Assigning Defined Daily Doses Animal: a European multi-country experience

In order to be able to compare antimicrobial usage data between countries with a uniform quantification method a Defined Daily Dose Animal (DDDA) per active substance was defined. Information of 731 antimicrobial products licensed for use in porcine medicine in four EU countries was used to establish mean DDDAs for 83 unique active substances (AS) including combinations of different AS. Common DDDAs were defined in spite of large variations in the authorized dosages for the same active substances and administration routes. These DDDAs will be used to quantify and compare antimicrobial usage in pig production in four EU countries

Mértola: museum-town and archaeological field

peer reviewedEn avril 2019, les étudiants du master en muséologie de l’Université de Liège (Belgique) ont eu la chance de visiter Mértola. Située dans le sud du Portugal, cette petite ville est l’héritière d’un riche patrimoine valorisé depuis 1978 par le « Campo Arqueológico de Mértola ». Reposant sur les observations réalisées au cours de ce voyage, cet article analyse les aspects innovants et les défis de cette expérience singulière de muséalisation de l'archéologie. Un premier axe d’analyse s’intéresse au concept de « développement durable » qui est au centre du projet développé à Mértola. En effet, ce projet est articulé autour d’une forme alternative de développement reposant sur la richesse du patrimoine local, alors que la région est menacée par la dépopulation. Aussi, face aux dangers inhérents au tourisme de masse, Mértola propose comme alternative un tourisme culturel et rural qui rend à la communauté locale le bénéfice de ses efforts dans la préservation du patrimoine. Un deuxième aspect développé dans cette contribution est l’intégration des espaces archéologiques muséalisés dans le quotidien de la population locale. Véritable ville-musée, Mértola propose une conception particulière de l’archéologie qui, en tant que science ouverte, ne doit pas uniquement s’adresser aux spécialistes, mais également se mettre au service de la société. Au final, l’expérience singulière et innovante proposée à Mértola conduit à s’interroger sur notre conception du musée et sur son rôle dans notre société.In April 2019, the students of the Master in Museology at the University of Liège (Belgium) had the opportunity to visit Mértola. Located in southern Portugal, this small town is characterized by a rich heritage valued thanks to the "Mértola’s Archaeological Field" since 1978. Based on the observations made during this trip, this article analyses the innovative aspects and the challenges of this singular experience of archaeological musealization. The first axis of analysis focuses on the concept of "sustainable development" that is at the heart of the project conducted in Mértola. As a matter of fact, this project is articulated around an alternative form of development based on the richness of local heritage, while the region is suffering depopulation. Furthermore, facing the risks related with to mass tourism, Mértola proposes a cultural and rural tourism as an alternative, giving back to the local community the benefit of their efforts in preserving the heritage. A second aspect developed in this contribution is the integration of the archaeological museum spaces into the daily life of the local population. As a true museum-town, Mértola proposes a particular conception of Archaeology which, as an open science, should not only be a prerogative for specialists, but should also put itself at the service of society. In conclusion, the singular and innovative experience proposed in Mértola leads us to question our conception of museum and its role in our society.Em abril de 2019, os estudantes do Mestrado em Museologia da Universidade de Liège (Bélgica) tiveram a oportunidade de visitar Mértola. Situada no sul de Portugal, esta pequena cidade é herdeira de um rico patrimônio valorizado desde 1978 pelo "Campo Arqueológico de Mértola". Com base nas observações feitas durante esta viagem, este artigo analisa os aspectos inovadores e os desafios desta singular experiência de musealização arqueológica. O primeiro eixo de análise centra-se no conceito de "desenvolvimento sustentável" que está no cerne do projeto desenvolvido em Mértola. De fato, este projeto se articula em torno de uma forma alternativa de desenvolvimento baseada na riqueza do patrimônio local, enquanto que a região está ameaçada pelo despovoamento. Além disso, face aos perigos inerentes ao turismo de massas, Mértola propõe como alternativa um turismo cultural e rural que devolve à comunidade local o benefício dos seus esforços na preservação do patrimônio. Um segundo aspecto desenvolvido nesta contribuição é a integração dos espaços dos museus arqueológicos na vida quotidiana da população local. Como uma verdadeira cidade-museu, Mértola propõe uma concepção particular da Arqueologia que, como ciência aberta, não deve ser somente prerrogativa de especialistas, mas também colocar-se ao serviço da sociedade. Finalmente, a experiência singular e inovadora proposta em Mértola leva-nos a questionar a nossa concepção do museu e o seu papel na nossa sociedade.Les muséologies insurgées: échanges transnationauxLes sens, les temps et les destins des choses11. Sustainable cities and communities4. Quality educatio

Effectiveness of alternative measures to reduce antimicrobial usage in pig production in four European countries

Background The reduction of antimicrobial usage (AMU) is in the focus in modern pig production. The objective of this study was to assess the effectiveness of alternatives to reduce AMU at herd level. In a prospective study, 68 farrow-to-finish pig herds located in Belgium, France, Germany and Sweden were recruited on a voluntary basis to implement tailor-made intervention plans to reduce their AMU. Alternative measures included improvement of biosecurity (n = 29 herds), vaccination (n = 30), changes of feeding schemes or drinking water quality (n = 45), improved pig health and welfare care (n = 21) as well as changes in stable climate and zootechnical measures (n = 14). Herds were followed for 1 year after implementation of measures. Annual antimicrobial expenditures or treatment records, as well as disease incidence scores were collected and compared to those of the year before intervention. AMU was measured as the treatment incidence and calculated by age category, antimicrobial class and administration route. Results Compliance with the intervention plans was high (median 93%). AMU was significantly reduced following the implementation of alternative measures: in the median herd of the four countries, pigs were treated before intervention 25% of their expected lifespan (200 days from birth to slaughter) and after intervention 16%. AMU of suckling and weaned pigs were significantly reduced by 37 and 54%, respectively. The usage of polymyxins and tetracyclines was significantly reduced by 69 and 49%, respectively. AMU via feed and water, as well as parenteral AMU were significantly reduced by 46 and 36%, respectively. Herds with a higher AMU level before intervention achieved a bigger reduction. The majority of disease incidence were similar before and after intervention, with a few exceptions of disorders related to the gastro-intestinal tract in suckling pigs (decreased) and in breeding pigs (increased). Conclusion Following tailor-made implementation of alternative measures, a substantial reduction of AMU in pig production was achievable without jeopardizing animal health. The AMU reduction in the youngest age categories (suckling and weaned pigs) and the reduction of group treatments via feed and water was in line with the recent European Guidelines on the prudent use of antimicrobials in veterinary medicine

Assigning defined daily doses animal: a European multi-country experience for antimicrobial products authorized for usage in pigs

Objectives To establish a consensus defined daily dose animal (DDDA) for each active substance (AS) and administration route for porcine veterinary antimicrobial products authorized in four European countries, thus allowing cross-country quantification and comparison of antimicrobial usage data. Methods All veterinary antimicrobial products authorized for porcine use in Belgium, France, Germany and Sweden were listed for each administration route. First, separate DDDAs for each product were defined based on the recommended dosing for the main indication. Second, a consensus DDDA was established by taking the mean of the DDDAs for each product within a certain category of AS plus administration route. Results One-hundred-and-fifty-nine, 240, 281 and 50 antimicrobial products were licensed in Belgium, France, Germany and Sweden, respectively, in February 2013. Large variations were observed for dosage and treatment duration recommendations between products and between countries for the same ASs. Only 6.8% of feed/water and 29.4% of parenteral AS groups had the same recommended dosage in the four countries. Conclusions This study presents a consensus DDDA list for use in the quantification and comparison of antimicrobial consumption. Four major recommendations have been formulated: (i) urgent need for harmonization of authorization and recommended summary of product characteristics (SPC) dosages; (ii) expand the developed preliminary DDDA list to include all authorized veterinary medicinal products in all EU member states and for all (food-producing) animal species; (iii) improved accessibility of country-specific SPC data would be preferable; and (iv) statement of the ‘long-acting' duration of a product in the SP

Capturing systematically users' experience of evaluation tools for integrated AMU and AMR surveillance

Tackling antimicrobial resistance (AMR) is a goal for many countries. Integrated surveillance of antimicrobial use (AMU) and resistance is a prerequisite for effective risk mitigation. Regular evaluation of any surveillance is needed to ensure its effectiveness and efficiency. The question is how to evaluate specifically integrated surveillance for AMU and AMR. In an international network called CoEvalAMR, we have developed guidelines for selection of the most appropriate tools for such an evaluation. Moreover, we have assessed different evaluation tools as examples using a country case format and a methodology with a focus on the user's experience. This paper describes the updated methodology, which consists of a brief introduction to the case and to the tool separately. Moreover, there are 12 functional aspects and nine content themes which should be scored using a 4-tiered scale. Additionally, four Strengths, Weaknesses, Opportunities, Threats (SWOT) questions should be addressed. Results are illustrated using radar diagrams. An example of application of the updated methodology is given using the ECoSur evaluation tool. No tool can cover all evaluation aspects comprehensively in a user-friendly manner, so the choice of tool must be based upon the specific evaluation purpose. Moreover, adequate resources, time and training are needed to obtain useful outputs from the evaluation. Our updated methodology can be used by tool users to share their experience with available tools, and hereby assist other users in identifying the most suited tool for their evaluation purpose. Additionally, tool developers can get valuable information for further improvements of their tool

Evaluation of the relationship between the biosecurity status, production parameters, herd characteristics and antimicrobial usage in farrow-to-finish pig production in four EU countries

Background: High antimicrobial usage and the threat of antimicrobial resistance highlighted the need for reduced antimicrobial usage in pig production. Prevention of disease however, is necessary to obtain a reduced need for antimicrobial treatment. This study aimed at assessing possible associations between the biosecurity level, antimicrobial usage and farm and production characteristics in order to advice on best practices for a low antimicrobial usage and maximum animal health and production. A cross-sectional study was conducted in 227 farrow-to-finish pig herds in Belgium, France, Germany and Sweden between December 2012 and December 2013. Associations between biosecurity status, antimicrobial usage, and production parameters were evaluated with multivariable general linear models, according to an assumed causal pathway. Results: The results showed that higher antimicrobial usage in sows tended to be associated with higher antimicrobial usage from birth until slaughter (p = 0.06). The antimicrobial usage from birth until slaughter was positively associated with the number of pathogens vaccinated against (p < 0.01). A shorter farrowing rhythm (p < 0.01) and a younger weaning age (p = 0.06) tended to be also associated with a higher antimicrobial usage from birth until slaughter whereas a better external biosecurity (p < 0.01) was related with a lower antimicrobial usage from birth until slaughter. Conclusion: Management practices such as weaning age and biosecurity measures may be important factors indirectly impacting on antimicrobial usage. We therefore promote a holistic approach when assessing the potential to reduce the need for antimicrobial treatments

How to move towards One Health surveillance? A qualitative study exploring the factors influencing collaborations between antimicrobial resistance surveillance programmes in France

IntroductionAntimicrobial resistance (AMR) is a major public health issue, against which international organisations and governmental bodies call for integration between surveillance programmes involved in human, animal, and environmental sectors. Collaborations are the primary feature of integration and deserve to be supported. However, little is known about the factors that can foster collaborations between surveillance programmes. This study aimed to provide a better understanding of the factors for setting-up collaborations between AMR surveillance programmes in France.MethodsWe performed a qualitative study based on 36 semi-structured interviews with programmes’ coordinators and 15 with key-informant experts involved in AMR surveillance.ResultsThe implementation of collaboration between sectors was multifactorial: we identified 42 factors grouped into six categories (i.e., characteristics of the overall AMR surveillance system, features of the collaborating programme, profile of the actors involved, characteristics of the collaboration itself, broader context, and AMR research activities). Collaborations were mainly fostered by good interpersonal relationship between actors, their interest in transdisciplinary approaches and the benefits of collaboration on the programmes involved. Limited resources and the complexity of the AMR surveillance system hindered collaboration. Paradoxically, coordinators generally did not perceive collaborations as a resource-pooling tool since they generally set them up only after consolidating their own programme.DiscussionSince most factors identified were not specific to AMR, these results can be useful for other collaborative surveillance system. Ultimately, they provide a better understanding of stakeholders’ motivations and influences driving collaboration, and can help researchers and risk managers promoting a One Health approach against public health threats

Quantitative analysis of antimicrobial use on British dairy farms

Antimicrobial resistance has been reported to represent a growing threat to both human and animal health, and concerns have been raised around levels of antimicrobial usage (AMU) within the livestock industry. To provide a benchmark for dairy cattle AMU and identify factors associated with high AMU, data from a convenience sample of 358 dairy farms were analysed using both mass-based and dose-based metrics following standard methodologies proposed by the European Surveillance of Veterinary Antimicrobial Consumption project. Metrics calculated were mass (mg) of antimicrobial active ingredient per population correction unit (mg/PCU), defined daily doses (DDDvet) and defined course doses (DCDvet). AMU on dairy farms ranged from 0.36 to 97.79 mg/PCU, with a median and mean of 15.97 and 20.62 mg/PCU, respectively. Dose-based analysis ranged from 0.05 to 20.29 DDDvet, with a median and mean of 4.03 and 4.60 DDDvet, respectively. Multivariable analysis highlighted that usage of antibiotics via oral and footbath routes increased the odds of a farm being in the top quartile (>27.9 mg/PCU) of antimicrobial users. While dairy cattle farm AMU appeared to be lower than UK livestock average, there were a selection of outlying farms with extremely high AMU, with the top 25 per cent of farms contributing greater than 50 per cent of AMU by mass. Identification of these high use farms may enable targeted AMU reduction strategies and facilitate a significant reduction in overall dairy cattle AMU

Users’ perception of the OH-EpiCap evaluation tool based on its application to nine national antimicrobial resistance surveillance systems

Introduction: Antimicrobial resistance (AMR) is a One Health (OH) challenge. To achieve or maintain an effective and efficient AMR surveillance system, it is crucial to evaluate its performance in meeting the proposed objectives, while complying with resource restrictions. The OH-EpiCap tool was created to evaluate the degree of compliance of hazard surveillance activities with essential OH concepts across the following dimensions: organization, operational activities, and impact of the surveillance system. We present feedback on the application of the OH-EpiCap tool from a user's perspective, based on the use of the tool to evaluate nine national AMR surveillance systems, each with different contexts and objectives. Methods: The OH-EpiCap was assessed using the updated CoEvalAMR methodology. This methodology allows the evaluation of the content themes and functional aspects of the tool and captures the user's subjective experiences via a strengths, weaknesses, opportunities, and threats (SWOT) approach. Results and discussion: The results of the evaluation of the OH-EpiCap are presented and discussed. The OH-EpiCap is an easy-to-use tool, which can facilitate a fast macro-overview of the application of the OH concept to AMR surveillance. When used by specialists in the matter, an evaluation using OH-EpiCap can serve as a basis for the discussion of possible adaptations of AMR surveillance activities or targeting areas that may be further investigated using other evaluation tools.This study was funded by the Canadian Institutes for Health Research through the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR). The Portuguese case study was supported by funding from the European Union’s Horizon 2020 Research and Innovation programme under grant agreement No 773830: One Health European Joint Programme (MATRIX project).info:eu-repo/semantics/publishedVersio

Guidance on the Selection of Appropriate Indicators for Quantification of Antimicrobial Usage in Humans and Animals

An increasing variety of indicators of antimicrobial usage has become available in human and veterinary medicine, with no consensus on the most appropriate indicators to be used. The objective of this review is therefore to provide guidance on the selection of indicators, intended for those aiming to quantify antimicrobial usage based on sales, deliveries or reimbursement data. Depending on the study objective, different requirements apply to antimicrobial usage quantification in terms of resolution, comprehensiveness, stability over time, ability to assess exposure and comparability. If the aim is to monitor antimicrobial usage trends, it is crucial to use a robust quantification system that allows stability over time in terms of required data and provided output; to compare usage between different species or countries, comparability must be ensured between the different populations. If data are used for benchmarking, the system comprehensiveness is particularly crucial, while data collected to study the association between usage and resistance should express the exposure level and duration as a measurement of the exerted selection pressure. Antimicrobial usage is generally described as the number of technical units consumed normalized by the population at risk of being treated in a defined period. The technical units vary from number of packages to number of individuals treated daily by adding different levels of complexity such as daily dose or weight at treatment. These technical units are then related to a description of the population at risk, based either on biomass or number of individuals. Conventions and assumptions are needed for all of these calculation steps. However, there is a clear lack of standardization, resulting in poor transparency and comparability. By combining study requirements with available approaches to quantify antimicrobial usage, we provide suggestions on the most appropriate indicators and data sources to be used for a given study objective