Bourély Clémence, Fortané Nicolas, Calavas Didier, Leblond Agnès, Gay Émilie
École Nationale des Services Vétérinaires, VetagroSup, 69280, Marcy l'Étoile, France; Lyon University-ANSES, Laboratoire de Lyon, Unité Épidémiologie, 31 Avenue Tony Garnier, 69007, Lyon, France; EPIA, Epidémiologie des Maladies Animales et Zoonotiques, INRA, VetagroSup, Université de Lyon, 69280, Marcy L'Etoile, France.
IRISSO, CNRS, INRA, Université Paris-Dauphine, PSL Research University, 75016, Paris, France.
Prev Vet Med. 2018 Nov 1;159:123-134. doi: 10.1016/j.prevetmed.2018.09.009. Epub 2018 Sep 11.
For public health reasons, increasing attention has focused on more rational use of antimicrobials in farm animals. Guidance concerning the prescription of antibiotics and antimicrobial susceptibility testing (antibiograms in this case) are beneficial tools to help control the development of antimicrobial resistance. Nevertheless, even though there are already several qualitative studies analysing the determinants of antimicrobial prescription and use in veterinary medicine, little is known about decision-making concerning the use of antibiograms. The aim of this study was to provide a better understanding of veterinarians' motivations and role-players' influence concerning the choice of whether to ask for an antibiogram in the bovine, porcine, poultry and equine sectors in France. We concurrently evaluated the impact of a new French decree (2016) requiring an antibiogram before certain critically important antimicrobial agents can be used in veterinary medicine. Semi-structured interviews with veterinarians were conducted in France. Thematic analysis was used to analyse transcripts. In all, we surveyed 66 veterinarians. Use of antibiograms in veterinary medicine was multifactorial - 46 factors grouped into 11 categories were identified - and differed between animal sectors: use was almost systematic in poultry, frequent in pigs and rare in both the bovine and equine sectors. The decree has not increased the use of antibiograms but has induced a change in prescriptions due to field constraints and the time needed to obtain the results of antibiograms. Respondents see the decree as an aid in promoting responsible and rational use of antibiotics, fostering the use of alternatives. Our findings provide the basis of veterinarians' position regarding antibiogram use and antimicrobial resistance, pointing out levers to facilitate the use of antibiograms in veterinary medicine (for example communication on the benefits of this test and external financial support). Furthermore, the evaluation of the impact of the decree aimed at reducing the use of critically important antibiotic highlights key factors for a successful change in regulations, such as advance planning, precise and adapted communication, and demonstration of the measure's legitimacy. These results will be useful in guiding representative veterinary bodies and regulatory authorities during their decision-making, communication, and policy and regulation choices to combat antimicrobial resistance.
出于公共卫生原因，人们越来越关注农场动物抗菌药物的更合理使用。有关抗生素处方和抗菌药敏试验（此处指抗菌谱）的指导是有助于控制抗菌药物耐药性发展的有益工具。然而，尽管已经有多项定性研究分析了兽医学中抗菌药物处方和使用的决定因素，但对于抗菌谱使用的决策却知之甚少。本研究的目的是更好地了解法国牛、猪、家禽和马行业兽医在决定是否要求进行抗菌谱检测方面的动机以及相关角色的影响。我们同时评估了法国一项新法令（2016年）的影响，该法令要求在某些极其重要的抗菌药物用于兽医学之前必须进行抗菌谱检测。在法国对兽医进行了半结构化访谈。采用主题分析法对访谈记录进行分析。我们总共调查了66名兽医。兽医学中抗菌谱的使用是多因素的——共识别出46个因素并分为11类——且在不同动物行业有所不同：在家禽行业几乎是系统性使用，在猪行业频繁使用，在牛和马行业则很少使用。该法令并未增加抗菌谱的使用，但由于实际操作限制以及获取抗菌谱结果所需时间，导致了处方的改变。受访者认为该法令有助于促进抗生素的合理和负责任使用，推动替代药物的使用。我们的研究结果为兽医在抗菌谱使用和抗菌药物耐药性方面的立场提供了依据，指出了促进兽医学中抗菌谱使用的方法（例如宣传该检测的益处以及提供外部资金支持）。此外，对旨在减少极其重要抗生素使用的法令影响的评估突出了法规成功变革的关键因素，如提前规划、准确且适当的沟通以及证明该措施的合理性。这些结果将有助于指导代表性兽医机构和监管当局在其决策、沟通以及对抗菌药物耐药性的政策和法规选择过程中发挥作用。
