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Source: https://www.cidrap.umn.edu/news-pers...an-may-27-2020
Stewardship / Resistance Scan for May 27, 2020
Post-surgical antibiotics; UK report on food-animal antibiotics; Antibiotics in dairy farming
Filed Under:
Antimicrobial Stewardship
Review supports WHO guidance against post-surgery antibiotics
A review and meta-analysis of randomized controlled trials (RCTs) has found no conclusive evidence that post-operative antibiotic prophylaxis reduces incidence of surgical-site infections, a finding that supports the World Health Organization's (WHO's) recommendation for discontinuation of the practice, researchers reported yesterday in The Lancet Infectious Diseases.
The aim of the review, which was conducted by Dutch, Swiss, and US researchers, was to update and reassess the evidence upon which the WHO's 2016 recommendation was based. The WHO's Global Guidelines for the Prevention of Surgical Site Infections, put together by a panel of 20 experts in infection control, recommended that prophylactic antibiotics be administered 2 hours before incision or during the surgery to prevent infections, but not after, based on a lack of evidence that post-surgery antibiotics reduce infections. Despite this advice, the practice remains common worldwide, with antibiotics frequently continued for days after surgery.
The reviewers identified 83 relevant RCTs, with 52 (involving 19,273 participants) comparing post-operative continuation of antibiotics for 1 to 5 days with immediate discontinuation. The initial meta-analysis of those 52 RCTs showed an indication of a benefit of post-operative continuation of antibiotics in preventing surgical-site infection (relative risk [RR], 0.89; 95% confidence interval [CI], 0.79 to 1.00).
But further analysis showed that compliance with best practice standards for surgical antibiotic prophylaxis, such as timely administration of the first dose, modified the results. In the 27 trials that were not compliant with best-practice standards, continuation of antibiotic prophylaxis after surgery was associated with a reduction in surgical-site infections compared with immediate discontinuation (RR, 0.79; 95% CI, 0.67 to 0.94). But in the 24 studies that did meet best practice standards, no benefit was found (RR, 1.04; 95% CI, 0.85 to 1.27).
The meta-analysis also found that, when costs and adverse events were reported, post-operative continuation of antibiotics appeared to increase costs and lead to more adverse events.
"Our findings support WHO recommendations against the practice of continuing surgical antibiotic prophylaxis postoperatively," the authors concluded. "Considering the associated adverse effects—in particular, antimicrobial resistance—this prevalent practice has no basis."
May 26 Lancet Infect Dis abstract
British report highlights high antibiotic use in US livestock, trade concerns
A new report shows antibiotic use in food-producing animals is much higher in the United States than the United Kingdom, and warns that a potential US trade deal with Britain risks reversing the progress that British farmers have made in reducing antibiotic use in livestock.
Using data from the US Food and Drug Administration, the United Kingdom's Veterinary Medicines Directorate, and the European Medicines Authority, the UK-based Alliance to Save Our Antibiotics compared US and UK antibiotic use by farm-animal species and found that total antibiotic use in US farm animals is more than five times higher than in UK farm animals, with US cattle receiving eight to nine times as many antibiotics as UK cattle. The comparison takes into account the size of the different livestock populations.
The comparison was made to highlight how the United Kingdom's pending exit from the European Union could threaten food safety and animal welfare standards. With the government planning to cut tariffs on importation of meat from countries with which it does not currently have a free trade deal, that could mean a significant increase in meat and dairy imports from the United States, which has less restrictive policies on the use of antibiotics and growth promoters in animals than the UK or the EU. Most imported meat in Britain currently comes from the EU.
"US farmers continue to massively overuse antibiotics despite increasing warnings about the threat this poses to human health," Alliance scientific advisor C?il?n Nunan said in a press release. "British consumers should be concerned if a UK-US trade deal results in increasing imports of US meat and dairy produced in this way, as we know that antibiotic-resistant bacteria can pass to humans through the food chain."
According to the report, US livestock industry representatives and lobbyists have insisted that in any trade deal, UK farmers should adopt US standards. Among the many concerns expressed is that the US government is opposed to banning the use of antibiotics to prevent disease in livestock, as has been recommended by the WHO. An EU ban on preventive antibiotic treatment will go into effect in 2022
The report notes that British farmers cut their antibiotic use by 50% from 2014 through 2018, while antibiotic use on US farms increased by 9% in 2018 after several years of decline.
May 27 Alliance to Save Our Antibiotics report
May 27 Alliance to Save Our Antibiotics press release
Study: Conventional, organic dairy farmers differ on antibiotic use, resistance
A study exploring perceptions about antibiotic use and resistance in dairy farming suggests conventional and organic farmers have differing views that align with their respective business practices, researchers from Cornell University report today in PLOS One.
For the study, the researchers conducted semi-structured interviews with farmers representing 20 dairy farms in New York state—15 conventional and 5 US Department of Agriculture–certified organic farmers—and used thematic analysis to compare and contrast the farmers' characterization of their beliefs, values, and concerns. Among the themes they found was that, for conventional farmers, concerns about antibiotic use and resistance mainly related to the near-term impact on their livestock should antibiotics lose their efficacy, rather than the potential impact on human health. Conventional farmers also believed their antibiotic use was judicious, even if it didn't always fit the definition of judicious use, and felt that further regulation on antibiotic use could threaten their cattle's health.
In contrast, organic dairy farmers expressed more concern about antibiotic resistance, frequently framed it as a public health issue, and exhibited a more detailed understanding of judicious antibiotic use. Both groups had similar doubts about shared concerns about the impact of marketing and consumer perceptions on dairy, and emphasized herd health management as an effective preventive tool that could limit the need to antibiotics.
The authors of the study say the findings provide some targets for additional research and educational interventions.
"Given farmers' interest in disease prevention, they would likely be amenable to interventions focused on improving the efficiency and financial viability of their operation through improved herd health practices, including optimal antibiotic use/best practices," they write. "Such interventions would likely be best delivered by a veterinarian given farmers' trust of them."
May 27 PLOS One study
Stewardship / Resistance Scan for May 27, 2020
Post-surgical antibiotics; UK report on food-animal antibiotics; Antibiotics in dairy farming
Filed Under:
Antimicrobial Stewardship
Review supports WHO guidance against post-surgery antibiotics
A review and meta-analysis of randomized controlled trials (RCTs) has found no conclusive evidence that post-operative antibiotic prophylaxis reduces incidence of surgical-site infections, a finding that supports the World Health Organization's (WHO's) recommendation for discontinuation of the practice, researchers reported yesterday in The Lancet Infectious Diseases.
The aim of the review, which was conducted by Dutch, Swiss, and US researchers, was to update and reassess the evidence upon which the WHO's 2016 recommendation was based. The WHO's Global Guidelines for the Prevention of Surgical Site Infections, put together by a panel of 20 experts in infection control, recommended that prophylactic antibiotics be administered 2 hours before incision or during the surgery to prevent infections, but not after, based on a lack of evidence that post-surgery antibiotics reduce infections. Despite this advice, the practice remains common worldwide, with antibiotics frequently continued for days after surgery.
The reviewers identified 83 relevant RCTs, with 52 (involving 19,273 participants) comparing post-operative continuation of antibiotics for 1 to 5 days with immediate discontinuation. The initial meta-analysis of those 52 RCTs showed an indication of a benefit of post-operative continuation of antibiotics in preventing surgical-site infection (relative risk [RR], 0.89; 95% confidence interval [CI], 0.79 to 1.00).
But further analysis showed that compliance with best practice standards for surgical antibiotic prophylaxis, such as timely administration of the first dose, modified the results. In the 27 trials that were not compliant with best-practice standards, continuation of antibiotic prophylaxis after surgery was associated with a reduction in surgical-site infections compared with immediate discontinuation (RR, 0.79; 95% CI, 0.67 to 0.94). But in the 24 studies that did meet best practice standards, no benefit was found (RR, 1.04; 95% CI, 0.85 to 1.27).
The meta-analysis also found that, when costs and adverse events were reported, post-operative continuation of antibiotics appeared to increase costs and lead to more adverse events.
"Our findings support WHO recommendations against the practice of continuing surgical antibiotic prophylaxis postoperatively," the authors concluded. "Considering the associated adverse effects—in particular, antimicrobial resistance—this prevalent practice has no basis."
May 26 Lancet Infect Dis abstract
British report highlights high antibiotic use in US livestock, trade concerns
A new report shows antibiotic use in food-producing animals is much higher in the United States than the United Kingdom, and warns that a potential US trade deal with Britain risks reversing the progress that British farmers have made in reducing antibiotic use in livestock.
Using data from the US Food and Drug Administration, the United Kingdom's Veterinary Medicines Directorate, and the European Medicines Authority, the UK-based Alliance to Save Our Antibiotics compared US and UK antibiotic use by farm-animal species and found that total antibiotic use in US farm animals is more than five times higher than in UK farm animals, with US cattle receiving eight to nine times as many antibiotics as UK cattle. The comparison takes into account the size of the different livestock populations.
The comparison was made to highlight how the United Kingdom's pending exit from the European Union could threaten food safety and animal welfare standards. With the government planning to cut tariffs on importation of meat from countries with which it does not currently have a free trade deal, that could mean a significant increase in meat and dairy imports from the United States, which has less restrictive policies on the use of antibiotics and growth promoters in animals than the UK or the EU. Most imported meat in Britain currently comes from the EU.
"US farmers continue to massively overuse antibiotics despite increasing warnings about the threat this poses to human health," Alliance scientific advisor C?il?n Nunan said in a press release. "British consumers should be concerned if a UK-US trade deal results in increasing imports of US meat and dairy produced in this way, as we know that antibiotic-resistant bacteria can pass to humans through the food chain."
According to the report, US livestock industry representatives and lobbyists have insisted that in any trade deal, UK farmers should adopt US standards. Among the many concerns expressed is that the US government is opposed to banning the use of antibiotics to prevent disease in livestock, as has been recommended by the WHO. An EU ban on preventive antibiotic treatment will go into effect in 2022
The report notes that British farmers cut their antibiotic use by 50% from 2014 through 2018, while antibiotic use on US farms increased by 9% in 2018 after several years of decline.
May 27 Alliance to Save Our Antibiotics report
May 27 Alliance to Save Our Antibiotics press release
Study: Conventional, organic dairy farmers differ on antibiotic use, resistance
A study exploring perceptions about antibiotic use and resistance in dairy farming suggests conventional and organic farmers have differing views that align with their respective business practices, researchers from Cornell University report today in PLOS One.
For the study, the researchers conducted semi-structured interviews with farmers representing 20 dairy farms in New York state—15 conventional and 5 US Department of Agriculture–certified organic farmers—and used thematic analysis to compare and contrast the farmers' characterization of their beliefs, values, and concerns. Among the themes they found was that, for conventional farmers, concerns about antibiotic use and resistance mainly related to the near-term impact on their livestock should antibiotics lose their efficacy, rather than the potential impact on human health. Conventional farmers also believed their antibiotic use was judicious, even if it didn't always fit the definition of judicious use, and felt that further regulation on antibiotic use could threaten their cattle's health.
In contrast, organic dairy farmers expressed more concern about antibiotic resistance, frequently framed it as a public health issue, and exhibited a more detailed understanding of judicious antibiotic use. Both groups had similar doubts about shared concerns about the impact of marketing and consumer perceptions on dairy, and emphasized herd health management as an effective preventive tool that could limit the need to antibiotics.
The authors of the study say the findings provide some targets for additional research and educational interventions.
"Given farmers' interest in disease prevention, they would likely be amenable to interventions focused on improving the efficiency and financial viability of their operation through improved herd health practices, including optimal antibiotic use/best practices," they write. "Such interventions would likely be best delivered by a veterinarian given farmers' trust of them."
May 27 PLOS One study