming as rabbit consumption declines and antibiotic-resistant strains of E. coli cause enteric diseases. The aim of this study was to investigate the antibiotic resistance profile, genetic diversity, and biofilm formation in cefotaxime-resistant E. coli strains isolated from twenty rabbit farms in Northern Portugal to address the effect of the pressing issue of antibiotic resistance in the rabbit farming industry. Resistance to critically antibiotics was observed, with high levels of resistance to several categories, such as tetracycline, ampicillin, aztreonam, and streptomycin. However, all isolates were susceptible to cefoxitin and imipenem. Multidrug resistance was common, with strains showing resistance to all antibiotics tested. The blaCTX-M variants (blaCTX-3G and blaCTX-M9), followed by the tetracycline resistance genes, were the most frequent resistance genes found. ST10 clones exhibiting significant resistance to various categories of antibiotics and harboring different resistance genes were detected. ST457 and ST2325 were important sequence types due to their association with ESBL-E. coli isolates and have been widely distributed in a variety of environments and host species. The strains evaluated showed a high capacity for biofilm formation, which varied when they were grouped by the number of classes of antibiotics to which they showed resistance (i.e., seven different classes of antibiotics, six classes of antibiotics, and three/four/five classes of antibiotics). The One Health approach integrates efforts to combat antimicrobial resistance in rabbit farming through interdisciplinary collaboration of human, animal, and environmental health. Our findings are worrisome and raise concerns. The extensive usage of antibiotics in rabbit farming emphasizes the urgent need to establish active surveillance systems.

Participatory identification of the causes of antimicrobial use and how they may vary according to differences in sector structure: The case of the Flemish pork and veal sectors

The increasing threat of antimicrobial resistance (AMR) to human health has prompted many countries to adopt national action plans to reduce antimicrobial use (AMU) in farm animals. To achieve this goal, it is necessary to gain a deeper understanding of the factors driving AMU in farm animals. While previous research has focused on gaining a better understanding of AMU from the perspective of farmers and veterinarians, less emphasis has been placed on examining the systemic and contextual factors that influence AMU from multiple viewpoints within the food supply chain. To this end, this paper describes a participatory approach involving multiple stakeholders from two distinct livestock sectors to identify the underlying drivers of AMU and explore their case-specificity. For each sector, we identified causes of AMU during four online focus groups, by co-creating a "problem tree", which resulted in the identification of over 50 technical, economic, regulatory, and sociocultural causes per sector and exploration of causal links. Following this, we analysed the focus group discussion through a content analysis and clustered causes of AMU that were related into 17 categories (i.e. main drivers of AMU), that we then classified as drivers of AMU at sector level or drivers of AMU at farm level. Finally, we compared the two sectors by assessing whether the generated categories (i.e. main drivers for AMU) had been discussed for both sectors and, if so, whether they involved the same causes and had the same implications. Through our analysis, we gained a better understanding of several main drivers of AMU at sector level, that result from systemic and/or contextual causes. As these cannot always be addressed by farmers and/or their veterinarian, we suggest that interventions should also target other actors related to these causes or consider them to help implement certain strategies. Furthermore, based on the results of our comparative analysis, we suggest that systemic structural differences, such as size and level of supply chain integration/fragmentation, may lead to differences in how animal health management is approached. This in turn may influence AMU's decision-making and the effectiveness of interventions, if they are generic and not tailored to the specificities of the sector.

Development of a Training Strategy Aimed at Increasing Veterinarians' Awareness of the Proper Use of Antibiotics on Rabbit Farms

The rabbit sector faces significant challenges with antimicrobial usage (AMU) and antimicrobial resistance (AMR). A focus group involving nine rabbit sector stakeholders identified key issues contributing to high AMU and the need for veterinarians' training. Participants emphasized the lack of clear legislation, biosecurity standards, and the importance of training on best practices to reduce AMU. To address these concerns, a blended learning course for rabbit veterinarians was organized, focusing on responsible drug use to lower AMU. The course design promoted participant interaction using group exercises and online discussions. The output was an operational tool, encompassing crucial elements to reduce drug dependence, covering housing, environmental conditions, feed, reproduction, disease prevention, diagnosis, and treatments. Validated in veterinarians' daily practices, the tool proved valuable. The tool, presented as a checklist, assists veterinarians in supporting field activities regarding proper drug use and AMR issues. It also helps farmers address knowledge gaps in breeding management and adopt biosecurity practices for disease prevention. Participants were encouraged to use the tool during farm visits and collaborate with farmers. The project presented in the manuscript is a crucial step towards the development of effective strategies for responsible AMU and AMR mitigation in the rabbit sector and beyond.

Social and cognitive factors influencing commercial chicken farmers' antimicrobial usage in Bangladesh

Adapting the Social Cognitive Theory framework, we conducted a cross-sectional study on 137 commercial chicken farms in Bangladesh to investigate factors influencing the behaviour of farmers towards the application of antimicrobials to their birds. Almost all farmers used antimicrobials to treat poultry diseases, while 38.6% also were using them to promote healthy growth of chickens and 10.2% to increase egg production or improve meat quality. Using Structural Equation Modeling (SEM), we identified that inappropriate usage of antimicrobials (behaviour) was strongly driven by farmers' short-term goals to maintain the health of their chickens in a production cycle (β = 0.813, p = 0.029), rather than long-term concerns. Farmers' perception about their ability to control antimicrobial administration based on their skills and opportunities (self-efficacy) marginally influenced the short-term goals of antimicrobial usage (β = 0.301, p = 0.073). The results of this study can be used to develop targeted education programs for farmers, to reduce the application of antimicrobials in their poultry flocks.

Knowledge and practices regarding antibiotic use among small-scale poultry farmers in Enugu State, Nigeria

This study examined the knowledge and practices regarding antibiotic use among small-scale poultry farmers in Enugu State, Nigeria. A multistage sampling technique was employed to select 88 poultry farmers. The interview schedule was used for data collection. Respondents' indices of knowledge of antibiotic use (KABU), antibiotic resistance (KABR) and antibiotic use practices (PABU) were determined. Binary logistic regression was performed to ascertain the effect of socio-demographics of respondents, knowledge of antibiotic use and knowledge of antibiotic resistance on the likelihood that farmers use antibiotics inappropriately. All poultry farmers studied used antibiotics for growth promotion, disease prevention, and treatment. The mean index of KABU was 0.54 with 48 % of the respondents having good KABU while the mean index of KABR was 0.65 and 70.5 % of the farmers had good KABR. The farmers' mean index of PABU was 0.47 and 83 % of them used antibiotics inappropriately. Farmers with good KABU (OR = 4.2; 95% CI = 1.030-17.222) and KABR (OR = 4.5; 95% CI = 1.258-15.791) were more likely to misuse antibiotics than those with poor knowledge. Antibiotics are routinely, and on many occasions inappropriately, used in small-scale poultry production in Enugu State, Nigeria. Antibiotics are valuable agents whose efficacy can only be preserved if they are handled with care. Training small-scale farmers will allow them to improve their knowledge and practices regarding antibiotic use.

A Survey on Knowledge, Attitude, and Practices of Large-Animal Farmers towards Antimicrobial Use, Resistance, and Residues in Mymensingh Division of Bangladesh

The widespread and indiscriminate use of antimicrobials in food animals is a key contributor to antimicrobial resistance and antimicrobial residue, which have become a growing public and animal health concern in developing countries such as Bangladesh. This study was aimed to assess the knowledge, attitude, and practices (KAP) of large-animal farmers towards antimicrobial use (AMU), antimicrobial resistance (AMR), and antimicrobial residue (AR) with their correlation. A cross-sectional survey was conducted with a structured and pretested questionnaire in the Mymensingh division of Bangladesh. A total of 212 large-animal farmers (dairy, beef fattening, buffalo, sheep, and goat farmers) were surveyed. Results showed that most of the farmers are male (85.8%) and belong to the 18-30 age group (37.3%). About 20.3% had no formal education, and nearly half of the participants (48.1%) received training regarding antibiotic use and resistance. Penicillin is the most common class of antibiotic used (61.8%) in the study area, followed by other antimicrobials. Only 37.7% of the farmers used antimicrobials on the recommendation of their veterinarian. Overall, 41.5%, 42.5%, and 21.7% of farmers possess adequate knowledge and a satisfactory attitude and perform desirable practices, respectively. Farmers in the 31-40 age group have adequate knowledge, attitude, and ability to implement desired practices compared to farmers in the 18-30 age group. Farmers having a graduate or post-graduate degree scored better in relation to knowledge, attitude, and practice than other farmers. Analysis revealed that farmers who received training on AMU and AMR had 10.014 times (OR = 10.014, 95% CIs: 5.252-19.094), 9.409 times (OR = 9.409, 95% CIs: 4.972-17.806), and 25.994 times (OR = 25.994, 95% CIs: 7.73-87.414) better knowledge, attitude, and performance, respectively, compared to their counterparts. A significant proportion of farmers (97.2%) dispose of leftover antibiotics inappropriately. The findings of the present study will be used to intervene in the education and training of the farmers, which will help to limit the indiscriminate and irrational use of antimicrobials, leading to reducing the chances of developing AMR.

Antimicrobial use in agriculture: critical review of the factors influencing behaviour

Antimicrobial resistance (AMR) is a global health emergency affecting humans and animals, diminishing the effectiveness of medication used to treat illness. The agri-food sector has attracted increased attention for imprudent antimicrobial use (AMU) and its contribution to AMR. Thus, ascertaining farmers' and veterinarians' behaviours surrounding AMU is essential to address imprudent AMU and generate behaviour change within the agri-food sector. Therefore, the aim of this critical review is to investigate, assess and collate the current body of evidence to identify psychosocial factors including knowledge, understanding, perceptions, attitudes and behaviours surrounding AMU. Database searches were limited to articles utilizing qualitative and quantitative methodologies, available in English with no restriction on publication year. Of the 1156 articles identified, 103 were retained for this review. Findings on the psychosocial aspects were thematically analysed. Five key themes emerged from the data: (i) knowledge and awareness of antimicrobials; (ii) attitudes towards antimicrobials; (iii) influential relationships; (iv) resources; and (v) factors influencing AMU. Results indicated that to overcome barriers experienced by key stakeholders, a carefully considered, evidence-based approach, incorporating behaviour change theory, is required when designing intricate interventions/strategies, in order to elicit successful and sustained AMU behaviour change.

The Economics of Rabbit Farming: A Pilot Study on the Impact of Different Housing Systems

This research evaluates the economic sustainability of rabbit farms using different housing systems-bicellular (BI), conventional dual-purpose (DP) and enriched cages designed according to the World Rabbit Science Association guidelines (WRSA)-through a field-based study involving six farms over the course of five years. The cages were compared based on three productivity indices expressed in kg of produced live weight/m² and on eight cost indices expressed in EUR/kg of produced live weight. The results showed that WRSA significantly reduced the productivity index per walkable cage area in buildings and cages, thanks to the longer platform area included in the cage compared to the other systems. Concerning cost indexes, total variable costs were not different among housing systems, whereas significant differences were observed within costs items. As for the feed costs, DP underperforms compared to BI or WRSA (1.15 vs. 1.02 and 0.99 EUR/kg produced live weight); for drugs costs, BI was less competitive compared to DP and WRSA (0.12 vs. 0.06 and 0.05 EUR /kg). In conclusion, under the conditions of the present study, the economic results of farms that adopted housing systems designed to improve rabbit welfare, such as WRSA enriched systems, were economically sustainable and, comparable to conventional housing systems based on BI or DP cages, also provided a significant reduction in drug use in the tested farms. A comprehensive collection of data from more farms at a European level would be necessary to confirm these results on the economics of farms adopting alternative housing systems for rabbits.

Animal Production With Restrictive Use of Antibiotics to Contain Antimicrobial Resistance in Sweden-A Qualitative Study

Antibacterial resistance (ABR), is a growing global threat to human and animal health. Efforts to contain ABR are urgently needed. This qualitative interview study explored perceptions of work to contain ABR among stakeholders in food animal production in Sweden, with focus on broiler production. Semi-structured interviews were carried out with a strategic sample of 13 stakeholders in different parts of production, from professionals at policy level, veterinary authorities, to poultry farmers and poultry veterinarians. Conventional inductive content analysis was used for data analysis. A latent theme, “Working in unison,” emerged, based on the consistency expressed by the informants when they discussed ABR, use of antibiotics, and animal health management. This theme was built on four domains representing the content of the interviews: Knowledge and engagement; Cooperation; Animal health concept; and Development in balance with economic prerequisites. According to the informants, ABR has not been an isolated issue in Sweden but has been included in a tradition of animal health and welfare, and actions have been driven by the industry or by government regulations. Veterinarians described how they worked closely with farmers. Farmers felt involved in the development of animal health management methods. The One Health concept was well-known among stakeholders at national level but not at farm level. Close cooperation between stakeholders seems to facilitate development of animal production with low use of antibiotics.

Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review

Community pharmacists recognize the need to implement antimicrobial stewardship activities in community pharmacies. They are in a unique position to provide triage for common primary care indications and to lower the burden of patients at general practitioners’ offices. However, research shows that, in some areas, dispensing of antimicrobials without valid prescription is still highly prevalent. Regardless of training, every community pharmacist can give his contribution to antimicrobial stewardship. One of the basic elements should be antimicrobial dispensing according to regulations, either prescription only, or according to guidelines where pharmacists have prescribing authority. Patient consultation supported with educational materials, such as leaflets, may reduce patients’ expectations to receive antibiotics for self-limiting infections and reduce pressure on general practitioners to prescribe antibiotics on patients’ demand. Treatment optimization may be achieved in collaboration with the prescribing general practitioners or by providing feedback. At last, pharmacists provided with additional training may be encouraged to provide consultation services to long-term care facilities, to introduce point-of-care testing for infectious diseases in their pharmacies or prescribe antimicrobials for uncomplicated infections. These services are welcomed by patients and communities. Expanding pharmacy services and pharmacists’ prescribing autonomy have shown a positive impact by reducing antibiotics consumption, thus ensuring better compliance with treatment guidelines.

Knowing Is Not Enough: A Mixed-Methods Study of Antimicrobial Resistance Knowledge, Attitudes, and Practises Among Maasai Pastoralists

Global, national, and local efforts to limit antimicrobial resistance (AMR) often stress the importance of raising awareness among users, sellers, and prescribers of antimicrobial drugs. This emphasis is founded upon two assumptions. First, awareness is limited, particularly concerning the links between antimicrobial use (AMU) and AMR. Second, "filling the awareness gaps" will motivate practises that will limit AMR. The first assumption is supported by knowledge, attitudes, and practises (KAP) surveys but these same studies provide mixed support for the second, with several studies finding that knowledge and attitudes are not correlated with related practises. This disconnect may arise as these surveys typically do not collect data on the cultural or historical contexts that pattern AMU. To explore how these contexts impact KAP related to AMU and AMR, we use a mixed-methods approach to examine veterinary practises among Maasai pastoralists in Tanzania. We combine a quantitative KAP survey (N = 195 households) with extensive qualitative data from focus group discussions (N = 55 participants). Results document limited awareness of AMR but also find that knowledge and attitudes are not correlated with practise. Thematic analysis of qualitative data pointed to three reasons behind this disconnect, including (1) Maasai self-perceptions as veterinary experts, (2) the central role of livestock in Maasai culture, and (3) the use of ethnoveterinary knowledge in animal health treatment. We argue that mixed-method approaches will be critical to developing the targeted awareness campaigns needed to limit the emergence and transmission of AMR.

Farmers' Perceptions of Preventing Antibiotic Resistance on Sheep and Beef Farms: Risk, Responsibility, and Action

Antibiotic resistance is one of the most serious public health risks facing humanity. The overuse of antibiotics in the treatment of infectious disease have been identified as sources of the global threat of antibiotic resistance. This paper examines how farmers perceive and manage risks associated with overuse of antibiotics. Specifically, the paper examines the role of habitus and risk in determining farmers' decisions to adopt national antibiotic reduction targets set by members of the Responsible Use of Medicines in Agriculture Alliance's Targets Task Force. Semi-structured interviews were conducted with 34 sheep and beef farmers in England and Wales. Farmers presented four scripts which illuminated reasons for limited adoption of the targets. The scripts presented the farmers as “good farmers” facing an emerging threat to their ontological security. Scripts suggested that they engaged in preventative measures but deflected responsibility for reducing antibiotic resistance to veterinarians and poorly run farms. This research provides valuable insights for policy makers and highlight the benefits of including social science research to support effective implementation.

Farmers' Perceptions About Health and Welfare Issues in Turkey Production

Farmers play an essential role in the management of animals and ensuring their health and welfare. However, relatively little is known about the health and welfare-related issues farmers themselves find important in the turkey sector. As part of a larger study, a cross-sectional survey of turkey farmers was conducted in Canada to identify the main perceived reasons for culling, mortality, and carcass condemnations in their flocks. Additionally, farmers were asked to rate the importance of different health and welfare-related issues (i.e., mortality, aggressive pecking, disease, leg injuries, leg deformities, breast injuries, and varying body size) during their summer and winter production, as well as for the sector as a whole. A total of 83 responses were analyzed (response rate 20%). The most frequently mentioned reasons for the culling of turkeys included leg-related issues (90.0%), sickness (60.5%), and small body size (58.0%). The perceived reasons for mortality were most often unknown (59.7%), or related to cannibalism (41.6%) or dehydration (42.9%). The main reasons for carcass condemnations at processing were related to skin (33.8%) or subcutaneous conditions (64.7%). Leg deformities and mortality were considered the biggest issues for the turkey production sector. In general, farmers rated items as more of an issue when the question pertained to the sector as a whole rather than to their farm. These results increase our understanding of the health and welfare-related problems in turkey production that farmers find important. This can ultimately help focus research efforts in addressing these issues through improved management adaptations or breeding approaches, thereby improving both the well-being of farmers and birds.

Antimicrobial use on Italian Pig Farms and its Relationship with Husbandry Practices

The analysis of antimicrobial use (AMU) data in livestock allows for the identification of risk factors for AMU, thereby favoring the application of responsible AMU policies on-farm. Herewith, AMU in 36 finishing pig farms in northern Italy from 2015-2017 was expressed as defined daily doses for Italian pigs (DDDita) per population correction unit (DDDita/100kg). A retrospective analysis was then conducted to determine the effects of several husbandry practices on AMU. Overall, AMU ranged between 12 DDDita/100kg in 2015 and 8 DDDita/100kg in 2017, showing no significant trends, due to the large variability in AMU between farms. However, a 66% AMU reduction was observed in 19 farms during 2015-2017. Farm size, number of farm workers, air quality, average pig mortality, and presence of undocked pigs on the farm had no significant effects on AMU. Rather, welfare-friendly farms had 38% lower AMU levels (p < 0.05). In conclusion, animal welfare management seems to be relatively more important than farm structure and other managerial characteristics as drivers of AMU in finishing pig farms.

Exploring Perspectives on Antimicrobial Use in Livestock: A Mixed-Methods Study of UK Pig Farmers

Increasing levels of antimicrobial resistance in human and veterinary medicine have raised concerns over the irresponsible use of antimicrobials. The role of administering antimicrobials in food producing animals most frequently falls to the farmer, therefore it is essential that their use of antimicrobials is both optimal and responsible. This study sought in-depth information on the drivers behind antimicrobial use behaviors and farmer attitudes to responsible use using a mixed-methodological approach. Initially, in-depth semi-structured interviews were conducted with a purposively selected sample of farmers (n = 22). A thematic analysis approach was taken to identify key themes from these qualitative data. The generalizability and variation of these themes was then tested on a larger randomly selected sample of pig farmers through a questionnaire study (n = 261). The influences behind antimicrobial use were complex with multiple drivers motivating decisions. There was no consensual opinion on what farming systems resulted in either a low or high antimicrobial requirement however, farmers reported that good management practices, low stocking densities, and a high health status were associated with low antimicrobial use. Farmers expressed desire to avoid the long-term use of in-feed antimicrobials, but identified barriers to discontinuing such behaviors, such as pig morbidity, mortality, and economic losses. The high cost of antimicrobials was described as a motivation toward seeking alternative methods of controlling disease to prophylactic use; however, this expense was balanced against the losses from an increased burden of disease. The high financial costs involved in pig production alongside the economic uncertainty of production and pressure from retailers, were identified as limiting the scope for improvements in pig accommodation and facilities which could reduce the antimicrobial requirements on farm. Long-term, sustainable and economically stable relationships between retailers and farmers may allow farmers to make necessary investments in improving management and housing in order to reduce antimicrobial use. Greater use and more widespread deployment of effective vaccinations were highlighted by farmers as being a feasible alternative to antimicrobial use in preventing disease.