Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
Prev Vet Med. 2020 Jul;180:105025. doi: 10.1016/j.prevetmed.2020.105025. Epub 2020 May 11.
There has been an increased focus on antimicrobial stewardship (AMS) within the animal health domain (World Health Organization, 2015; O'Neill, 2016). Evidence of the effectiveness of interventions designed to enhance AMS is essential to support the development of this practice. This scoping review summarises for the first time the extent, range, and nature of global research activity on approaches for improving AMS in farmers and veterinarians involved in livestock farm animal management, health & well-being.
In November 2017 AGRICOLA, CAB Abstracts, EMBASE, MEDLINE, VetsRev and the Web of Science were searched. Studies were selected by two reviewers with 30 % of excluded and all included studies being independently reviewed by another reviewer. Inclusion criteria were primary studies or literature reviews focusing on antimicrobial use (AMU) in farming or veterinary practices for food-producing animals. Outcomes were changes in, or factors influencing farmers' or veterinarians' AMS. Exclusion criteria were studies on wild or companion animals or reports of the level of, rather influencing factors for AMS, or knowledge/awareness related to antimicrobial resistance (AMR). Study characteristics and relevant outcomes were extracted, identified facilitators and barriers grouped into categories, and a narrative synthesis was conducted. The PRISMA checklist extension for scoping reviews was used to guide the reporting of the review.
52 studies were included in the review; seven were intervention studies and 45 were studies of facilitators and barriers of AMU or antimicrobial prescribing (AMP). Studies were predominantly from high-income countries with only seven studies from low- or middle-income countries. Evidence for effective interventions was limited in terms of number of studies and robustness of evidence. There was some effect for an educational intervention in European cattle farmers and the Yellow Card scheme for Danish pig farmers. Significant facilitators to veterinarians' prudent AMP, in the cattle and pig livestock sector, included education, veterinarians' positive attitudes towards AMU reduction, and diagnostic. For farmers, significant facilitators to reduction of AMU were most frequently related to farming management practices.
This review describes a scarcity of robust study designs and recommendations can be confidently made for better designed studies. Furthermore, greater consideration needs to be given to the outcome measures used in such studies. Nevertheless, the review summarises the evidence on the effectiveness of interventions and significant facilitators to farmers' and veterinarians' AMS, which can provide best currently available evidence to guide improvements in different livestock sectors.
在动物健康领域，人们越来越关注抗菌药物管理（AMS）（世界卫生组织，2015 年；奥奈尔，2016 年）。为了支持这种实践的发展，必须提供旨在增强 AMS 的干预措施的有效性的证据。本范围综述首次总结了全球范围内针对提高参与牲畜农场动物管理、健康和福利的农民和兽医的 AMS 的方法的研究活动的范围、范围和性质。
2017 年 11 月，在 AGRICOLA、CAB 摘要、EMBASE、MEDLINE、VetsRev 和 Web of Science 上进行了搜索。两名评审员对研究进行了选择，30%的排除研究和所有纳入研究都由另一名评审员独立评审。纳入标准是侧重于用于生产食品的动物的农业或兽医实践中的抗菌药物使用（AMU）的原始研究或文献综述。结果是农民或兽医的 AMS 的变化或影响因素。排除标准是关于野生动物或伴侣动物的研究，或者报告 AMS 的水平，而不是影响因素，或者与抗菌药物耐药性（AMR）相关的知识/意识。提取了研究特征和相关结果，将相关因素分为几类，并进行了叙述性综合。使用扩展的 PRISMA 清单指南来指导综述报告。
本综述纳入了 52 项研究；其中 7 项为干预研究，45 项为 AMU 或抗菌药物处方（AMP）的促进因素和障碍研究。研究主要来自高收入国家，只有 7 项来自低收入或中等收入国家。从研究数量和证据稳健性来看，有效干预措施的证据有限。欧洲奶牛养殖户的教育干预和丹麦猪养殖户的黄牌计划有一定效果。在牛和猪畜牧业中，兽医谨慎使用 AMP 的重要促进因素包括教育、兽医对减少 AMU 的积极态度和诊断。对于农民来说，减少 AMU 的重要促进因素最常与农业管理实践有关。
本综述描述了稳健研究设计的稀缺性，可以为更好的设计研究提出建议。此外，需要更多地考虑此类研究中使用的结果衡量标准。尽管如此，该综述总结了关于干预措施有效性和农民和兽医 AMS 的重要促进因素的证据，这可以为不同的牲畜部门提供最佳的现有证据，以指导改进。
