Improving farm-level antimicrobial stewardship benchmarks by reporting antimicrobial use within the context of both the magnitude of disease pressure and the outcome of therapy

Effect of a dairy farmworker stewardship training program on antimicrobial drug usage in dairy cows

Antimicrobial use (AMU) is critical to preserving animal health and welfare. However, the development of antimicrobial resistance (AMR) represents a public health threat. Although most antimicrobials used on the farm require a veterinarian prescription, farmworkers make daily on-farm treatment decisions. Therefore, farmworker training is vital to promote responsible AMU. This research project aimed to evaluate the effect of farmworker antimicrobial stewardship (AMS) training on the quantity of AMU on dairy farms in Ohio and California. We hypothesized that farms receiving AMS training would have reduced AMU in dairy cattle compared with farms where training wasn't administered. We designed a quasiexperimental study with 18 conventional dairy farms enrolled in Ohio and California. Twelve farms received AMS training, and 6 farms did not. The AMS program included a 12-wk training focused on accurate identification of cows requiring antimicrobial treatment. We quantified AMU by collecting used drug containers, manually counted by researchers during farm visits. Treatment incidence (TI) was calculated using animal daily doses (ADD), and Poisson regression models were used to analyze the TI data. Disease incidence rate (DIR) in lactating cows was 2.2, 1.5, 1.0, 0.4, 0.3, 0.2, and 0.03/1,000 cow-days for mastitis, lameness, metritis, pneumonia, retained placenta, diarrheas, and other diseases (e.g., conjunctivitis, injuries), respectively. The highest TI by antimicrobial class (provided in ADD/1,000 cow-days) was cephalosporin (5.9), penicillin (5.2), tetracyclines (0.4), lincosamides (0.2), and sulfonamides (0.1). Among the trained farms using a within-treatment group analysis, no significant differences were observed in TI pre-intervention (10.9 ADD/1,000 cow-days) compared with TI postintervention (10.3 ADD/1,000 cow-days). Treatment incidence from the training group was 10.8 ADD/1,000 cow-days and although numerically lower, it was not significantly different compared with TI in the control groups at 13.9 ADD/1,000 cow-days (rate ratio = 0.77, CI = 0.25-2.38). Future research on AMS should incorporate farmworker training with social science approaches to overcome barriers and promote on-farm responsible use.

Antimicrobial Metaphylaxis and its Impact on Health, Performance, Antimicrobial Resistance, and Contextual Antimicrobial Use in High-Risk Beef Stocker Calves

The objective of this blinded, cluster-randomized, complete block trial was to evaluate the impact of metaphylaxis on health, performance, antimicrobial resistance, and contextual antimicrobial use (AMU) in high-risk beef stocker calves. Calves (n = 155) were randomly assigned to receive either saline or tulathromycin at the time of arrival processing. Deep nasopharyngeal swabs were collected from each calf at arrival and 14 d later. Calves were monitored for bovine respiratory disease (BRD) for 42 d. Body weights were obtained at arrival, days 14, 28, and 42. Contextual antimicrobial use (AMU) was calculated using dose and mass-based metrics. Calves given tulathromycin had a greater average daily gain (0.96 ± 0.07 kg vs. 0.82 ± 0.07 kg; P = 0.034) and lower prevalence of BRD than controls (17% vs. 40%; P = 0.008). Proportions of calves with BRD pathogens identified at arrival were similar between treatment groups [17%; P = 0.94]. Proportions of calves with BRD pathogens identified at day 14 were lower for calves receiving tulathromycin compared to controls (15% vs. 60%, P < 0.001). Overall, 81% of Pastuerella multocida isolates and 47% of Mannheimia haemolytica isolates were pansusceptible. When measured as regimens per head in, AMU in calves receiving tulathromycin was higher than calves receiving saline (P = 0.01). Under the conditions of this study, metaphylaxis had positive impacts on the health and performance of high-risk beef stocker calves, did not contribute to the selection of resistant bacterial isolates in the nasopharynx of treated cattle, and increased AMU.