Disarm : Managing antibiotic resistance through multi-actor farm health plans and a community of practice

Background: By the end of the first decade of 2000, monitoring systems in place to follow antimicrobial resistance of pathogenic bacteria and antimicrobial usages both raised concerns regarding third- and fourth-generation cephalosporins resistance trends in pig production in France. The French swine production sector mobilized and collectively committed reflection in the following months, which led to a multi-professional voluntary stewardship program enforced in 2011. Methods: The stewardship program targeted 3rd and 4th generation cephalosporins. A veterinarian consensus process defined restrictive rules for their prescription. All pig sector professionals including veterinarians, technicians and farmers were informed e.g. through personal letters and press articles. Existing national monitoring systems regarding usage (i.e. national sales annual surveillance) and resistance (i.e. the European regulation application for surveillance of commensal and zoonotic bacteria resistance and the RESAPATH network for pathogens) were completed by an ad hoc veterinarians’ cephalosporins deliveries collection and an on-farm survey on antimicrobial usage in a representative sample of pig farms. In a second step from 2014, regulatory measures (ecoAntibio National Plan) reinforced the program fixing quantitative reduction objectives and specifying terms and conditions for prescribing and dispensing a list of concerned critical molecules including cephalosporins. Results: All data sources confirmed an abrupt and significant decrease of cephalosporins usage in pig production by more than 90% between 2010 and 2016. Monitoring systems of resistance of commensal and pathogenic Escherichia coli isolates also displayed a concomitant and consistent decreasing trend (cf. Figure). No adverse effect could be detected on piglet’s mortality series during the same period.