By: Ann Hess, editor at National Hog Farmer
Ever since the Center for Disease Control released their 2013 report, Antibiotic Resistance Threats in the United States, stating that each year at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die, there has been a concerted effort to track antibiotic resistance. However, while there have been significant endeavors to track antimicrobial resistance in human health and food safety, not as much work has been done at the livestock level.
So, when the Veterinary Feed Directive went into effect Jan. 1, 2017, the 40-member veterinarian team at Pipestone Veterinary Services knew it was a prime time to see if antibiotic use in animals contributed to antimicrobial resistance over time. The Pipestone team examined 4,163 clinical case submissions over 15 years from the veterinary diagnostic labs of South Dakota State University, Iowa State University and the University of Minnesota from 2002-2017.
Based on whether bacteria recovered from these cases were sensitive (antibiotics would work) or resistant (antibiotics would not work) to the antibiotics in the food animal antimicrobial testing panels across these three labs, a resistance index was calculated and plotted over the 15-year period.
“This novel approach to tracking antibiotic resistance from swine cases seems to indicate that despite the use of antimicrobials over a prolonged period of time, the overall level of resistance has not changed,” Nerem says. “Calculation of the index will continue as new cases are added to the database. Stay tuned as we continue to learn and share.”
The antibiotic resistance tracking project is only one area Pipestone Veterinary Services is conducting in antimicrobial stewardship. The team is also examining how antibiotic use on farm is reflected in resistance for human pathogens.
Scott Dee, DVM, director of research at Pipestone Veterinary Services has been working on developing a means of how to measure pathogens of food safety and human health at the farm level. Since the National Antimicrobial Resistance Monitoring Service is already accepted by the government and the national medical community, Dee used those standards to measure the level of four specific bacteria, known to cause food-borne illness in people: E coli, salmonella, enterococcus and campylobacter. Unlike tracking AMR at the veterinary level, where you post 1-2 sick pigs out of 2,400 and send a few samples to a lab, Dee says he wanted a more comprehensive, representative sample of the population and its environment.
After collaborating with the Veterinary and Biomedical Sciences Department and Food Safety Microbiology Laboratory at South Dakota State University, Dee has developed a protocol to sample both live animals prior to marketing and their environments. In addition, the group has mimicked the exact antimicrobial susceptibility panel used by NARMS, so now they can start to track resistance patterns across the four bacteria.
“To make a long story short, our methods have proved to be accurate and repeatable, not only in swine environments but across alternative environments, such as human wastewater treatment plants, playground dirt and companion animal facilities,” Dee says. “We can routinely detect our 4 NARMS bacteria and determine their level of AMR.”
Pipestone has also started an antibiotic resistance research project with National Pork Board funding. Carissa Odland, a DVM with Pipestone and a master’s candidate at the University of Minnesota, is heading up that project, which will place pigs on feed, and then expose them to various levels of antibiotic therapy. She will then track and collect samples of antibiotic resistance for the lifetime of those pigs in a brand new BSL2 facility to help better control environment and maintain the isolation of these groups. The research project will follow those pigs all the way to harvest.
“We are very excited about this project and the funding that Pork Board and others have put into it to help us better understand what antibiotic resistance looks like at the farm level as it is related to pathogens of human interest,” Nerem says.
In addition to their antibiotic resistance investigations, Pipestone Veterinary Services has also launched their own tracking program at the producer level, the Pipestone Antibiotic Resistance Tracker.
“Being a company owned by veterinarians, we felt it was very important to show leadership in the area of antibiotic stewardship, because it ultimately starts with the veterinarian direction and recommendations, so we launched PART to increase that visibility, “ says Joel Nerem, DVM and director of health at Pipestone Veterinary Services, based out of Pipestone, Minn.
Two years later, more than 150 of Pipestone’s independent producers, representing 5 million weaned pigs and 3 million market hogs, have voluntarily signed up for PART, granting them access to a web-based tracker providing comprehensive antibiotic use (grams per head and cost per head), internal and external benchmarking and a quarterly veterinarian review and consultation.
The interactive, web-based tool, PART not only tracks resistance over time and benchmarks antibiotic use by farm, Nerem says it also serves as a platform to inform consumers, media and policy makers about the responsible antibiotic use practices being conducted on farm. Solely funded by Pipestone and producer subscription fees, PART uses the same metrics that the National Antibiotic Resistance Monitoring Service uses for human resistance.
Nerem says it’s also important to note that PART is focused on tracking antibiotic resistance and demonstrating responsible antibiotic use practices and is not about reducing antibiotics.
“I think one thing we were very cognizant of was that we didn’t want to create a race to the bottom on antibiotic use. We think that is bad for the pig,” Nerem says. “If suddenly, the producer is now more concerned about how we can get lower than our neighbors, we don’t necessarily think that is a good thing. It’s about responsible use and it’s about measuring. If we are not measuring, we are not being responsible.”
By monitoring and measuring antibiotic use on farm, PART gives the subscribed producers a record and review of their use as well as an opportunity to respond.
PART records antibiotic use information by compiling the water soluble and injectable information from Pipestone Veterinary Services, as well as feed-grade medical information from the producer’s feed mill.
Each producer that participates then has their own log-in identification and can see how antibiotic use is measured, the form of administration, the drug type, classification and its relevance to human medicine.
PART then takes all of this information and displays it into easy-to-understand graphs, allowing the producer to review antibiotic use by site and group, make cost comparisons, and observe anonymous benchmarking against other producers and resistance patterns.
“We can show a producer where they fit within our benchmark, compared to other producers and medication practices and can also show where they track over time compared to the rest of the producers participating,” Nerem says.
Now, with a better understanding of antibiotic use, Nerem says the producer can respond by working with his or her veterinarian to decide what changes in antibiotic use may improve herd health, performance and bottom line.
“In the end we know antibiotics are just a piece of the comprehensive approach we take to managing and improving the health of animals,” Nerem says. “So, when we talk about a comprehensive approach to health at Pipestone, we are talking about how are we designing facilities to raise pigs, what are the biosecurity practices we are putting in place to keep disease out, what’s the disease status and which diseases are we going to choose to eliminate.”
Nerem says the Pipestone team are very strong believers in disease elimination. They also recognize that there are more components to eliminating disease than just antibiotics. Ventilation, air filtration and nutrition are just as important to the health status of the pig.
“Antibiotics and vaccination are important, but they are not the whole picture either,” Nerem says.
Nerem says the VFD requirements only helped demonstrate that further.
“I think with the requirement now for VFDs and the topic of antibiotic use being at the forefront of our customers minds, we have had customers now asking for and supporting disease elimination programs, particularly mycoplasma pneumonia at the breeding herd level,” Nerem says. “A lot of the feed grade medication that’s been used in our customer base has been because of respiratory disease. I think that bringing the feed grade use to the forefront or in the spotlight has helped usher that in, which I think again is good for the pig and good for everyone. It’s better to eliminate disease than treat it.”