In November 2015, the National Institute for Animal Agriculture (NIAA) hosted an antibiotics symposium titled Antibiotic Stewardship: From Metrics to Management in Atlanta. This was the latest in a series of conferences NIAA has organized, intending to bring together diverse stakeholders to seek common ground and develop solutions to the emergence of antibiotic resistance in pathogen populations. This week, NIAA, with support from the Beef Checkoff, released a white paper summarizing the outcomes of the workshop.
The 2015 symposium addressed the issue of how to determine the success of current and planned efforts to improve antibiotic use in animal and human health.
According to the white paper, Presentations during the symposium revealed dramatic changes since the first NIAA antibiotic symposium in 2011. These include:
· Animal and human health professionals and medical practitioners are much more aware of the concept of antimicrobial stewardship.
· Consumers have begun to drive change with their increasing interest in having “antibiotic-free” options at the retail groceries and restaurants.
· Federal and state governments have instituted a variety of new guidelines and regulations covering both animal and human health pertaining to the labeling and use of antibiotics.
· The Federal government has issued a new National Strategy and formed an independent advisory panel to address AMR and provide guidance to government agencies.
· Virtually all stakeholders who use or prescribe antibiotics as well as consumers of healthcare and food products are changing their practices in an ongoing way and adopting new approaches that are highly variable as they seek to conform both to external expectations as well as their own evolving understanding of the AMR problem.
· Despite the many reports, action plans, meeting and conferences which have taken place and the numerous initiatives announced by both public and private sectors organizations, there is a dearth of established, well-accepted metrics to assess the success of the efforts which are underway and planned.
After sitting in on plenary sessions, participants joined in breakout groups to work on revising a roadmap toward better antibiotic stewardship, using a “strawman” template developed by Tom Chapel, MA, MBA, who serves as the Chief Evaluation Officer at Centers for Disease Control and Prevention. The breakout groups also worked to developed four specific measures as a first step in leading the way to consensus metrics for progress in antimicrobial stewardship. These measures are:
1. The percentage of states with ongoing, working committees overseeing collection and dissemination of data on antimicrobial resistance from human, animal and environmental sources.
2. The number of useful and practical new diagnostic tests for the rapid identification and characterization of infection and antibiotic resistance (developed within a specific time frame).
3. Proportion of production units that have a documented Veterinarian-Client-Patient Relationship (VCPR) with at least one veterinarian.
4. The degree to which new and alternative interventions are being used in practice by veterinarians.
According to the white paper, participants noted that these early efforts will require discussion and input from an even broader array of interested and concerned parties and that these four metrics can only be a start in identifying an agreed-upon set of process and outcome measures. However, speakers and participants agreed that difficulties in reaching consensus and implementing metrics must be overcome as ongoing evaluation and continuous improvement in antibiotic stewardship practices are urgent issues for all stakeholders.
The 2015 symposium was funded in part by the Beef Checkoff, U.S. Department of Agriculture Animal and Plant Health Inspection Service – Veterinary Services, Zoetis, Merial – A Sanofi Company, United Soybean Board, Drovers CattleNetwork, Dairy Herd Management, Bovine Veterinarian, PorkNetwork, Pork Checkoff, Merck Animal Health, Elanco, American Veterinary Medical Association, Norbrook and Auburn University – Food Systems Institute.