Antimicrobial use practices of veterinary clinicians at a veterinary teaching hospital in the United States

Indiscriminate antimicrobial use (AMU) is a factor contributing to antimicrobial resistance (AMR). The objec-tives of this study were to (1) identify factors influencing AMU practices of veterinary clinicians at TheUniversity of Tennessee Veterinary Medical Center (UTVMC), (2) analyze the clinicians’preferential choices ofantimicrobials, and (3) evaluate their perceptions, opinions, and concerns regarding AMU and AMR. A total of121 clinicians were surveyed. Among the 62 respondents, culture and susceptibility test results and pressurefrom clients were the most and least important factors in their antimicrobial prescription decision-making, re-spectively. Compared to clinicians who obtained their veterinary degree from 1970 to 1999, those who grad-uated from 2000 to 2009 and 2010–2016 were 3.96 (P= 0.034) and 5.39 (P= 0.01) times less concerned aboutAMR, respectively. There is a critical need to increase awareness about judicious AMU practices among clin-icians, increase emphasis about AMR in the present veterinary curriculum, and implement antimicrobialstewardship program (AMS) in this institution. Educational activities in combination with awareness campaignsand the stewardship programs could be used to improve AMU practices at this hospital. More client education onAMR is needed

Perceptions of Tennessee cattle producers regarding the Veterinary Feed Directive

Since January 1, 2017, the United States Food and Drug Administration (FDA) has fully implemented the Veterinary Feed Directive (VFD) final rule aimed at facilitating the judicious use of medically important antimicrobials in food-producing animals. The objective of this study was to identify the common perceptions of Tennessee (TN) cattle producers regarding the VFD. We used a combination of focus groups and survey questionnaires to explore TN cattle producers’ perceptions regarding the VFD. Preliminary findings from seven focus groups of 62 producers were used in the development of the questionnaire sent both online and in-print to rest of cattle producers in TN. The beef focus group participants perceived the VFD: to be a top-down policy; to have led to unregulated access to in-feed antimicrobials; a regulation that has limited the producers’ ability to prevent disease and leading to economic losses; to negatively affect small producers; and to be affected by challenges related to prescription writing and disposal of un-used medicines. The dairy focus group participants perceived the VFD as unnecessary and burdensome, to have affected small producers, and introduced additional costs. Among the survey questionnaire respondents, 35 (15.4%) beef producers and 6 (13.6%) dairy producers respectively were not familiar at all with the VFD. Forty-eight (21.1%) beef producers and 11 (25%) dairy producers were slightly familiar with VFD. Gender was significantly associated (P = 0.02) with the beef producers’ belief in the usefulness of the VFD. Similarly, for dairy producers, herd size was significantly associated (P = 0.002) with their perceptions regarding the usefulness of the VFD. The findings of this study could inform future VFD policy review processes. More awareness regarding the VFD and its benefits is needed among both beef and dairy producers in TN

Drivers of Antimicrobial Use Practices among Tennessee Dairy Cattle Producers

Nonjudicious antimicrobial use (AMU) and inadequate antimicrobial stewardship are known modifiable factors driving the occurrence of antimicrobial resistance (AMR). A mixed methods approach using a combination of focus groups and survey questionnaires was used to explore the AMU practices of Tennessee (TN) dairy cattle producers. Specifically, the objectives of the study were to determine the following: (1) the most common drivers for using antimicrobials, (2) perceived alternatives to antimicrobials, (3) knowledge of and perceptions regarding AMR, (4) and the appropriate avenues for receiving information on prudent AMU. Two focus groups were conducted, one in July 2017 and the other in March 2018. The questionnaire was simultaneously made available to participants both in print form and online from January 26, 2018, through May 11, 2018. Twenty-three dairy producers participated in the focus groups and 45 responded to the survey. Eight (18.6%) producers never used bacterial culture and sensitivity testing (C/S) to select antimicrobials, more than half (25 producers (58.1%)) sometimes used C/S, four (9.3%) used C/S about half the time, five (11.6%) most of the time, and one (2.3%) always used C/S. The most common drivers for using antimicrobials were disease and animal welfare, pathogen surveillance, economic factors, veterinarian recommendation, producer’s experience and judgment, drug attributes, and the Veterinary Feed Directive. Good management practices, vaccination, use of immunomodulatory products, and use of appropriate technology for early disease detection were considered alternatives to AMU. Four (9.1%) dairy producers were very concerned about AMR, 27 (61.4%) moderately concerned, and 10 (22.7%) not concerned. The veterinarian was considered to be a trusted source of information on prudent AMU. Use of C/S test results for antimicrobial selection is widespread among TN dairy producers. There is a need to popularize/promote selective dry cow therapy among TN dairy producers

A survey of antimicrobial use practices of Tennessee beef producers

Background Inappropriate antimicrobial use (AMU) is a key modifiable factor that leads to the development of antimicrobial resistance (AMR). The objectives of this study were to determine the following among Tennessee beef cattle producers: (1) the opinions on factors driving AMU (2) opinions on alternatives to antimicrobials, (3) the knowledge and perceptions regarding AMU and AMR, and (4) the preferred avenues for receiving information on prudent AMU. A survey questionnaire was made available to participants both in print and online from January 26, 2018 through May 11, 2018. The questions targeted the producers’ demographics and their AMU practices; factors driving producer’s choice of antimicrobials; perceptions, opinions and concerns about AMU and AMR in cattle production. Ordinal logistic regression was used to test for associations between the captured demographic information and producers’ degree of concern about AMR. Results Overall, 231 beef producers responded to all or some of the survey questions. More than 60% of the participants mentioned that they kept up-to-date written records on antimicrobial purchases and AMU. Regarding extra-label use, 169 (84.1%) of the 201 respondents did not practice extra-label AMU. Profitability of the beef operation was a key factor influencing the decisions of many producers to use antimicrobials for disease management and prevention on their farms. Of the 228 producers who completed the question on the rating of their degree of concern about AMR, 50 (21.9%) reported that they were very concerned about AMR, 133 (58.3%) were moderately concerned, and 36 (15.8%) reported that they were not concerned about AMR. Nine producers (4%) did not rate their degree of concern about AMR because they were not familiar with what antimicrobial resistance meant. The inferential analyses suggested that younger beef producers were significantly less concerned about AMR when compared to the older ones (P = 0.019). Regarding avenues for receiving information on prudent AMU, no single medium was most preferred by all the respondents. Conclusions There is a need to promote the use of written antimicrobial treatment protocols among beef producers in Tennessee. Continued training for beef producers on infection prevention and control and prudent AMU is needed

Patterns of Antenatal Care Seeking Behavior in South East Nigeria: Exploring Relationship with Age, Education, and Socioeconomic Status

Background: Maternal and infant morbidity and mortality are major public health problems in Nigeria. Although it is well-known that appropriate antenatal care (ANC) is important in reducing maternal morbidity and mortality, there is limited information on inequities on ANC seeking pattern among the pregnant women in Nigeria. Aim: The study was designed to explore inequities due to age, education, and socioeconomic status (SES) of women of childbearing age in seeking ANC services in Nigeria. Subjects and Methods: A household survey was conducted in 10 randomly selected villages in Nnewi, Anambra State, South-East Nigeria. An interviewer-administered questionnaire was used to collect relevant data from 420 women of childbearing age from the villages. The effects of age, education, SES, and ANC seeking behavior were analyzed. Results: It was found that 61.4% (254/420) of the respondents attended ANC clinic at least 6times. Although most of the respondents sought ANC in formal health, a greater percentage utilized private hospitals/clinics more than public health facilities. Age (P < 0.01), educational level (P < 0.001), and SES (P < 0.01) had statistically significant effects on respondents’ antenatal clinic attendance and choice of facilities. The highest SES group was more likely to utilize teaching hospitals and private clinics than other SES groups. Conclusions: There were inequities due to SES, educational level, and age of respondents in the pattern of ANC seeking behavior. These inequities could negate the achievement of millennium development goals (MDGs). Interventions that would address the inequities should be developed and implemented if the health-related MDGs are to be achieved.KEY WORDS: Antenatal care, health seeking behavior, inequities, Nigeria, women of childbearing ag

Descriptive Epidemiology of Bovine Tuberculosis in Michigan (1975–2010): Lessons Learned

Despite ongoing eradication efforts, bovine tuberculosis (BTB) remains a challenge in Michigan livestock and wildlife. The objectives of this study were to (1) review the epidemiology of BTB in Michigan cattle, privately owned cervids, and wildlife between 1975 and 2010 and (2) identify important lessons learned from the review and eradication strategies. BTB information was accessed from the Michigan BTB Eradication Project agencies. Cattle herds (49), privately owned deer herds (4), and wild white-tailed deer (668) were found infected with BTB during the review period. BTB has occurred primarily in counties located at the northern portion of the state's Lower Peninsula. Currently used BTB eradication strategies have successfully controlled BTB spread. However additional changes in BTB surveillance, prevention, and eradication strategies could improve eradication efforts

Effect of Changes in Veterinary Feed Directive Regulations on Violative Antibiotic Residues in the Tissue of Food Animals from the Inspector-Generated Sampling in the United States

The presence of antibiotic residues in the tissue of food animals is a growing concern due to the adverse health effects that they can cause in humans, such as antibiotic resistance bacteria. An inspector-generated sampling (IGS) dataset from the United States National Residue Surveillance Program, collected between 2014 and 2019, was analyzed to investigate the association of changes in the veterinary feed directive (VFD) regulations on the detection of violative penicillin, tetracycline, sulfonamide, desfuroylceftiofur, tilmicosin, and florfenicol, residues in the tissue of food animals. Multivariable logistic regression models were used for analysis. While the animal production class was significantly associated with residue violations for tetracycline, having a sample collection date after the implementation of change in VFD regulations was not. However, the odds of detecting violative sulfonamide and penicillin residues in the tissue of food animals following the implementation of the change in VFD regulations were 36% and 24% lower than those collected before the implementation of the change in VFD regulations period, respectively, irrespective of animal production class. Violative desfuroylceftiofur, tilmicosin, and florfenicol residues in the tissue of food animals were not significantly associated with the implementation of changes in the VFD regulations. Further investigation of the factors that influence the presence of violative antibiotic residues in the tissue of food animals following the change in VFD regulations would lend clarity to this critical issue

Emotive Themes from Tennessee Cattle Producers Regarding Responsible Antibiotic Use

To improve judicious antimicrobial use (AMU) in food animals in the United States, all feed additives that were medically important antimicrobials were moved from over the counter to Veterinary Feed Directive in 2017. This action required a change in behavior of producers’ AMU practices. Because emotions are important aspects of behavior, several behavioral interventions have targeted people’s emotions as means of effecting change. Hence, understanding and incorporating the emotional experiences of producers towards current AMU practices can be a starting point to making future behavioral changes that could reduce the emergence of antimicrobial resistance challenge. Between June 2017 and March 2018, seven focus group meetings of Tennessee (TN) beef and dairy cattle producers were conducted to evaluate producers’ emotional views regarding responsible AMU in TN cattle. Sixty-two TN cattle producers participated and emotively expressed the following: (1) deep connections to animals in ways that improve animal and public health; (2) pride in their quality of products; (3) distress that consumers misconceive their AMU practices as indiscriminate; and (4) recommended that producers be more transparent about their AMU practices and the public improve their awareness for detecting marketers’ deceptive product labels that take advantage of public ignorance. Knowledge of these producers’ emotions would help educators target more successful behavioral change campaigns, improving stewardship in AMU practices among producers

Perceptions of Tennessee cattle producers regarding the Veterinary Feed Directive.

Since January 1, 2017, the United States Food and Drug Administration (FDA) has fully implemented the Veterinary Feed Directive (VFD) final rule aimed at facilitating the judicious use of medically important antimicrobials in food-producing animals. The objective of this study was to identify the common perceptions of Tennessee (TN) cattle producers regarding the VFD. We used a combination of focus groups and survey questionnaires to explore TN cattle producers' perceptions regarding the VFD. Preliminary findings from seven focus groups of 62 producers were used in the development of the questionnaire sent both online and in-print to rest of cattle producers in TN. The beef focus group participants perceived the VFD: to be a top-down policy; to have led to unregulated access to in-feed antimicrobials; a regulation that has limited the producers' ability to prevent disease and leading to economic losses; to negatively affect small producers; and to be affected by challenges related to prescription writing and disposal of un-used medicines. The dairy focus group participants perceived the VFD as unnecessary and burdensome, to have affected small producers, and introduced additional costs. Among the survey questionnaire respondents, 35 (15.4%) beef producers and 6 (13.6%) dairy producers respectively were not familiar at all with the VFD. Forty-eight (21.1%) beef producers and 11 (25%) dairy producers were slightly familiar with VFD. Gender was significantly associated (P = 0.02) with the beef producers' belief in the usefulness of the VFD. Similarly, for dairy producers, herd size was significantly associated (P = 0.002) with their perceptions regarding the usefulness of the VFD. The findings of this study could inform future VFD policy review processes. More awareness regarding the VFD and its benefits is needed among both beef and dairy producers in TN

Drivers of Antimicrobial Use Practices among Tennessee Dairy Cattle Producers

Nonjudicious antimicrobial use (AMU) and inadequate antimicrobial stewardship are known modifiable factors driving the occurrence of antimicrobial resistance (AMR). A mixed methods approach using a combination of focus groups and survey questionnaires was used to explore the AMU practices of Tennessee (TN) dairy cattle producers. Specifically, the objectives of the study were to determine the following: (1) the most common drivers for using antimicrobials, (2) perceived alternatives to antimicrobials, (3) knowledge of and perceptions regarding AMR, (4) and the appropriate avenues for receiving information on prudent AMU. Two focus groups were conducted, one in July 2017 and the other in March 2018. The questionnaire was simultaneously made available to participants both in print form and online from January 26, 2018, through May 11, 2018. Twenty-three dairy producers participated in the focus groups and 45 responded to the survey. Eight (18.6%) producers never used bacterial culture and sensitivity testing (C/S) to select antimicrobials, more than half (25 producers (58.1%)) sometimes used C/S, four (9.3%) used C/S about half the time, five (11.6%) most of the time, and one (2.3%) always used C/S. The most common drivers for using antimicrobials were disease and animal welfare, pathogen surveillance, economic factors, veterinarian recommendation, producer’s experience and judgment, drug attributes, and the Veterinary Feed Directive. Good management practices, vaccination, use of immunomodulatory products, and use of appropriate technology for early disease detection were considered alternatives to AMU. Four (9.1%) dairy producers were very concerned about AMR, 27 (61.4%) moderately concerned, and 10 (22.7%) not concerned. The veterinarian was considered to be a trusted source of information on prudent AMU. Use of C/S test results for antimicrobial selection is widespread among TN dairy producers. There is a need to popularize/promote selective dry cow therapy among TN dairy producers