Moving beyond metrics: Capturing the clinical context behind antibiotic prescriptions in French broiler production

Abstract

International audienceSignificant reductions in antimicrobial use (AMU) in food production animals have been observed over the last10 years across Europe. We sought to understand recent changes in AMU by characterising antibiotic prescribingpatterns in poultry production in the context of associated clinical information. We analysed trends in AMU forconventional broiler chicken production in France based on a dataset of 193,526 sales for 33,831 flocks on 2120farms for 2015–2023, including 21,218 antibiotic prescriptions. We found the percentage of flocks prescribedantibiotics dropped from 65 % in 2013 to 20 % in 2023, plateauing in 2020–2023 (oscillating between 13 % and23 %), and observed a reduction in the use of critical antibiotics. A multiple correspondence analysis and hierarchicalclustering on principal components of 1112 antibiotic prescriptions and associated clinical data for2021–2022 produced 1940 prescription events, grouped in five clusters of antibiotic prescribing patterns, eachcharacterised by a combination of clinical indicators related to age at treatment, lesions, syndromes, diagnoses,and isolated bacteria. Two main clusters were associated with bacterial diagnoses, suggesting that use of antibioticsin these clusters was necessary to manage disease. Two clusters were identified as potential targets forfurther interventions to improve antimicrobial stewardship, focusing on underlying factors driving AMU ratherthan outright reductions. Our findings raise questions about the sustainability of further reductions in AMU andtheir implications for animal health and welfare. This calls for a shift to a more sustainable approach to monitoringantimicrobial stewardship, using integrated indicators which consider AMU within its broader context