FARMS-SAFE: Future-proofing Antibacterial resistance Risk Management Surveillance and Stewardship in the Argentinian Farming Environment

Lead Research Organisation: University of Bristol
Department Name: Clinical Veterinary Science

Abstract

Antibacterial drug resistance (ABR) is a global threat to health and development and a problem that is getting steadily
worse. Within Latin America, Argentina has been tracking levels of ABR in human infections since 1986. Argentina was
also the first country in the region to develop a national strategy for the control of ABR. This national Strategy takes a
starting assumption that the use of antibacterial drugs (ABs) in livestock agriculture is in part responsible for the threat
of ABR in humans. The use of ABs on farms can potentially result in ABR human infections via 3 main pathways: (1)
ABR bacteria selected in the farm environment infect humans, or at least the mobile ABR genes carried within them
are transmitted to bacteria that infect humans; (2) Agricultural AB residues in food are ingested by humans, selecting
for ABR in human bacteria; (3) Agricultural ABs contaminate the non-farm environment, selecting ABR in bacteria
there, which then infect humans. In Argentina, data are extremely limited for the amount of ABR bacteria on farms
and in the near-farm environment. Furthermore, whilst AB residues are monitored in foodstuffs entering the formal
market, there is a significant informal market, and AB levels in the environment are not routinely measured. One
potential response to the rising threat of ABR is regulation, and both international organizations - led by the WHO -
and individual countries have sought to formulate, for example, new regulatory frameworks to address the and use of
ABs in farming, as well as the management of farm waste. As the O'Neill report recognises, however, developing
countries "...will need extra support and additional time to train veterinarians, develop regulations, build surveillance
capacity and improve farming practices". The premise of this project - FARMS-SAFE - is that as well as providing better
surveillance information for ABR and AB usage, extra support for Argentina and other Latin American countries should
encompass a risk-based approach to the design of regulation as well as to the strengthening of enforcement capacities;
their weakness is another source of risk.

FARMS-SAFE will address this issue by reference to four key risk areas via an UK/Argentinian research consortium:

1. Animal disease as a driver of ABR risk - We will identify why farmers use ABs in the context of animal disease.

2. Animal husbandry practice as a driver of ABR risk - We will identify what farm management practices are being
employed that influence the usage of ABs and will perform surveillance of the usage of ABs on farms in Argentina.

3. Farm waste management as a driver of ABR risk. We will perform surveillance of ABR bacteria with clear
potential to affect human health on farms in the near farm environment and will measure the levels of ABs and
other chemicals in the near-farm environment. We will correlate ABR with AB usage and will identify management risk
factors for ABR and AB contamination in the environment.

4. Regulatory capacity as a driver of ABR risk. We will identify the key individuals and organisations involved in
regulation of ABR and work with them to develop tools that can be used to regulate in a way that is informed by the
risks that drive ABR.

This work will lead to significant new understanding of the prevalence and causes of ABR in Argentinian farming
systems, how this influences the near-farm environment (and so potentially influences human health) and will inform
policy making within Argentina, Latin America and the wider world. We will also create a surveillance structure and
trained researchers who can continue to monitor ABR, AB usage and environmental contamination with ABs and ABR
into the future, and who can measure success and failure of strategies employed to reduce this risk.

Technical Summary

WS1: We will design and implement a nationwide telephone survey administered to farms. We will explore respondents' views about ABR, what ABs are being used on farms, how they are sourced, what diseases they are used to prevent or treat and how farmers view their use. A combination of qualitative and quantitative analyses will be used to examine differences in reported farmer perceptions and behaviours according to predictor variables.

WS2: We will undertake an in-depth social science analysis of how farmers deal with animal health, ABs and the risk of ABR. In-depth semi-structured interviews, ethnographic farms visits and participant observation at agro-shops will be used. Qualitative data will be thematically analysed using Quirkos qualitative text analysis software.

WS3: We will develop survey methodologies for AB, metal and biocide use using veterinary prescription and on-farm records, validated using bin audits. Evaluation of farm risk factors associated with ABU will be carried out using multilevel, multivariable regression modelling with variables identified in WSs 1 and 2.

WS4: We will establish surveillance protocols for ABR bacteria on farms. We will monitor prevalence and mechanism of ABR in Enterococci, Escherichia coli, Salmonella and Campylobacter using whole genome sequencing to link bacteria and ABR mechanisms between and within farms and near-farm environments. We will measure AB, metal and biocide contamination on farms and in near-farm environments and associate this with on-farm ABU, ABR and management practices using multilevel, multivariable linear regression modelling.

WS5: We will map regulatory actors for ABU and ABR, developing a heuristic model to summarise the major ABR risk factors for each livestock sector identified in WS1-4 in ways that are clear, understandable and actionable by regulators. We will produce policy briefing and best practice position papers to be shared with stakeholders in Argentina and the region.

Planned Impact

Health and welfare of Argentinian people and animals, along with those across Latin America
There is a significant burden of disease and economic cost of antibacterial drug resistance (ABR) in Argentina. Since
ABR is rising, inevitably the health and well-being cost of ABR will also rise, and probably moreso in developing areas
like those of Latin America, which are likely to have higher death tolls (of both humans and animals) than other regions.
Our aim is to develop an holistic picture of ABU and ABR in livestock systems in Argentina and to uncover their impact
on the environment as well as to identify potential interventions that can reduce ABU and so ABR. What we learn will
be transferable to other countries, particularly neighbouring countries in Latin America where ABR is also a significant
burden. In order to meet this challenge and improve human health, we need to have impact in policy engagement as
well as public engagement at all levels - from our study site to the entire Latin American region. One major advantage
of the timing of our proposed work is that it is contemporaneous with the implementation and review of Argentina's
Strategy to Control ABR, which is specifically focussed on reducing ABU and ABR in humans and animals. Our work will
synergise and expand current surveillance work ongoing in Argentina, and this synthesis will be extremely valuable
both in benchmarking success and informing modification of the Strategy for Argentina and her neighbours.

Policy makers and other stakeholders in Argentina and Latin America
Our project will provide timely information on key actions and resolutions for better control and traceability of ABs in
livestock farming and will identify the realities of compliance in these areas in ways that policy makers are currently
unable to fully assess. Findings of our study will be developed into policy briefings and disseminated through our
excellent policy partners and links in Argentina and throughout Latin America, impacting policy in the region directly.
Our work will also be presented at sub-national meetings within Argentina and meetings across Latin America as well
as internationally so that it can be applied to developing policy concurrently and subsequent to the work being
completed.

Industry (farming and veterinary)
Overuse of ABs, biocides and metals in Argentinian agriculture may reduce the economic efficiency of the agricultural
industries. Better farm management practices would not only reduce the reliance on medicines and chemicals, but
would improve yields in livestock agriculture, thereby improving overall economic growth. The risk factor analysis in
this project - combined with social science work - will uncover farm management practices and potential leverage
points that can be used to encourage more efficient practices across livestock agriculture. Many of these will reduce
ABR but all will lead to more responsible use of ABs. This project also addresses the impact that the farming industries
and veterinary profession might have on human health through animal-mediated contamination of publicly accessible
land and waterways with ABR bacteria. Understanding risk factors for acquisition of ABR in livestock and possible ways
to mitigate these will assist the livestock industries as they react to growing public concern about ABR and possible
legislation in an informed way. Directly involving stakeholders from these sectors in our project will allow them to
advocate for our findings in their own industries. For example, provision of first-hand evidence on the positive effect
of reducing ABU on ABR levels on the farms in our study may stimulate a peer-led process to encourage others to
reduce levels further. Limiting the rise of ABR will make farming in Argentina productive (via less untreatable disease)
and more economically successful, and will provide a model for tackling ABR elsewhere in the world.

Publications

10 25 50
 
Title Standard Operating Procedures (SOPs) for microbiology sample & data collection 
Description A data & sample collection SOP was designed in a participatory meeting during the Capacity Building Workshop in La Plata in February 2020. PI's, CoI's and Post Graduate Researchers from UoB, UNLP and UNRC jointly drafted a document with the methodological approach for data and sample collection and transportation to the labs. Research Teams for milking parlors and pig farms have been defined in both La Plata and Rio Cuarto in order to conduct the microbiological and molecular anaylisis for WS3. 
Type Of Material Biological samples 
Year Produced 2020 
Provided To Others? No  
Impact The capacity building workshop in La Plata aimed to ground our project's methodological proposal in the Argentinian context. Therefore, this outcome resulted from a mulitidisciplinary work that harmonised a methodological approach for WS3. The meeting opened a discussion space bewteen the team for further define research standards for sample & data collection within this workstream of the project. A document with a methodological approach for sampling and data collection has been agreed and validated among the team directly contributing to strengthen research capacities and knowledge exchange. 
 
Description AMR Force (Reyher) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Exploration of collaboration opportunities with VMD, Langford
Year(s) Of Engagement Activity 2019,2020
 
Description Agriculture and Horticulture Development Board Mastitis Control Plan Management Group meeting (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Mastitis Control Plan Management Group Committee meeting in Wells
Year(s) Of Engagement Activity 2019
 
Description Bristol AMR/Colston Research Symposium. The Antibiotic Age: The End or a New Beginning? 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Gave a speech entitled: 'Antibiotics Anonymous - Antimicrobial stewardship and voluntary reduction across the UK livestock sectors' and networked with conference attendees
Year(s) Of Engagement Activity 2019
URL https://www.bristol.ac.uk/amr/events/2019/colston-research-society-symposium.html
 
Description Bristol, North Somerset, South Gloucestershire CCG, One Health AMR meeting (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Meeting of the Bristol, North Somerset, South Gloucestershire Clincial Commissioning Group One Health AMR meeting at Bristol Royal Infirmary
Year(s) Of Engagement Activity 2019
 
Description CHAWG AMU Steering group (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Cattle Health and Welfare Group, Antimicrobial Use Group steering group committee meeting in London
Year(s) Of Engagement Activity 2019
 
Description Capacity Building Workshop for FARMS-SAFE research group 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Postgraduate students
Results and Impact The Capacity Building Workshop was held at the Faculty of Veterinary Medicine of University of La Plata from 3rd to 7th February 2020. The workshop was facilitated by the UK & Argentine PIs and CoIs to learn more about farm systems and the data that exists in Argentina, especially in La Plata and Cordoba.
By adopting a participatory approach SOPs were designed for data and sample collection for: i) drafting a national survey & tools for WS1 and WS2, ii) AMU and AMR for WS3, iv) AMR and AM/chemical contamination for WS4 and v) developing a risk-based approach to targeting AMR for WS5. National Autorities from SENASA, academics and postgraduate students from UNLP and Rio Cuarto as well as the team from UoB participated in the meeting.
During the workshop farm visits were organised for both the UK and Argentine colleagues to interview and participatorily observe and analyse the different farming practices among dairy and pig farms around La Plata.
Year(s) Of Engagement Activity 2020
 
Description Cattle Health and Welfare AMU Steering Group (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact committee meeting of the steering group on Cattle Health and Welfare at Stoneleigh
Year(s) Of Engagement Activity 2019
 
Description Food Industry Initiative on Antimicrobials Research & Development Committee + Data Committee - Quarterly Meeting (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Quarterly committee meeting of the Food Industry Initiative on Antimicrobials Research & Development Committee + Data Committee
Year(s) Of Engagement Activity 2019
 
Description Gloucestershire One Health AMR group (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact Prepared communication plan for Gloucestershire on One Health AMR
Year(s) Of Engagement Activity 2019
 
Description Grant Launch Workshop - UK & Argentina AMR in the environment 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact The Grant Launch Workshop was organised by BBSRC & CONICET. Five projects funded through DoHSC/UKAid (along with BBSRC & NERC) in the UK and CONICET in Argentina presented their workpackages in order to create a collective proposal to develop a Pan-Program Intregration Project (PPIP) and policy translation activities within the Argentine context. A draft PPIP document was gathered from the workshop aiming to:

- Aim 1 Combine expertise and data from all five project teams to provide consistency to (i) the co-design of policy with agricultural livestock sectors (ii) the measurement of antimicriobial use (AMU) and resistance (AMR), and (iii) knowledge exchange messages across all the livestock species and production systems encompassed by the program.
- Aim 2 "A whole that is greater than the sum of its parts" - to generate research outcomes at the level of the program that would not be possible for any one project alone through combining effort and new work in specifically defined areas.

The aims will be addressed through four work packages. UoB through the FARMS-SAFE project leads Work Package 1 (WP1) - Harmonising antimicrobial use and data collection.
Year(s) Of Engagement Activity 2019
URL https://bbsrc.ukri.org/news/events/2018/1806-argentina-antimicrobial-resistance/
 
Description Host Head of Population Health and Head of Research, Ontario Veterinary College, Guelph University, Ontario, Canada 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Discuss AMR research and possible overlaps in collaborations
Year(s) Of Engagement Activity 2019
 
Description Initial engagement w/ Pan-American Center for Foot and Mouth Disease and Veterinary Public Health, PANAFTOSA-PAHO/WHO 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The project had an initial engagement with the Food Safety Specialist of the Pan-American Center for Foot and Mouth Disease and Veterinary Public Health at PAHO. It is intended to work closely to boost the AMR information in Argentina jointly with SENASA across the Americas.
Year(s) Of Engagement Activity 2020
 
Description International Antibiotic Usage Forum (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Collaborative catch-up with AMR groups around the world - collaborations and contributions to practice
Year(s) Of Engagement Activity 2019
 
Description Interview for BBC Points West 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Discussed AMR research at the Bristol Veterinary School on 14th November 2019.
Year(s) Of Engagement Activity 2019
 
Description MOOC, Creating course on antimicrobial stewardship for vets (Reyher) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Discussion about AMR Massive Open Online Course phone meeting re training of practitioners and professionals
Year(s) Of Engagement Activity 2019
 
Description Medical Research Foundation AMR PhD student cohort meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Gave a talk at the training day for PhD students - discussed my background and journey in research and AMR research at Bristol - 15th November 2020.
Year(s) Of Engagement Activity 2019
 
Description Meeting with National Milk Labs (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Collaboration with FarmAssist, thinking about AMU metrics. Meeting in Langford
Year(s) Of Engagement Activity 2019
 
Description Meeting with representatives of the Welsh Government 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Phone meeting with Welsh Government to discuss about AMR
Year(s) Of Engagement Activity 2019
 
Description Podcast 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Podcast with Royal College of Veterinary Surgeons Trust on AMR with the UK's Chief Veterinary Officer
Year(s) Of Engagement Activity 2019
 
Description Project presentation to the research community at University of La Plata 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Organised by the Faculty of Veterinary Medicine of the University of La Plata, up to 60 Postgraduate students and Senior Researchers attended this talk on:

1.Selection and transmission of AMR in a One Health context, Matthew Avison.
2.Investigating prescription, usage and control of veterinary medicines: methods and insights from a social science approach, Maria Paula Escobar.
3.Strategies to optimize antimicrobial efficacy in veterinary medicine in the context of One Health, Nora Mestorino
4.FARMS-SAFE, an overview of the project, Kristen Reyher
Year(s) Of Engagement Activity 2019
 
Description RUMA Independent Scientific Group committee meeting (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Responsible Use of medicines in Agriculture Alliance (RUMA) scientific group meeting in London
Year(s) Of Engagement Activity 2019
 
Description Research meeting with representative from Boehringer Ingelheim 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Research meeting with representative from Boehringer Ingelheim to discuss AMR topics
Year(s) Of Engagement Activity 2019
 
Description Responsible use of medicines in Agriculture Alliance (RUMA) Targets Task Force 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Gave an invited talk to challenge livestock industries in AM stewardship targets in Stoneleigh on 10th September 2019
Year(s) Of Engagement Activity 2019
 
Description SENASA / ANLIS - Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The seminar "Antimicrobials, One Animal Health and Production" was held at the Laboratory of the National Service of Agrifood Health and Quality (Senasa) in Buenos Aires. Presentations were oriented to the impact of AMR on the environment, animal production, public health and regional economies seeking to highlight the importance of AMR surveillance programs and the way AMR affects national production.

At the end of the event, a discussion table was set up to analyse the perspectives of the different actors working on reducing the impact of AMR and to assess the possible options for a better and coordinated efforts. FARMS-SAFE PI and CoIs attended and contributed to discussions and networking.
Year(s) Of Engagement Activity 2019
 
Description Speak with BBC Radio4 Costing the Earth 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Phone interview with the BBC Radio4 to discuss AMR research - background information to be used in radio presentation
Year(s) Of Engagement Activity 2020
 
Description Speak with Channel 4 Dispatches 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Phone interview with Channel 4 Dispatches to inform a documentary about food safety
Year(s) Of Engagement Activity 2020
 
Description V RELIM Annual Meeting - "Milk Quality in One Health" 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The Latin American Mastitis Research Network (RELIM) is a non-profit professional network of milk quality and bovine mastitis control specialists from all the countries of Latin America. This professional network has as a main goal to improve the exchange of knowledge about intramammary infections affecting herds in the various dairy production systems utilized in the member countries, to ultimately produce quality milk by environmentally sustainable standards.
The members of our organization include professionals from the milk production industry and dairy processors, researchers, milk quality consultants, young veterinary students and graduate students. The University of La Plata presented the different strains of the FARMS-SAFE project by showcasing an informative brief during the annual meeting in La Plata between 25th and 28th November 2019.
Year(s) Of Engagement Activity 2019
 
Description Veterinary Schools Council AMR (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact phone meeting
Year(s) Of Engagement Activity 2019
 
Description Veterinary Schools Council, AMR (Reyher) 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Phone meeting with committee
Year(s) Of Engagement Activity 2019