There are very few published data describing and quantifying consumption of AAIs (AGPs) in commercial feeds in poultry farming systems in low-and middle income countries (LMICs) (6). Our findings complement existing data on antimicrobials administered to chicken flocks (mainly through water) (~ 792 mg/kg) in the Mekong Delta region of Vietnam (21). Consumption of in-feed antimicrobials over the life of the flock (~ 85 mg/kg), represents ~ 10% of total flock AMU. These figures are consistent with previous estimates (77–95 mg/kg) (14, 15).
This study is based on data from an large cohort study aiming at reducing AMU in chicken production in the Mekong Delta of Vietnam (22). The study is representative since the selection of farms was random. Even though our data came from an intervention study, our advice to farmers was focused on reducing AMU as medicine (both prophylaxis and therapeutic), and did not include any advice on feed. We did not find any difference between flocks allocated to the intervention compared with the baseline phase (data not shown).
A major concern is the relatively high number of products that did not comply with Vietnamese regulations. Bacitracin, banned in feed rations in Vietnam since May 2016 (18), was the second most common AAI found. More worryingly, 6/35 (17%) antimicrobial-containing feeds included AAIs in concentrations above those permitted by the Vietnamese authorities. For example, the colistin concentration in all feed products examined was 3–5 times greater than that permitted by the Government. Non-authorised antimicrobials (avilamycin, flavomycin, oxytetracyline) were also found in some chicken feeds. This raises concerns regarding compliance of commercial feed mills with regulations and casts doubts over the effective enforcement of the new decree on animal feeds (19, 20). An additional challenge is the ambiguous labelling with regards to AAI in about a third of the rations investigated, posing an additional difficulty to Government authorities for quality control.
Recent studies have reported a high prevalence of colistin resistance encoded by mcr-1 in chicken flocks in the area (15, 23). This antimicrobial, classified as highly critically important by WHO (24), was listed in 5% feeds examined (brooder feeds) and it was estimated that on average, flocks consumed 5 mg/kg (about 3% of total in feed AMU). Compared with the reported magnitude of AMU through water administration (42 mg/kg) this is a modest amount. However it is of concern that in our study cohort farms tended to use these feeds towards the end of the production cycle with high drug concentration. This resulted in long elimination profile of antimicrobials, therefore high risk of residues in poultry meat (25).
Quantitatively, chlortetracycline, bacitracin and enramycin were the AAIs most consumed through commercial feeds. Tetracyclines were also the most consumed antimicrobial administered through water (21). Tetracyclines is also the class against which resistance among Escherichia coli and non-typhoidal Salmonella strains in the Mekong Delta is highest (15, 23, 26–30). Bacitracin has been shown to promote resistance among Clostridium perfringens isolates from chickens (31–33). With regards to enramycin, there is little information on its impact on AMR. A Japanese study that investigated Enterococcus faecium isolates from chicken flocks found no evidence of resistance against enramycin (34), although the study presented no enramycin use data.
The inclusion of AGPs in animal feeds and its impact on human health have been the subject of heated debate since the ban of AGP in animal production in Europe (35, 36). A major concern in Europe was the widespread use of avoparcin (glycopeptide) as AGP in animal feeds, which resulted in vancomycin resistance among zoonotic Enterococcus faecium bacteria (37). In contrast, studies have indicated that the use of enramycin and bacitracin as AGPs involves no risk to human health (38, 39). The association between AGPs in animal feeds and human health beyond the scope of this study, and the evidence has been reviewed elsewhere (40). The finding that AAIs in feed were consumed during the latter weeks of the production cycle is of concern given the potential for generating residues in chicken meat. A recent survey showed that 8.4% of chicken meat samples in Vietnam contained antimicrobials residues, with tetracyclines being the most common residue detected (41).
Many researchers have postulated that the withdrawal of AGPs may result in an increase use of antimicrobials for prophylaxis (prevention) or metaphylaxis (mass treatment) (9). In our study, AGPs in chicken feeds represented a small (10%) fraction of total AMU and probably have comparatively little impact on disease given the types of antimicrobials included. In low-biosecurity systems, the economic impact and productivity of AGP have been proven to be higher than in optimized-biosecurity production units (9). However, a number of studies recently have been highlighted the overall poor effects of AGPs in poultry productivity (42, 43). In the Mekong Delta region of Vietnam, high incidence of infectious disease and losses due to mortality are thought to be the major drivers of productivity. In such cases the potential weight gains are unlikely to be noticeable.