Division of Infectious Diseases and Immunology, Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 1, Utrecht, 3584 CL, The Netherlands.
Tilburg School of Humanities and Digital Sciences, University College Tilburg, PO Box 90153, Tilburg, 5000 LE, The Netherlands.
Sci Rep. 2024 Nov 29;14(1):29694. doi: 10.1038/s41598-024-81155-x.
Veterinary guidelines have been published in the Netherlands to promote antimicrobial stewardship. An evidence-based intervention program using Implementation Mapping and performance indicators was developed to enhance veterinarians' adherence to the veterinary guideline "Streptococcus suis in weaned pigs". The present study evaluates the effect of this eight-month intervention program in a multicenter, pragmatic, stepped-wedge cluster design trial. Of the 49 veterinarians that participated, 33 provided data from 125 S. suis problem farms. A baseline measurement (M0) before the intervention program, and two measurements during (M1) and partly after (M2) the intervention program were conducted. A significant reduction in farm-level antimicrobial use of 25% in M1 and 49% in M2 was achieved compared to M0. For the performance indicators at veterinarian level, a significant reduction (- 36%) was found for antimicrobial prescription in M2, a significant increase occurred in argumentation for 2nd choice antimicrobials (M2) and the usage of bacteriological examination (M1). Two other performance indicators (ratio of 1st to 2nd or 3rd choice antimicrobials and corticosteroids) did not change significantly. These results show how an evidence-based intervention program to foster adherence to an existing veterinary clinical practice guideline achieved a significant reduction in antimicrobial prescriptions by swine veterinarians.
荷兰发布了兽医指南，以促进抗菌药物管理。本研究采用实施映射和绩效指标的循证干预方案，开发了一种方案，以增强兽医对“断奶猪中猪链球菌”兽医指南的遵循度。本研究采用多中心、实用、阶梯式楔形集群设计试验，评估了该为期八个月的干预方案的效果。在参与的 49 名兽医中，有 33 名兽医提供了 125 个猪链球菌问题农场的数据。在干预方案之前进行了基线测量（M0），并在干预方案期间（M1）和部分之后（M2）进行了两次测量。与 M0 相比，M1 时农场层面的抗菌药物使用量减少了 25%，M2 时减少了 49%。在兽医层面的绩效指标方面，M2 时抗菌药物处方的减少具有统计学意义（-36%），对第二选择抗菌药物的论证（M2）和细菌学检查的使用（M1）显著增加。其他两个绩效指标（第一选择与第二或第三选择抗菌药物和皮质类固醇的比例）没有显著变化。这些结果表明，循证干预方案如何促进对现有兽医临床实践指南的遵循，从而使猪兽医的抗菌药物处方显著减少。
