Antimicrobial Use in Animals in Timor-Leste Based on Veterinary Antimicrobial Imports between 2016 and 2019

Prevalence of Antimicrobial Resistance in Escherichia coli and Salmonella Species Isolates from Chickens in Live Bird Markets and Boot Swabs from Layer Farms in Timor-Leste

The rapid emergence of antimicrobial resistance is a global concern, and high levels of resistance have been detected in chicken populations worldwide. The purpose of this study was to determine the prevalence of antimicrobial resistance in Escherichia coli and Salmonella spp. isolated from healthy chickens in Timor-Leste. Through a cross-sectional study, cloacal swabs and boot swabs were collected from 25 live bird markets and two layer farms respectively. E. coli and Salmonella spp. from these samples were tested for susceptibility to six antimicrobials using a disk diffusion test, and a subset was tested for susceptibility to 27 antimicrobials using broth-based microdilution. E. coli and Salmonella spp. isolates showed the highest resistance towards either tetracycline or ampicillin on the disk diffusion test. E. coli from layer farms (odds ratio:5.2; 95%CI 2.0-13.1) and broilers (odds ratio:18.1; 95%CI 5.3-61.2) were more likely to be multi-drug resistant than those from local chickens. Based on the broth-based microdilution test, resistance to antimicrobials in the Timor-Leste Antimicrobial Guidelines for humans were low, except for resistance to ciprofloxacin in Salmonella spp. (47.1%). Colistin resistance in E. coli was 6.6%. Although this study shows that antimicrobial resistance in chickens was generally low in Timor-Leste, there should be ongoing monitoring in commercial chickens as industry growth might be accompanied with increased antimicrobial use.

A scoping review of antibiotic use practices and drivers of inappropriate antibiotic use in animal farms in WHO Southeast Asia region

Antibiotic use (ABU) plays an important role in the proliferation of antimicrobial resistance (AMR). Global antimicrobial consumption in food production is projected to rise by 67% from 2010 to 2030, but available estimates are limited by the scarcity of ABU data and absence of global surveillance systems. The WHO South-East Asia (WHO SEA) region is at high risk of emergence of AMR, likely driven by intensifying farm operations and worsening ABU hotspots. However, little is known about farm-level ABU practices in the region. To summarize emerging evidence and research gaps, we conducted a scoping review of ABU practices following the Arksey and O'Malley methodological framework. We included studies published between 2010 and 2021 on farm-level ABU/AMR in the 11 WHO SEA member states, and databases were last searched on 31 October 2021. Our search strategy identified 184 unique articles, and 25 publications underwent full-text eligibility assessment. Seventeen studies, reported in 18 publications, were included in the scoping review. We found heterogeneity in the categorizations, definitions, and ABU characterization methods used across studies and farm types. Most studies involved poultry, pig, and cattle farms, and only one study examined aquaculture. Most studies evaluated ABU prevalence by asking respondents about the presence or absence of ABU in the farm. Only two studies quantified antibiotic consumption, and sampling bias and lack of standardized data collection methods were identified as key limitations. Emerging evidence that farm workers had difficulty differentiating antibiotics from other substances contributed to the uncertainty about the reliability of self-reported data without other validation techniques. ABU for growth promotion and treatment were prevalent. We found a large overlap in the critically important antibiotics used in farm animals and humans. The ease of access to antibiotics compounded by the difficulties in accessing quality veterinary care and preventive services likely drive inappropriate ABU in complex ways.

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The methods used to characterize antibiotic use in farm animals are heterogenous.

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Studies characterizing antibiotic use are limited in number and validity.

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The antibiotics used in farm animals are critically important to human medicine.

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Easy antibiotic access and limited veterinary care likely drive inappropriate use.

Knowledge, attitudes and practices of government animal health workers on antibiotic use and antibiotic resistance in Timor-Leste

Introduction

Antibiotic resistance is a global health threat, and there is growing concern on the inappropriate use of antibiotics in the livestock sector especially in low and middle income countries. The purpose of the study was to understand the knowledge, attitudes and practices on antibiotic use and antibiotic resistance of government animal health workers in Timor-Leste.

Method

A cross-sectional survey using a census approach was conducted between August 2021 and January 2022 focusing on government animal health workers involved in field work and access to antibiotics. Interviews were face-to-face in the local Tetun language. Descriptive and regression analysis informed by causal diagrams were performed.

Result

The study found poor knowledge of antibiotics among participants, with only 8.0% (13/162) able to correctly answer questions on how antibiotics worked. Knowledge of antibiotic resistance was poor as only 29.0% (47/162) of participants had heard of antibiotic resistance and were able to accurately identify that it made antibiotics less effective. Knowledge of antibiotics and knowledge of antibiotic resistance were crudely associated with being a veterinary technician and having university education. Attitude scores were positively influenced by knowledge of antibiotics and antibiotic resistance. Antibiotics were most commonly used in pigs, cattle and buffalo, with oxytetracycline being the most commonly used antibiotics in pigs and chicken. However, most participants reported a lack in supply of this antibiotic (137/162, 78.4%) and other antibiotics. Empiric use of antibiotics in sick animals was common, and some participants used antibiotics for parasitic diseases. Less than a fifth of participants reported ever using human antibiotics, and use of antibiotics for growth promotion was uncommon.

Conclusion

There is a need to develop Timor-Leste specific treatment guidelines, strengthen veterinary diagnostic support, improve antibiotic procurement, and develop training programs to address knowledge gaps and poor practices found in this study.

Veterinary consumption of highest priority critically important antimicrobials and various growth promoters based on import data in Pakistan

Background

Antimicrobial resistance (AMR) is a global public health emergency driven by the indiscriminate use of antimicrobial agents in humans and animals. Antimicrobial consumption surveillance guides its containment efforts. In this study, we estimated, for the first time, veterinary consumption of Critically Important Antimicrobials with Highest Priority (CIA-HtP) for Pakistan.

Methods

The study used an export/import database which provided imports data collected from the Pakistan Customs Authority. We investigated imports of 7 CIA-HtP and various poultry feed additives/growth promoters (FAs/GPs) identified from a survey of 10 poultry and dairy farms in Punjab province in Pakistan and a previously published study, over a three-year period of 2017–2019. Antimicrobial consumption was estimated in mg/kg of country’s animal biomass.

Findings

Imports, in tonnes, for these 7 CIA-HtP were for the years 2017–19: tylosin 240.84, enrofloxacin 235.14, colistin 219.73, tilmicosin 97.32, spiramycin 5.79, norfloxacin 5.55, ceftiofur 1.02 for a total 805.39 tonnes. The corresponding antimicrobial consumption was 10.05 mg/kg of animal biomass. The poultry FAs/GPs contained: zinc bacitracin, enramycin, bacitracin methylene disalicylate, tylosin, tiamulin, colistin, lincomycin, streptomycin, flavophospholipol, tilmicosin, and penicillin with a total antimicrobial chemical compound (ACC) import volume of 577.18 tonnes for the years 2017–2019; and an estimated consumption of 96.53 mg/kg of poultry biomass.

Interpretation

These antimicrobials were a mix of macrolides, quinolones, polymyxins and cephalosporins, among which are some also on the Watch or Reserve list by the WHO, indicating the need for stewardship and to conserve essential antimicrobials to contain AMR. The finding that a yearly average of 192.39 tonnes of the ACC imported were FAs/GPs further highlight the need for stronger regulation and enforcement.

Categorisation of Antimicrobial Use in Fijian Livestock Production Systems

Antimicrobial resistance (AMR) is a major global threat to human and animal health. The use of antimicrobials in the livestock sector is considered to contribute to AMR. Therefore, a reduction in and prudent use of antimicrobials in livestock production systems have been advocated. This cross-sectional survey aimed to investigate the extent of imprudent antimicrobial use (AMU) and to determine whether the AMU practice was affected by either the farming system or species of farmed livestock in the largest island (Viti Levu) of Fiji. A total of 276 livestock enterprises were surveyed and antimicrobials were used on 309 occasions over 90 days. Overall, in 298 of 309 (96%) incidents, antimicrobials were used imprudently, comprising antibiotics, 160 of 170 (94%) and anthelmintics, 138 of 139 (99%). Prudent use of antibiotics was associated with commercial farming systems (X2 = 13, p = 0.001), but no association was observed with anthelmintic use (p > 0.05). Imprudent antibiotic use was associated with dairy (OR = 7.6, CI = 1.41, 41.57, p = 0.018) followed by layer and beef (p > 0.05) compared to broiler enterprises. Imprudent AMU was more common in the backyard and semi-commercial enterprises compared to commercial broiler enterprises. Policies promoting the prudent use of antimicrobials in Fiji should focus on smaller livestock production systems and enterprises.

Knowledge and Practices on Antibiotic Use and Antibiotic Resistance Among Smallholder Pig Farmers in Timor-Leste

Antibiotic resistance is an emerging global health threat which is linked to the overuse and misuse of antibiotics. This study was conducted to understand the knowledge and practices of smallholder pig farmers on antibiotic use and resistance in Timor-Leste. A cross-sectional study using a structured face-to-face interview was conducted in three municipalities. The interview was piloted and implemented in the local Tetun language. This study found that knowledge of antibiotics was very poor as only 12.7% (95% CI: 6.3–23.9) of farmers reported knowing what antibiotics were, and of these only one was able to correctly explain how an antibiotic worked. None of the farmers knew about antibiotic resistance and were able to explain the concept correctly. After the definition of antibiotic was explained to the farmer, only 3.6% (95% CI: 0.8–14.9) reported that their pigs had ever received antibiotics, and the majority of farmers whose pigs had not received antibiotics reported the lack of access to veterinary services. When used, antibiotics were only used for treatment with no reported use for disease prevention or growth promotion. None of the commonly used antibiotics were critically important antimicrobials. Compliance with withdrawal periods was not routinely followed. There is a need to improve access to government veterinary services for farmers in Timor-Leste, while addressing identified knowledge gaps on antibiotics and promoting prudent use practices. The findings from this study serve as baseline information to inform future interventions.