Stewardship for Poultry: Antimicrobial Use in Poultry

Chuck HofacreThe University of Georgia

Poultry Diagnostic and Research Center

Athens, Georgia

John SmithFieldale Farms

Baldwin, Georgia

Drivers for Stewardship in Poultry1. Use of antibiotics can be a significant

cost of production2. Customers (not consumers) move

toward ABF (antibiotic free)3. Governmental regulations4. Export markets

Advantage for Poultry

GGP

Grandparents

Parent Stock

TurkeysBroilersLayers

Consumer

PrimaryBreedingCompany

IntegratedPoultry Company

Breeder Pullets

Breeder Layer

Broiler Eggs

Broiler Hatchery

Broiler Farm

Processing Plant

Consumer

Integrated Industry

Field Condemnations, 1990-2002

0.40.60.8

11.21.41.6

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

1.40

0.74

Agri Stats

Livability, 1990-2000

94.494.694.8

9595.295.495.695.8

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

ALV-J?

94.8

95.6

Disease Prevention - Biosecurity

In the U. S. for Poultry the Debate is Over:

Growth Promoter Antibiotics◦Bambermycin◦Virginiamycin ◦Avoparcin (Never approved in U.S.)◦Bacitracin

In the U. S. the Debate is Over:Growth Promoter Antibiotics

◦Oxytetracycline (10-50 g/ton)◦Penicillin (2.4-50 g/ton)◦Chlorotetracycline (10-50 g/ton)◦Lincomycin (2-4 g/ton)◦Tylosin (4-50 g/ton)

Survey of Southeast U. S. BroilerVeterinarians – September, 2012

12 Questions17 Broiler Industry Veterinarians30 Complexes Represented9 States (AL, AR, GA, KY, LA, MS, NC,

SC, & TX)

Top 5 Broiler Issues

Ranked by Respondents#1 Coccidiosis#2 Necrotic Enteritis#3 Infectious Bronchitis#4 Infectious Process#5 Infectious Bursal Disease

Antibiotic Stewardship in PoultryNo longer using CeftiofurReduced use of GentamicinLess use of AGPs today (market

driven)Many companies already beginning

prescription for feed and water use

On Farm PoultryNational Antimicrobial Resistance Monitoring (NARMS)

Chuck Hofacre Randy SingerThe University of GeorgiaThe University of Minnesota

Roy Berghaus Pat McDermottThe University of GeorgiaFDA - CVM

Structure of on Farm NARMSFDA

(Dr. Patrick McDermott)

$

U.S.D.A.(Dr. Eileen Thacker)

$CRADA

University of Minnesota University of Georgia

2014 On-Farm NARMSGoals

• National representation of the U. S. poultry industry (broiler and turkey)–Enroll at least 60% of annual

production• Complexes within companies randomly

selected• Collect matched antibiotic usage

information

2014 On-Farm NARMSSample Size Calculations

• Estimate annual prevalence of resistance to a specific antimicrobial with 95% confidence and a margin of error of ± 5%, assuming:– Resistance prevalence will be 50%– Prevalence of organism will be 50% – Intra-cluster correlation (ICC) for isolates

collected from the same farm is 0.90• 1,448 samples required, totaling 362

farms and approximately 46 complexes

Broiler On Farm NARMS Logistics

• 8 Farms sampled/week in U.S.• 4 Boot socks per farm• 32 Weekly boot socks• Sampling kits and surveys are sent to

each producer the week prior to sampling• Sampling is conducted the week prior to

processing

On Farm NARMSThe University of Georgia

Send sampling coded boxesTurkey Companies Broiler Companies

Boot Socks to U. of MN Boot Socks to UGA

·Coded Salmonella isolates ·Coded Salmonella isolates·Coded Campylobacter isolates ·Coded Campylobacter isolates

The University of GeorgiaPDRC · Salmonella Serotyping · Antimicrobial Resistance testing-sensititre

Results share annually with Poultry Industry

Results shared with FDA

Antibiotic Usage Survey1. What is the age of the flock at sampling? ______________ days Farm Name*: ___________________________________

*Optional, but necessary if you wish to receive data back on a per farm basis.  2. What anticoccidial prevention has been used in the current flock? Circle all that apply. Ionophore Product Name:______________________________ Chemical Product Name:______________________________ Vaccine Product Name:______________________________

Antibiotic Usage Survey

3. Were any antimicrobial growth promotants used in this flock?  YES NO  3a. If yes, what antimicrobials were used? (Please circle all that

apply) 

Bacitracin (BMD) Lincomycin (Lincomix)  Virginiamycin (Stafac) Bambermycins

(Flavomycin) Tylosin (Tylan) Other:

____________________ 

Antibiotic Usage Survey 4. Have there been any health issues with this flock that required antimicrobial treatment?

 YESNO 4a. If yes, what was the health issue? (Please circle) 

Airsac Peritonitis Enteric Dermatitis IP Other: ____________________

 4b. If yes, what antimicrobial(s) was/were used for treatment? (Please

circle all that apply) Bacitracin Lincomycin

Virginiamycin Chlortetracycline Penicillin Other:

____________________ Oxytetracycline Tylosin

2014 On-Farm NARMSResults

• Results for 258 broiler farms and 39 turkey farms

• Salmonella prevalence– 57.0% for broilers– 32.1% for turkeys

• Campylobacter prevalence– 22.5% for broilers– 11.4% for turkeys

Antibiotic Resistance ResultsSalmonella

Antimicrobial Source (n) %I1 %R2 [95% CI]3 0.015 0.03 0.06 0.125 0.25 0.50 1 2 4 8 16 32 64 128 256 512 1024Aminoglycosides

Gentamicin Broiler (585) 0.0 9.1 [6.9 - 11.7] 29.6 49.1 8.7 0.2 0.3 4.6 4.4Turkey (59) 0.0 30.5 [19.2 - 43.9] 20.3 47.5 1.7 6.8 23.7

Streptomycin Broiler (585) N/A 38.5 [34.5 - 42.5] 61.5 25.8 12.6Turkey (59) N/A 74.6 [61.6 - 85.0] 25.4 30.5 44.1

β-Lactams/ β-Lactamase Inhibitor Combinations

Amoxicillin- Broiler (585) 0.3 7.2 [5.2 - 9.6] 86.3 2.2 2.4 1.5 0.3 5.3 1.9 Clavulanic Acid Turkey (59) 6.8 3.4 [0.4 - 11.7] 66.1 8.5 15.3 6.8 3.4

Cephems Ceftiofur Broiler (585) 3.1 4.1 [2.6 - 6.0] 48.5 43.2 1.0 3.1 2.9 1.2

Turkey (59) 0.0 10.2 [3.8 - 20.8] 37.3 52.5 10.2 Ceftriaxone Broiler (585) 0.2 6.8 [4.9 - 9.2] 92.8 0.2 0.2 2.4 3.1 1.2 0.2

Turkey (59) 0.0 10.2 [3.8 - 20.8] 89.8 1.7 8.5 Cefoxitin Broiler (585) 2.4 3.9 [2.5 - 5.8] 15.4 57.3 17.9 3.1 2.4 3.4 0.5

Turkey (59) 0.0 3.4 [0.4 - 11.7] 5.1 47.5 40.7 3.4 3.4

MIC Distribution among Salmonella from Broilers and Turkeys, 2014Distribution (%) of MICs (µg/ml)4

Antibiotic Resistance ResultsSalmonella

Antimicrobial Source (n) %I1 %R2 [95% CI]3 0.015 0.03 0.06 0.125 0.25 0.50 1 2 4 8 16 32 64 128 256 512 1024Folate Pathway

Sulfisoxazole Broiler (585) N/A 31.3 [27.5 - 35.2] 27.7 18.3 15.7 5.5 1.54 31.3Turkey (59) N/A 28.8 [17.8 - 42.1] 23.7 25.4 15.3 5.1 1.69 28.8

Trimethoprim- Broiler (585) N/A 1.9 [0.9 - 3.3] 96.6 1.2 0.2 0.2 1.9 Sulfamethoxazole Turkey (59) N/A 8.5 [2.8 - 18.7] 91.5 8.5Macrolides

Azithromycin Broiler (585) N/A 1.5 [0.7 - 2.9] 1.2 34.4 57.6 4.6 0.7 1.5Turkey (59) N/A 0.0 [0.0 - 6.1] 6.8 84.7 5.1 3.4

Penicillins Ampicillin Broiler (585) 0.0 9.6 [7.3 - 12.3] 83.9 4.6 1.7 0.2 0.5 9.1

Turkey (59) 0.0 32.2 [20.6 - 45.6] 66.1 1.7 1.7 30.5Phenicols Chloramphenicol Broiler (585) 0.9 0.2 [0.0 - 0.9] 3.2 69.6 26.2 0.9 0.2

Turkey (59) 0.0 1.7 [0.0 - 9.1] 6.8 50.8 40.7 1.7Quinolones

Ciprofloxacin Broiler (585) 0.0 0.0 [0.0 - 0.6] 94.7 4.8 0.3 0.2Turkey (59) 0.0 0.0 [0.0 - 6.1] 100.0

Nalidixic Acid Broiler (585) N/A 0.0 [0.0 - 0.6] 0.7 64.8 33.5 1.0Turkey (59) N/A 0.0 [0.0 - 6.1] 71.2 28.8

Tetracyclines Tetracycline Broiler (585) 0.0 51.5 [47.3 - 55.6] 48.5 1.2 50.3

Turkey (59) 1.7 61.0 [47.4 - 73.5] 37.3 1.7 6.8 54.21 Percent of isolates w ith intermediate susceptibility. N/A used w hen there is no intermediate breakpoint established.2 Percent of isolates w ith resistance. Discrepancies betw een %R and sums of distribution are due to rounding.3 95% confidence intervals for percent resistant (%R) w ere calculated using the Clopper-Pearson exact method.4 Unshaded areas indicate the dilution range of the Sensititre plates used to test isolates. Susceptibility breakpoints are indicated by single black vertical bars and resistance breakpoints are double red vertical bars. Numbers in shaded areas indicate % of isolates w ith MIC's greater than the highest concentrations on the Sensititre plate. Numbers listed for the low est tested concentrations represent % of isolates w ith MICs equal to or less than the low est tested concentration. CLSI breakpoints used w hen available. There are no CLSI breakpoints for streptomycin or azithromycin.

MIC Distribution among Salmonella from Broilers and Turkeys, 2014Distribution (%) of MICs (µg/ml)4

Antibiotic Resistance ResultsCampylobacter

Antimicrobial Species %I1 %R2 [95% CI]3 0.008 0.015 0.03 0.06 0.125 0.25 0.50 1 2 4 8 16 32 64 128Aminoglycosides

Gentamicin jejuni (126) 0.0 0.0 [0.0 - 2.9] 10.3 30.2 55.6 2.4 1.6coli (16) 0.0 0.0 [0.0 - 20.6] 6.3 18.8 50.0 25.0

KetolidesTelithromycin jejuni (126) 1.6 0.0 [0.0 - 2.9] 4.0 1.6 3.2 22.2 30.2 23.0 13.5 0.8 1.6

coli (16) 0.0 0.0 [0.0 - 20.6] 18.8 25.0 12.5 12.5 12.5 18.8Macrolides

Azithromycin jejuni (126) 0.0 2.4 [0.5 - 6.8] 33.3 15.1 34.9 13.5 0.8 2.4coli (16) 0.0 0.0 [0.0 - 20.6] 18.8 25.0 31.3 6.3 12.5 6.3

PhenicolsFlorfenicol5 jejuni (126) N/A 0.0 [0.0 - 2.9] 1.6 6.3 3.2 29.4 48.4 9.5 1.6

coli (16) N/A 0.0 [0.0 - 20.6] 6.3 18.8 62.5 12.5Quinolones

Ciprofloxacin jejuni (126) 0.8 16.7 [10.6 - 24.3] 4.0 2.4 45.2 23.8 5.6 1.6 0.8 2.4 10.3 4.0coli (16) 0.0 25.0 [7.3 - 52.4] 50.0 6.3 12.5 6.3 25.0

Nalidixic Acid jejuni (126) 1.6 14.3 [8.7 - 21.6] 65.1 11.1 7.9 1.6 8.7 5.6coli (16) 6.3 25.0 [7.3 - 52.4] 50.0 18.8 6.3 18.8 6.3

Tetracyclines Tetracycline jejuni (126) 0.8 37.3 [28.9 - 46.4] 18.3 29.4 11.1 1.6 0.8 0.8 0.8 0.8 4.8 14.3 17.5

coli (16) 0.0 25.0 [7.3 - 52.4] 6.3 25.0 18.8 18.8 6.3 6.3 18.81 Percent of isolates w ith intermediate susceptibility. N/A used w hen there is no intermediate breakpoint established.2 Percent of isolates w ith resistance. Discrepancies betw een %R and sums of distribution are due to rounding.3 95% confidence intervals for percent resistant (%R) w ere calculated using the Clopper-Pearson exact method.

5 For Florfenicol, percent non-susceptible (MIC ≥8 µg/ml) is reported rather than percent resistant because a resistance breakpoint has not been established.

MIC Distribution among Campylobacter from Broilers, 2014Distribution (%) of MICs (µg/ml)4

4 Unshaded areas indicate the dilution range of the Sensititre plates used to test isolates. Susceptibility breakpoints are indicated by single black vertical bars and resistance breakpoints are double red vertical bars. Numbers in shaded areas indicate % of isolates w ith MIC's greater than the highest concentrations on the Sensititre plate. Numbers listed for the low est tested concentrations represent % of isolates w ith MICs equal to or less than the low est tested concentration. CLSI breakpoints used w hen available. There are no CLSI breakpoints for streptomycin.

Antibiotic Usage Survey - Results

Antibiotic Usage Survey - Results

Summary of Survey Responses for Turkey Producers (N=39)Median Age at Sampling 88 Days

Anticoccidial Prevention Yes (%)Ionophores 35 (89.7)Chemical 20 (51.3)Vaccine 0

Use Growth Promoters 35 (89.7) Reported AntimicrobialsBacitracin 19 Lincomycin 0Virginiamycin 15 Bambermycin 0Tylosin 0

Experienced Health Issues 23 (74.2) Reported Health ConditionsAirsac 11 Dermatitis 6Peritonitis 2 IP 1Enteric 13

Reported TreatmentsBacitracin 0 Chlortetracycline 1Lincomycin 2 Oxytetracycline 12Virginiamycin 0 Penicillin 23Tylosin 0 Gentamycin 7Neomycin 8

2014 On-Farm NARMSConclusions

• Excellent industry participation– Currently between 60% and 70% for

broilers and turkeys• Success dependent on our close-

working relationship with U.S. poultry producers and their confidence in our ability to maintain confidentiality

• Compliance with antibiotic usage survey

Next Steps – December, 2015• Antibiotic use survey with USPOULTRY

Why Should the Poultry Industry Do This?

“The current strategy of voluntary guidance regarding ‘judicious use’ of antibiotics is doomed to fail, and it does not reflect the extreme urgency of this issue.”Rep. Louise Slaughter, March 14, 2013

Letter to FDA CommissionerMargaret Hamburg

Stewardship for PoultryIntegration – more easily allow programs

implementedPreventive Medicine – significantly improves bird

healthMarketing Driver Reduction of useOn Farm NARMS – excellent participation

(December - 2015) Antibiotic Use Survey (December 2015)

◦ Academia Industry U. S. Poultry Assoc. USDA