Coaching aids in reduction of antimicrobial use and resistance in Belgian and Dutch pig farms: I-4-1-health project results

Abstract

Background and Objectives Reduction of antimicrobial use (AMU) is the first step in curbing antimicrobial resistance (AMR). However, influencing farmer behavior is challenging. In the i-4-1-health project in the Dutch(NL)-Belgian(BE) crossborder region, 29 pig farms were coached to reduce AMU and study effects on AMR. To assess farmer’s attitude and behavior towards AMU the ADKAR coaching tool, scoring for Awareness, Desire, Knowledge, Ability and Reinforcement was adjusted to use for farmers. Material and Methods Four farm visits were conducted on 29 farms with high AMU over 18 months. Biosecurity (BioCheck-UGent), technical performance, AMU (treatment incidence/100 days) and AMR were assessed. AMR was determined in Enterobacteriaceae from fecal samples (FecalSwab, Copan Italy) on selective agar plates (ChromID ESBL/CARBA/OXA-48, bioMérieux; McC-ciprofloxacin 2 mg/L, in house). Coaching started four weeks after the first visit, based on a tailor-made action plan. The farms were revisited twice to evaluate implementation and reinforce compliance and collect samples. MLE models with random farm and fixed country and time effects were used. Results The initial AMU in weaned pigs was 65% lower for NL versus BE farms and decreased with 53% in BE, and 7% for NL herds. Biosecurity scores significantly improved in BE farms, but overall were not significantly associated with AMU course on farms. High scores for farmer’s Awareness, Desire and Knowledge on AMU were significantly associated with lowering AMU. Ciprofloxacin-resistant (Cipro-R) and ESBL-producing Enterobacteriaceae (ESBL-E) were found more on BE compared to NL farms. No Carbapenem resistance was detected. A significant decrease in Cipro-R was observed over time, but not for ESBL-E. 36% of Cipro-R samples tested ESBL+, in contrast to 16% of Cipro-S samples (adjusted OR=2.4). Discussion and Conclusion Coaching towards improvemed infection control and prudent AMU resulted in clear reduction of AMU and the project provided insights in AMR on pig farms.