antibiotic consumption and resistance in ......2018/10/29 · antibiotic consumption and resistance...
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ANTIBIOTIC CONSUMPTION AND RESISTANCE
IN VETERINARY MEDICINE IN BELGIUM
Fabiana Dal Pozzo, DVM, PhD
AntiMicrobial Consumption and Resistance in Animals - AMCRA
Spanish Agency of Medicines and Medical Devices, Madrid, Spain
29 October 2018
Center of expertise
Antimicrobial Consumption and Resistance in Animals
TIMELINE
1999: BAPCOC and the working group in veterinary medicine
2007 and 2009: First Flemish and Walloon reports about AMR in veterinary pathogens
2010: First BelVet-SAC report on veterinary AMU in Belgium
2011: Start of national surveillance programs on AMR in major livestock species using indicator bacteria
2012: Creation of AMCRA
Center of expertise
Antimicrobial Consumption and Resistance in Animals
AMU – SALES DATA BELGIUM
Center of expertise
Antimicrobial Consumption and Resistance in Animals
Mission
• Tackle antibiotic resistance • Preserve human and animal
health and welfare • Promote rational reduction of
antibiotic use and sustainable antibiotic policy in veterinary medicine
AntiMicrobial Consumption and Resistance in Animals
Activities
• Analyse • Communicate • Awareness raising
Recommendations
Center of expertise
Antimicrobial Consumption and Resistance in Animals
Staff: advices and communications
STEERING COMMITTEE
Advisory board
Technical committees
Staff: scientific analyses
BOARD OF DIRECTORS
Center of expertise
Antimicrobial Consumption and Resistance in Animals
TIMELINE
2012-2014: first AMCRA recommandations
Center of expertise
Antimicrobial Consumption and Resistance in Animals
AMCRA VADE MECUM
• Guidelines for veterinarians in antibiotic therapy
• For the most important food-producing and companion animal species – organized per indication
• Paper format in 2013
• Second edition, electronic format in 2016
Center of expertise
Antimicrobial Consumption and Resistance in Animals
AMCRA VADE MECUM
Prophylactic 2 months
stock at the farm level
Pathogen identification
Antibiotic sensitivity test
No Yes By preference By preference
No Yes Condition By preference
No No Condition Condition
1st – 2nd – 3rd option Based on susceptibility/resistance, pharmacokinetic, pharmacodynamic
• Per species and indication: most frequent bacterial agents, general information on the disease, preventive measures, prophylaxis
• Antibiotic therapy:
Color codes used to classify the molecules in function of the importance/priority in human and veterinary medicine (WHO and OIE classifications)
9 9
9
Center of expertise
Antimicrobial Consumption and Resistance in Animals
TIMELINE
2012-2014: AMCRA guidelines for prudent use,
numerous published advices ……
2014: AMCRA Vision 2020
Center of expertise
Antimicrobial Consumption and Resistance in Animals
AMCRA 2020: ACTION PLAN
1. 50% total antibiotic use by 2020
2. 75% critical antibiotics by 2020
3. 50% with antibiotics feed medicated by 2017
4. A global data collection system by 2016
5. A plan for each farm
6. Benchmarking of farmers and veterinarians
7. No antibiotics for prophylaxis, promotion of alternatives
8. Awareness-raising, repeatedly
9. Transparency and monitoring of suppliers and users
10. Surveillance of antibiotic resistance
Reduction targets
Operational targets
11
Center of expertise
Antimicrobial Consumption and Resistance in Animals
TIMELINE
2012-2014: AMCRA guidelines for prudent use,
numerous published advices ……
2014: AMCRA Vision 2020
2014:
Center of expertise
Antimicrobial Consumption and Resistance in Animals
AMCRA DATA ANALYSIS
Center of expertise
Antimicrobial Consumption and Resistance in Animals
Monthly use
Benchmarking
Evolution
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Antimicrobial Consumption and Resistance in Animals
www.e-vademecum.be
Center of expertise
Antimicrobial Consumption and Resistance in Animals
Use of colistin
Use of zinc oxide
Center of expertise
Antimicrobial Consumption and Resistance in Animals
EVOLUTION AMU AT FARM LEVEL PIGS
2014 2015 2016 2017 2017-2014
BDAB-R_KG-varken 31,1 30,4 27,5 24,7 - 20,6%
P50: -65,6% P50: -27,9%
P50: -18,9% P50: -36,8%
Fattening pigs Sows/bears
Weaning pigs Suckling piglets
www.amcra.be
Center of expertise
Antimicrobial Consumption and Resistance in Animals
www.aacting.org
Center of expertise
Antimicrobial Consumption and Resistance in Animals
AMU AT FARM LEVEL IN BELGIUM
• 1 apr 2017 – 31 march 2018
PIG: 75,1% – 81,5% mean: 79,0%
VEAL: 9,0% – 14,5% mean: 11,3%
POULTRY: 8,6% – 11,1% mean: 9,7%
www.amcra.be
Center of expertise
Antimicrobial Consumption and Resistance in Animals
Totaal: 62,731 39,473 37,567 26,449 11,170 7,211 3,289 1,991 1,438 1,431 0,828 0,382 0,249 0,099 0,006 0,001
AMU AT FARM LEVEL IN BELGIUM
BROIR VECLF PIGB PIGLW PIGF PIGLU
Cefalosporines 3G/4G 0,003 0,115 0,143 0,048 0,098
Fluoroquinolones 17,635 2,908 1,050 0,869 0,218 0,034
0
5
10
15
20
Miljoen dagdosissen rode producten per diercategorie
Market authorization for Coryza Colibacillosis Mycoplasmosis Pasteurellosis
Million of daily doses of critical molecules per animal type
Center of expertise
Antimicrobial Consumption and Resistance in Animals
2016: ANTIBIOTIC COVENANT
•Action Plan defined by AMCRA, authorities and
stakeholders in a Covenant “Covenant between the Federal Government and all relevant sector partners regarding the reduction in the use of antibiotics in the animal sector”
www.amcra.be
Center of expertise
Antimicrobial Consumption and Resistance in Animals
ROYAL DECREE OF JULY 21 2016: CONDITIONS OF USE OF CRITICAL MOLECULES IN FOOD-PRODUCING ANIMALS
ROYAL DECREE OF JANUARY 31 2017: COMPULSORY REGISTRATION OF ANTIMICROBIALS AT FARM LEVEL
14/11/2018 23 Center of expertise
Antimicrobial Consumption and Resistance in Animals
EXAMPLES OF ACTIONS UNDERTAKEN WITHIN THE ANTIBIOTIC COVENANT
• Pharmaceutical industry Training and seminaries for
employees Awareness raising
communications for farmers and veterinarians
• Private quality schemes Compulsory registration of AMU
at farm level Implementation of the herd
health plan Follow-up of farmers in function
of the AMU
• Animal health associations Laboratory diagnosis and report
of AMR in animal pathogens
• Medicated feed industry Electronic prescription only Medicated feed only from one
veterinarian Benchmarking of members
• Agricultural organizations Participation to private data
collection systems Trainings Awareness raising
communications
• Veterinarians organizations Trainings Awareness raising
communications
Center of expertise
Antimicrobial Consumption and Resistance in Animals
AMCRA: AWARENESS RAISING
24 24 24 24
Center of expertise
Antimicrobial Consumption and Resistance in Animals
AMCRA YOUTUBE CHANNEL TV-SPOTS
Center of expertise
Antimicrobial Consumption and Resistance in Animals
WWW.AMCRA.BE
• Informative about AMR for a broad public
•Gathering information about AMU and AMR
•Awareness raising with specific tools for different animal sectors
• Link to the e-vademecum
•Methodology about quantification of AMU at farm level
• Links to national and international organisations and reports
Center of expertise
Antimicrobial Consumption and Resistance in Animals
EVOLUTION OF PREMIX CONSUMPTION IN REFERENCE TO 2011
0,0
5,0
10,0
15,0
20,0
25,0
30,0
2011 2012 2013 2014 2015 2016 2017
realisation goal
2011 -> 2017: -66,6%
mg
acti
ve s
ub
stan
ce/k
g b
iom
ass
www.amcra.be
Center of expertise
Antimicrobial Consumption and Resistance in Animals
EVOLUTION TOTAL CONSUMPTION OF CRITICAL IMPORTANT ANTIBIOTICS
IN REFERENCE TO 2011
0,0000
0,0005
0,0010
0,0015
0,0020
0,0025
0,0030
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
realisation goal
2011 -> 2017: -84,4%
Fluoroquinolones, cephalosporins of 3rd and 4th generation
mg
acti
ve s
ub
stan
ce/k
g b
iom
ass
www.amcra.be
Center of expertise
Antimicrobial Consumption and Resistance in Animals
EVOLUTION TOTAL CONSUMPTION IN REFERENCE TO 2011
0,0
20,0
40,0
60,0
80,0
100,0
120,0
140,0
160,0
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
realisation goal
2011 -> 2017: -25,9%
mg
acti
ve s
ub
stan
ce/k
g b
iom
ass
www.amcra.be
Center of expertise
Antimicrobial Consumption and Resistance in Animals
EVOLUTION AMR IN INDICATOR ESCHERICHIA COLI IN FOOD-PRODUCING ANIMALS
Pre
vale
nce
of
resi
stan
ce (
%)
Pre
vale
nce
of
resi
stan
ce (
%)
Resistance to fluoroquinolones (%)
Veal calves Beef cattle Broilers Fattening pigs
Veal calves Beef cattle Broilers Fattening pigs
Resistance to cephalosporins of 3rd generation (%)
www.amcra.be
Center of expertise
Antimicrobial Consumption and Resistance in Animals
EVOLUTION MDR IN INDICATOR ESCHERICHIA COLI IN FOOD-PRODUCING ANIMALS
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 2012 2013 2014 2015 2016 2017
Broilers
0 1 2 3 ≥ 3
0%
20%
40%
60%
80%
100%
2011 2012 2013 2014 2015 2016 2017
Beef cattle
0 1 2 3 ≥ 3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 2012 2013 2014 2015 2016 2017
Veal calves
0 1 2 3 ≥ 3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 2012 2013 2014 2015 2016 2017
Fattening pigs
0 1 2 3 ≥ 3
Center of expertise
Antimicrobial Consumption and Resistance in Animals
•Current BAPCOC & AMCRA action plans end in 2019
and 2020
•Opportunity to implement a national One Health AMR
Action Plan with interactions between human health,
animal health and the environment
PERSPECTIVES ONE HEALTH APPROACH
Center of expertise
Antimicrobial Consumption and Resistance in Animals
www.amcra.be [email protected]