60 years of probabilisation

Transcription

1 Analyse de l'efficience des traitements de mammites de 50 fermes de Wallonie dans la base LAECEA 1 THERON L., 3 REDING E., 2 DETILLEUX J., 1 RAO A.S., 3 BERTOZZI C., 1 HANZEN Ch. 1 Département clinique des animaux de production 2 Service de Génétique quantitative, Département des productions animales, Faculté vétérinaire, Université de Liège, Belgique. 3 Service recherche et développement, Association Wallonne de l élevage. Ciney, Belgique Empirical antibiotherapy Antibiotics : 1897 suspicion of inhibition 1928 Flemming Penicilline Antibiograms : 1944 beginning 1950 formalisation 60 years of probabilisation 2 1

2 Evolution of AM-resistance in S. aureus 24/11/ Sustainable empirical Antibiotherapy Enhancement : Epidemiology/Herd medicine Probability based antibiotherapy Key performance indicators: Clinical? Bacteriological? Tissular/Cellular? «Anyhow it works because he continues to buy it» 2

3 55 vétérinaires ruraux - Journées pluridisciplinaires UPV 8) Which antibiotic is the most indicated for the treatment of a severe mastitis? 1. Fluoroquinolones (marbo, enro, danofloxacine) 2. Aminopenicillins (Ampi, amoxicilline) 3. Polymyxins (colistine) 4. Trimethoprim-sulfamids 5. None 6. All 55 vétérinaires ruraux - Journées pluridisciplinaires UPV 9) Which antibiotic do you use the most for the treatment of a severe mastitis?? 1. Fluoroquinolones (marbo, enro, danofloxacine) 2. Aminopenicillins (Ampi, amoxicilline) 3. Polymyxins (colistine) 4. Trimethoprim-sulfamids 5. None 6. All 3

4 Mastitis encoding project Collaboration University of Liège Walloon Herd Association Research Key production indexes Vet Agro Encoding system and treatment recording Tactical document for the vet and the farmer Epidemiological analysis of udder health Udder Health File «LAECEA» Milk in walloon dialect MASTITIS? Projet LAECEA (Financé par la RW) 4

5 UHF : Recap Cure in Lactation 5

6 Cure in Dry-off UHF : Attention list 6

7 Material 50(70) farmers 4200 cows (82/farms, ) 8100 L on average( ) Methods Animal factors Data DHI (Breed, NL, DIM, cells etc ) Mastitis factors Quarters atteined Severity Treatment Withdrawal time 14 7

8 Methods An indicator reccurent, strong and frequent Individual somatic cell counts Cellular Cure = SCC days after mastitis threshold cell/ml 15 «If there are no solution, Then there are no problem» 8

9 Nombre de cas cliniques janv févr mars avr mai juin juil août sept oct nov déc janv févr mars avr mai juin 11/24/2013 Project LAECEA : Mastitis Cohort >5000 mastitis recorded Time Incidence Figure 3 - Incidence des cas cliniques en fonction du temps

10 Number of cases 11/24/2013 Incidence along production cycle Days in milk 10,0% 0,3% 6% 1% 1% 2% 3% 47,1% 49% 42,6% 38% IMM only IMM+P IMM+P+AI P only Severity IMM+AI P+AI AI only Treatment 10

11 Cellular variation analysis 51% = new cases 55% Cellular cure<60 jours 75% Cellular cure<120 jours 25% High SCC after 5 months 49% = Chronic/High SCC cows 33% Cellular cure<60 jours 44% Cellular cure<120 jours 56% High SCC after 5 months If a chronic case present a high SCC since >120 days before, odds for cure <25% 21 Cure risk factors 11

12 SEVERITY, QUARTER, WAY OF ADMINISTRATION, MOLECULE Study groups Mastitis 2169 IMAM AB 2078 Parenteral AB 79 AI Treatment 12 + Parenteral AB AI treatment AI treatment 15 + AI treatment

13 Intramammary treatment 20 % of cases received a 2 nd IMM. Mostly a C1G associated or not with AG st intention intramammary AG : Aminoglycosides PENA : Aminopenicillins PENM : Penicillin M MACR : Macrolids/Lincos Parenteral treatment AG : Aminoglycosides PENA : Aminopenicillins PENM : Penicillin M MACR : Macrolids/Lincos PENET : Penethamate Parenteral 1 st choice 26 13

14 Anti-inflammatory therapy N= 309 cases (15%) Choice of AI therapy (N=309) Cure rate: ALL+IMM once (N=797) 100% 90% 80% 70% 60% 50% 40% 30% 20% NOCURE OK30 10% 0% A l aveugle Usage habituel 14

15 Cure rate : NEW+IMM once (N=393) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% NOCURE OK30 0% Cure rate : NEW+IMM once (N=393) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% NOCURE OK30 0% 15

16 Cure rate: CHRO+IMM once 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% NOCURE OK30 0% Cure rate : NEW+P +/- IMM once (N=500) 100% 90% 80% 70% 60% 50% 40% NOCURE 30% 20% 10% OK30 0% 32 16

17 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Efficacy of parenteral according to chronicity(n=761) Parenteral No parenteral Parenteral HSCC No parenteral HSCC Cure No Cure Combinations? 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% IMM IMM+P IMM+P+AI Non guérison Guérison 17

18 Combinations of treatments Combination Odds-ratio for cure p-value IMM+AI 1,4 p<0,05 IMM+P 1,4 p<0,05 IMM+P+AI 2,0 p<0,05 IMM+P+AI on new cases 1,7 p<0,05 IMM+P+AI on chronic 2,4 p<0,05 Worst situation 3 rd lactation 2 nd half of lactation Rear quarter Have to check SCC!! 18

19 Sum-up Few NSAID (too few?) However enhancing AB association Efficacy over inflammation ~60% for new cases ~35% for chronic cases Parenteral treatment Enhance cure rate on acute cases 37 Résumé - SumUp Hypothesis? Streptococcus spectrum? Cell cure, efficient/real? Farm/cow effect? Consequences in prescription Define a Chronic Class Define criterium for treatment postposition at dry-off Define criterium for extended treatment 38 S. aureus Biofilm 19

20 What farmers/society/professionnals think? What farmers/society/professionnals think? 20

21 What farmers/society/professionnals think? Most of the time they don t need us «Mastitis treatment can be seen as an archaism, with few new diagnosis methods, lots of new therapeutical medium and eventually very poor evaluation of the results» (Hillerton and Berry, 2005) 42 21