IS-03 Practical Aspects of Antibiotic Stewardship in Animal Production

Antimicrobial resistance (AMR) is emerging and is a threat for human and animal health. This increasing resistance results into treatment failures and increased mortality in humans and animals. If there is no action to reduce antimicrobial use (AMU), it is forecasted that the number of people dying due to AMR will increase considerably in the near future. AMU in animals poses a potential risk for public health as it contributes to the selection and spread of AMR which can disseminate to humans. Therefore, at global level WHO, FAO and OIE combined efforts in a such called One Health approach to minimize the public health impact of AMR associated with AMU in farm animals. The Global Action Plan on antimicrobial resistance (GAP) has been adopted by the World Health Assembly in 2015. This plan contains five strategic objectives. WHO urged all member states to develop a National Action Plan in line with the five objectives of the GAP, and with a One Health approach. Indonesia has submitted the National Action Plan on Antimicrobial Resistance 2017-2019 in the Library of National Action Plans of WHO.Although it is not clear to what level AMU in animal production contributes to the AMR problem humans, there is a worldwide urge to reduce AMU in animal production to a minimum to protect human health. The basis of this so-called ‘antimicrobial stewardship’ is focusing on (preventive) measures which enable animals to remain healthy and thus take away the need for antimicrobial treatment. Another pillar of stewardship is limiting and strictly regulating the use of so-called ‘’critically important antimicrobials for human medicine’’, like fluoroquinolones. It can be difficult to change AMU practices which have become habits for farmers and veterinarians; therefore specific triggers are required. In the Netherlands the total therapeutic AMU (in mass sold) in farm animals doubled between 1990 and 2007; parallel to the EU-ban of antimicrobial growth promotors which were completely phased out by 2006. From 2005 onwards, several events triggered a series of measures and initiatives to reduce AMU in livestock with almost 70%. This reduction was followed by reduced AMR levels in livestock. Some key success factors were: clear reduction targets defined by the government, having full transparency on antimicrobial prescription and usage, the existence of a surveillance system for AMR, and a close collaboration of all stakeholders and a shared goal. Although specific contexts differ between countries and production systems, tailored approaches taking into account specific contexts and stakeholders can be effective in responsible use of antimicrobials

IS-03 Practical Aspects of Antibiotic Stewardship in Animal Production

Antimicrobial resistance (AMR) is emerging and is a threat for human and animal health. This increasing resistance results into treatment failures and increased mortality in humans and animals. If there is no action to reduce antimicrobial use (AMU), it is forecasted that the number of people dying due to AMR will increase considerably in the near future. AMU in animals poses a potential risk for public health as it contributes to the selection and spread of AMR which can disseminate to humans. Therefore, at global level WHO, FAO and OIE combined efforts in a such called One Health approach to minimize the public health impact of AMR associated with AMU in farm animals. The Global Action Plan on antimicrobial resistance (GAP) has been adopted by the World Health Assembly in 2015. This plan contains five strategic objectives. WHO urged all member states to develop a National Action Plan in line with the five objectives of the GAP, and with a One Health approach. Indonesia has submitted the National Action Plan on Antimicrobial Resistance 2017-2019 in the Library of National Action Plans of WHO.Although it is not clear to what level AMU in animal production contributes to the AMR problem humans, there is a worldwide urge to reduce AMU in animal production to a minimum to protect human health. The basis of this so-called ‘antimicrobial stewardship’ is focusing on (preventive) measures which enable animals to remain healthy and thus take away the need for antimicrobial treatment. Another pillar of stewardship is limiting and strictly regulating the use of so-called ‘’critically important antimicrobials for human medicine’’, like fluoroquinolones. It can be difficult to change AMU practices which have become habits for farmers and veterinarians; therefore specific triggers are required. In the Netherlands the total therapeutic AMU (in mass sold) in farm animals doubled between 1990 and 2007; parallel to the EU-ban of antimicrobial growth promotors which were completely phased out by 2006. From 2005 onwards, several events triggered a series of measures and initiatives to reduce AMU in livestock with almost 70%. This reduction was followed by reduced AMR levels in livestock. Some key success factors were: clear reduction targets defined by the government, having full transparency on antimicrobial prescription and usage, the existence of a surveillance system for AMR, and a close collaboration of all stakeholders and a shared goal. Although specific contexts differ between countries and production systems, tailored approaches taking into account specific contexts and stakeholders can be effective in responsible use of antimicrobials

The performance of two-implant overdentures in the atrophic maxilla:a case series with 1-year follow-up

PURPOSE: To assess the implant and prosthesis survival rates, the clinical, radiographical and patient-related outcome measures, and the masticatory performance of maxillary overdentures supported by two implants in patients with an atrophic maxilla. METHODS: In this case series, 15 consecutive patients who were eligible for maxillary implant overdenture therapy, but who had insufficient bone volume to place at least four implants and were unwilling to be treated with reconstructive surgery were asked to participate. After giving consent, participants received two implants in the maxilla under local anaesthesia. After 3 months of osseointegration, a maxillary overdenture with palatal coverage and solitary attachments was fabricated. Implant and overdenture survival, marginal bone level change, clinical outcome measures, masticatory performance and patient-related outcomes were evaluated at baseline and 1 year after overdenture placement. RESULTS: Fourteen out of 15 participants completed the follow-up period of 12 months. Implant and overdenture survival rate were 89.3% and 85.7%, respectively. Change in marginal bone level (− 0.5 ± 0.7 mm), change in probing depth (0.0 ± 1.0 mm), and clinical outcomes were favourable. Masticatory performance and patient-related outcomes improved significantly compared to baseline. Complications were minimal. CONCLUSIONS: Within the limitations of this study, it can be concluded that patients with extreme resorption of the maxilla that are unwilling to be treated with reconstructive surgery, benefit from two-implant maxillary overdentures retained by solitary attachments in terms of improved masticatory functioning and denture satisfaction. However, they have relatively high risk of implant loss. Trial registration: UMCG Trial Register (RR201900060), registered 22 January 2019. GRAPHICAL ABSTRACT: [Image: see text

Why Veterinarians (Do Not) Adhere to the Clinical Practice Streptococcus suis in Weaned Pigs Guideline: A Qualitative Study

The Netherlands has been very successful in the last decade in reducing antimicrobial use in animals. On about a quarter of farms, antimicrobial use in weaned pigs remains relatively high. As Streptococcus suis ( S. suis) infections are responsible for a high consumption of antimicrobials, a specific veterinary guideline to control S. suis was developed, but seemed to be poorly adopted by veterinarians. Guided by the theoretical domains framework, the aim of this study was to identify determinants influencing veterinarians' adherence to this guideline. We interviewed 13 pig veterinarians. Interviewees described multiple approaches to managing S. suis problems and adherence to the guideline. Mentioned determinants could be categorized into 12 theoretical domains. The following six domains were mentioned in all interviews: knowledge, skills, beliefs about capabilities, beliefs about consequences, social influences, and environmental context and resources. The insights derived from this study are relevant for understanding factors influencing veterinarians' adoption of scientific evidence and guidelines and can be used to develop evidence-based implementation strategies for veterinary guidelines

Using Implementation Mapping to develop an intervention program to support veterinarians' adherence to the guideline on Streptococcus suis clinical practice in weaned pigs

Streptococcus suis (S. suis) infections in weaned pigs are common and responsible for a high consumption of antimicrobials, and their presence is assumed to be multi-factorial. A specific evidence-based veterinary guideline to support the control of S. suis in weaned pigs was developed for veterinary practitioners in the Netherlands in 2014. Adherence to the S. suis clinical practice guideline helps veterinary practitioners to prevent and control the disease in a systematical approach and thereby improve antimicrobial stewardship and contribute to the prevention of antimicrobial resistance in animals and humans. The impact of such a clinical practice guideline on (animal) disease management depends not only on its content, but also largely on the extent to which practitioners adhere to the clinical guideline in practice. When the S. suis guideline was published, no specific activities were undertaken to support veterinarians' uptake and implementation, thereby contributing to suboptimal adherence in clinical practice. As the S. suis guideline was comprehensively written by veterinary experts following an evidence-based approach, our aim was not to judge the (scientific) quality of the guideline but to study the possibility to improve the currently low adherence of this guideline in veterinary practice. This paper describes the systematic development, using Implementation Mapping, of a theory-based intervention program to support swine veterinarians' adherence to the S. suis guideline. The knowledge, skills, beliefs about capabilities, and beliefs about consequences domains are addressed in the program, which includes seven evidence-based methods (modelling, tailoring, feedback, discussion, persuasive communication, active learning, and self-monitoring) for use in program activities such as a peer-learning meeting and an e-learning module. The intervention program has been developed for practicing swine veterinarians, lasts eight months, and is evaluated through a stepped-wedge design. The Implementation Mapping approach ensured that all relevant adopters and implementers were involved, and that outcomes, determinants (influencing factors), and objectives were systematically discussed

Regulation of the zebrafish goosecoid promoter by mesoderm inducing factors and Xwnt1

Goosecoid is a homeobox gene that is expressed as an immediate early response to mesoderm induction by activin. We have investigated the induction of the zebrafish goosecoid promoter by the mesoderm inducing factors activin and basic fibroblast growth factor (bFGF) in dissociated zebrafish blastula cells, as well as by different wnts in intact embryos. Activin induces promoter activity, while bFGF shows a cooperative effect with activin. We have identified two enhancer elements that are functional in the induction of the goosecoid promoter. A distal element confers activin responsiveness to a heterologous promoter in the absence of de novo protein synthesis, whereas a proximal element responds only to a combination of activin and bFGE Deletion experiments show that both elements are important for full induction by activin. Nuclear proteins that bind to these elements are expressed in blastula embryos, and competition experiments show that an octamer site in the activin responsive distal element is specifically bound, suggesting a role for an octamer binding factor in the regulation of goosecoid expression by activin. Experiments in intact embryos reveal that the proximal element contains sequences that respond to Xwnt1, but not to Xwnt5c. Furthermore, we show that the distal element is active in a confined dorsal domain in embryos and responds to overexpression of activin in vivo, as well as to dorsalization by lithium. The distal element is to our knowledge the first enhancer element identified that mediates the induction of a mesodermal gene by activin

Chlamydia trachomatis Test-of-Cure Cannot Be Based on a Single Highly Sensitive Laboratory Test Taken at Least 3 Weeks after Treatment

Current test-of-cure practice in patients with Chlamydia trachomatis (Ct) infection is to confirm cure with a single test taken at least 3 weeks after treatment. Effectiveness of single-time-point testing however lacks a scientific evidence basis and the high sensitivity of laboratory assays nowadays in use for this purpose may compromise the clinical significance of their results. Prospectively following 59 treated Ct infections, administering care as usual, the presence of Ct plasmid DNA and rRNA was systematically assessed by multiple time-sequential measurements, i.e. on 18 samples taken per patient during 8 weeks following treatment with a single dose of 1000 mg Azythromycin. A high proportion (42%) of Ct infections tested positive on at least one of the samples taken after 3 weeks. Patients' test results showed substantial inter-individual and intra-individual variation over time and by type of NAAT used. We demonstrated frequent intermittent positive patterns in Ct test results over time, and strongly argue against current test-of-cure practice

Immediate implant placement in edentulous oral cancer patients: a long-term retrospective analysis of 207 patients

Although the functional benefits of implants in the rehabilitation of edentulous cancer patients are well-known, most studies report on postponed implant placement. The outcome of immediate implant placement regarding successful rehabilitation, implant loading and survival is unclear. Two hundred and seven edentulous oral cancer patients that received implants during ablative surgery at the Radboud University Medical Centre between 2000 and 2011 were included. Data regarding the oncological treatment, implant placement, follow-up and prosthodontic rehabilitation were recorded retrospectively with a follow-up period of 5–17 years. Functioning implant-retained dentures were made in 73.9% of the patients. Of the surviving patients, 81.9% had functioning dentures after 2 years and 86.3% after 10 years. Patients with ASA score 1 and younger patients were rehabilitated more frequently. The median time of functioning denture placement was 336 days after surgery, with a negative influence of postoperative radiotherapy. Implant survival was 90.7%, and was lower when the implant was placed in a jaw involved in the tumour. Immediate implant placement during oral cancer surgery led to a high number of edentulous patients rehabilitated with implant-retained dentures, which are placed at an early time

The course of swallowing problems in the first 2 years after diagnosis of head and neck cancer

Introduction: Head and neck cancer (HNC) and its treatment often negatively impact swallowing function. The aim was to investigate the course of patient-reported swallowing problems from diagnosis to 3, 6, 12, and 24 months after treatment, in relation to demographic, clinical, and lifestyle factors. Methods: Data were used of the Netherlands Quality of Life and Biomedical Cohort Study in head and neck cancer research (NET-QUBIC). The primary outcome measures were the subscales of the Swallowing Quality of Life Questionnaire (SWAL-QOL). Linear mixed-effects models (LMM) were conducted to investigate changes over time and associations with patient, clinical, and lifestyle parameters as assessed at baseline. Results: Data were available of 603 patients. There was a significant change over time on all subscales. Before treatment, 53% of patients reported swallowing problems. This number increased to 70% at M3 and decreased to 59% at M6, 50% at M12, and 48% at M24. Swallowing problems (i.e., longer eating duration) were more pronounced in the case of female, current smoking, weight loss prior to treatment, and stage III or IV tumor, and were more prevalent at 3 to 6 months after treatment. Especially patients with an oropharynx and oral cavity tumor, and patients receiving (C)RT following surgery or CRT only showed a longer eating duration after treatment, which did not return to baseline levels. Conclusion: Half of the patients with HNC report swallowing problems before treatment. Eating duration was associated with sex, smoking, weight loss, tumor site and stage, and treatment modality, and was more pronounced 3 to 6 months after treatment