ABSTRACTS

SESSION 10.1: SOME ALTERNATIVES TO ANTIBIOTICS IN LIVESTOCK PRODUCTION: A REVIEW

1 2 SiakaS.DiarraandPaulA.Iji

1 Discipline of Agriculture and Food Technology, the University of the South Pacific, Samoa Campus

2 College of Agriculture, Fiji National University

The overuse of antibiotics in livestock farming has raised significant concerns due to the development of antibiotic resistance (AR) and its potential impact on human health. As a result, thereisagrowingneedtoexplorealternativestrategiestomaintainanimalhealthandproductivity whileminimizingtheuseofantibiotics.

Several compounds, which selectively stimulate the growth and/or activity of beneficial microorganisms in the gut, have emerged as promising alternatives to antibiotics in livestock production, especially in monogastric species. This review aims to provide a comprehensive overview of the use of selected antibiotic alternatives (prebiotics, probiotics, dietary fibre, and phytogenic compounds) as an alternative approach to antibiotics in livestock, focusing on their mechanisms of action, effects on gut microbiota composition, and their impact on animal health andperformance.

The review highlights the potential of several alternative compounds to antibiotics in maintaining animal health and addressing the concerns related to AR. There is , however, the need for further investigationsonthepracticalapplicationandcost-effectivenessinlargescalelivestockoperations.

SPEAKERPROFILE: DrSiakaS.Diarra

Dr SiakaSeribaDiarraisanAssociateProfessorofAnimalScienceintheDisciplineofAgricultureand FoodTechnologyatUSPSamoaCampus.Academicqualifications:BachelorofAgriculture(Animal Husbandry) from Mali, MSc (Animal Production and Management), PGD (Education), and PhD (Monogastric Animal Nutrition) from Nigeria. Work experience: taught animalproductioncoursesindifferentinstitutionsinNigeriaandjoined USPinAugust2012 Ihavesuccessfullysupervisedandexaminedseveral Higher Degree (Master and PhD) theses in Animal Science from different institutions. I have published in excess of 100 publications in alternative feed resources and animal welfare in peer reviewed journals and presented at several international conferences Language experience:Bambara(nativelanguage),French,English,andHausa.

SESSION 10.2: ANTIMICROBIAL SUSCEPTIBILITY OF BACTERIAL ISOLATES FROM CLINICAL SPECIMENS IN FOUR PACIFIC ISLAND COUNTRIES, 2017–2021

a b,** a,c d e Michael J. Loftus, Richard J. Everts, Allen C. Cheng, Perenise Eti, Timote Fakasiieiki, Lupeoletalelei d f a,g h d d a Isaia, Enita Isopo, Adam W. J. Jenney, Viali Lameko, Hinauri Leaupepe, Folototo Leavai, Sue J. Lee, e a f i i Mele Moungaevalu, Andrew J. Stewardson, Rosemary Tekoaua, Douglas Tou, Geoffrey Wuatai, and a,j,* Anton Y. Peleg a Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia b Nelson Bays Primary Health, Nelson, New Zealand c School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia d Tupua Tamasese Mea'ole Hospital, Apia, Samoa e Vaiola Hospital, Nuku'alofa, Tonga f Tungaru Central Hospital, Tarawa, Kiribati g College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji h Oceania University of Medicine, Apia, Samoa i Rarotonga Hospital, Rarotonga, Cook Islands j Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia

Abstract

Background

There are limited antimicrobial resistance (AMR) surveillance data from low- and middle-income countries, especially fromthePacificIslandsregion.AMRsurveillancedataisessentialtoinformstrategiesforAMRpathogencontrol.

Weperformedaretrospectiveanalysisofantimicrobialsusceptibilityresultsfromthenationalmicrobiologylaboratoriesof four Pacific Island countries – the Cook Islands, Kiribati, Samoa and Tonga – between 2017 and 2021. We focused on four bacteria that have been identified as 'Priority Pathogens' by the World Health Organization: Staphylococcus aureus, Escherichiacoli,KlebsiellapneumoniaeandPseudomonasaeruginosa.

Findings

Followingdeduplication,atotalof20,902bacterialisolateswasincludedintheanalysis.Themostcommonorganismwas E coli(n=8455)followedbyS aureus(n=7830),K.pneumoniae(n=2689)andP aeruginosa(n=1928).Theprevalenceof methicillinresistanceamongS.aureusisolatesvariedbetweencountries,rangingfrom8%to26%intheCookIslandsand Kiribati,to43%inbothSamoaandTonga.CeftriaxonesusceptibilityremainedhightomoderateamongE.coli(87%–94%) and K. pneumoniae (72%–90%), whereas amoxicillin + clavulanate susceptibility was low against these two organisms (50%–54%and43%–61%,respectively).Highsusceptibilitywasobservedforallanti-pseudomonalagents

Methods (83%–99%).

Interpretation

Despitechallenges,thesePacificIslandlaboratorieswereabletoconductAMRsurveillance.Thesedataprovidevaluable contemporary estimates of AMR prevalence, which will inform local antibiotic formularies, treatment guidelines, and nationalprioritiesforAMRpolicy

Funding

SupportedbytheNationalHealthandMedicalResearchCouncil.

SPEAKER: Dr Michael Loftus

Dr Michael Loftus is an Infectious Diseases Physician and researcher from Monash University,Australia.From2019-2022hecompletedhisPhDonantimicrobialresistance in the Pacific Islands, with a particular focus on Fiji. His other research interests include theintersectionsbetweenclimatechangeandhealth.

SESSION 10.3: LESSONS LEARNED FROM BOVINE TUBERCULOSIS SURVEILLANCE PROGRAM IN THE FIJI ISLANDS

Elva Borja , Anabel Argelis Garcia, Richard J. Whittington, Jenny-Ann L. M. L. Toribio

1 Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW,Australia,

2 World Organisation for Animal Health

Mycobacterium bovis causes tuberculosis in cattle and when transmitted to humans typically causes extra-pulmonary tuberculosis (EPTB). Bovine tuberculosis (bTB) has a global distribution and is controlled in most countries to protect animalandpublichealth.

CattlefarminghaslongbeentraditionallyconsideredasapromisinglivestocklivelihoodinFiji.Thus,thecontrolofbovine tuberculosis(bTB)ishighlyconsideredapriorityforanimalhealth,biosecurity,andhumanhealthauthoritiesinthissmall islandasevidentfromthelong-termfundingoftheBovineBrucellosisandTuberculosisEradicationandControlprogram (BTEC). The surveillance program made notable improvements since it commenced in the 1980's, sustained by government funding and industry cooperation. Two retrospective studies utilizing data of the Fiji BTEC program from 1999to2020wasundertakenthrutheUniversityofSydneywithsupportfromtheFijiGovernment AllavailablebTBdatafor cattlewereanalyzedtoevaluatetheperformanceoftheFijiBTECprogramfrom1999to2014andagainfrom2015to2020 A pilot investigation was conducted to look for putative zoonotic TB (extra pulmonary tuberculosis) in people, complimentary to the Fiji BTEC program cases. The study aimed to evaluate practices that might contribute to persistenceandtransmissionofM.bovisbetweencattleandtohumans.ExistingdatasetsweresharedbetweenMinistry ofAgricultureandMinistryofHealthFiji.

This case study highlights the lessons learned for bTB control in Fiji, the One Health consequences associated with the persistenceofbTBinfectionincattleherdsinFiji,theimportanceoftechnicalandsocialconsiderationstoachievesuccess indiseasecontrol;theimpactofcontributionfromregionalpartnersintheprocess.

Control of bTB in Fiji is a long-term objective that must have multiple stakeholder engagement and regular review to measuresuccess.FurtherstrengtheningoftheprogramtargetingthemaincontributorstobTBpersistence,maintenance ofacomprehensivereportingandtraceabilitysystem,industryawarenessandsupportarekeyactions.

CorrelationofbovinetuberculosisandEPTBcasesinhumans,particularlyinthecattlefarmingcommunitiesinFiji,needs to be fully established thru follow up study including an assessment of lifetime EPTB diagnoses, classification of farms basedonmorerecentbTBtestdataandmoleculartypingofM.bovisisolatesfromhumans,cattleandtheenvironment A targetedawarenessandeducationapproachisrequiredtoreducethefutureriskofzoonoticTBandtohelpensureuptake ofrecommendationsandpracticesaimedatcontrollingandpreventingbTB.

Keywords: bovine tuberculosis, zoonotic TB, One Health, disease control, surveillance, BTEC, Fiji,

SPEAKERPROFILE: DrElvaBorja

DrElvaBorja,isaveterinarianwithaMastersdegreeinVeterinaryPublicHealthManagement SheiscurrentlyaSupportConsultantof theWorldOrganisationforAnimalHealthoftheRegionalRepresentationforAsia-PacificbasedinTokyo Herroleisfocusedonsupporting WOAH regional activities on national veterinary workforce development and transboundary animal diseases, particularly in the Pacific Islandcountries.

Her 16-years work experience in the Pacific gave her the opportunity to take on various roles and be connected with different agencies in the veterinary domain, including as an Animal Health Laboratory Scientist and Animal Health Training Officer for the SPC LRD Animal Health and Production, Senior Veterinary Officer at the Fiji Veterinary Laboratory, OIC for Animal Health with the Ministry of Agriculture, as consultant with GIZ on climate change livestock adaptation and with World Animal Protection for livestock emergency management She also established a private veterinary clinical practice to cater for pet animals along the SuvaNavua corridor. Dr Borja also had academic teaching experience conducting trainings on animal health, veterinary epidemiology, veterinary microbiology, laboratory diagnostics, Paraveterinary training, livestock emergency management and animal welfare. Her research publications is focused on zoonotic bovine tuberculosis, documenting the progress of the bovine tuberculosis control program and its impact on the communities of Fiji.

As a veterinarian in the Pacific, her main goal is to foster a community with a healthy population of animals and humans harmoniously living together in a rich natural environment with a selfsustaining livestock livelihood.

SESSION 11.1: GOVERNANCE FOR ONE-HEALTH MANAGEMENT OF AMR IN FIJI

Antimicrobial resistance (AMR) is a complex challenge of global significance that decision makers are addressing at multiple scales – local, national and international. Addressing AMR effectively requires governance interventions tailored to local and national contexts connected to global initiatives,buildingsharedunderstanding,networksandcapacity

The Enhancing the Management of Antimicrobial Resistance (EMAR) project explored the governance of AMR and antimicrobial use (AMU) in Fiji, taking a One Health perspective. My presentation will share how this work built on previous One Health and Pacific climate adaptation governanceresearch,thetoolsandapproachesused,andprojectoutcomes.

SPEAKERPROFILE: DrSeonaMeharg

Dr Seona Meharg is an interdisciplinary social scientist researching how individuals and organisationslearnandchange,specificallyaskingwhatenablesindividualsandgroupstotakeup ownership of knowledge, tools, and processes for more informed decision-making in complex domains such as climate adaptation, disasterriskreductionandhealth.

Seona’s research addresses the vital challenge of implementation, asking why even with the necessary information, people do not act. In addition,herresearchmeasurestheimpactofhowchangesinbehaviour andknowledgeleadtoimproveddecisionsandactions.

SESSION 11.2: ATTRIBUTABLE MORTALITY AND EXCESS LENGTH OF STAY ASSOCIATED WITH THIRD-GENERATION CEPHALOSPORIN-RESISTANT ENTEROBACTERALES BLOODSTREAM

INFECTIONS:APROSPECTIVECOHORTSTUDYINSUVA,FIJI b,1 a b a,1

MichaelJ.Loftus ,TraceyE.M.W.Young-Sharma ,SueJ.Lee ,ShitanjniWati ,

GneiZ.Badoordeen , LukeV.Blakeway , SallyM.H.Byers , AllenC.Cheng ,

Ben S. Cooper , Hugh Cottingham , Adam W.J. Jenney Jane Hawkey , Nenad Macesic b b b b b a

RaviNaidu , AmiteshPrasad , VinitaPrasad , LitiaTudravu , TimociVakatawa , ElkevanGorp , Jessica a h a , i , 2 a ,2

A. Wisniewski , Eric Rafai , Anton Y. Peleg , **, Andrew J. Stewardson , * a Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, b Australia Colonial War Memorial Hospital, Suva, Fiji c d School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia Centre for Tropical e Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom Mahidolf Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand Fiji National University, Suva, Fiji

Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia

Objectives: There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure theeffectofthird-generationcephalosporinresistance(3GC-R)onmortalityandexcesslengthofhospitalstay inFiji.

Methods: We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional haz- ards modelstoestimatetheeffectof3GC-Ronthedailyrisk(hazard)ofin-hospitalmortalityandbeingdischarged alive(competingrisks),andweusedmultistatemodellingtoestimatetheexcesslengthofhospitalstay.

Results: From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs; 3GC-R was presentin66(407%).Crudemortalityforpatientswith3GC-susceptibleand3GC-RBSIswas167%(16/96)and 303% (20/66), respectively 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio [aHR] 1.13, 95% confidence interval [CI] 0.51–2.53) or being discharged alive (aHR 0.99, 95% CI 065–1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36–1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31–971) were both associated with an increased hazard rate of in-hospital mortality 3GC-R wasassociatedwithanincreasedlengthofstayof2.6days(95%CI2.5–2.8).3GC-Rwasmorecommonamong hospital-associatedinfections,butgenomicsdidnotidentifyclonaltransmission.

Conclusion: Patients with Enterobacterales BSIs in Fiji had high mortality There were high rates of 3GC-R, whichwasassociatedwithincreasedhospitallengthofstaybutnotwithin-hospitalmortality

SPEAKERPROFILE: DrMichaelLoftus

Dr Michael Loftus is an Infectious Diseases Physician and researcher from Monash University, Australia. From 2019 - 2022 he completed his PhD on antimicrobial resistance in the Pacific Islands, with a particular focus on Fiji. His other research interests include the intersections betweenclimatechangeandhealth.

SESSION 11.3: MULTI-SPECIES CARBAPENEM-RESISTANT ORGANISM (CRO) CASE INVESTIGATIONATCOLONIALWARMEMORIAL(CWM)HOSPITAL,FIJI

Tracey Young, Annabelle Turner , Sanjeshni Autar, Ana Suka, Aneley Strobel

Getahun, Ashlyn Datt, Anisi Kavoa, Kirsty Buising , Benjamin Howden and on behalf of the broader COMBAT-AMR Team*

1Colonial War Memorial Hospital, Suva, Fiji,

2Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection & Immunity,

3Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia,

4Department of Infectious Diseases, The University of Melbourne, Melbourne, Australia,

5Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia,

6Department of Infectious Diseases, Austin Health, Melbourne, Australia.

*COMBAT-AMR broader team members include Adam Jenney, Rodney James, Chantel Lin, Donna Cameron, Mathilda Wilmot and Karishma Nandan

Introduction: Carbapenem-resistant organisms (CROs) cause infections in hospitalised patients and are associated with limited options for treatment, and elevated rates of morbidity and mortality Long-term colonization leads to complex outbreaks, with transmission frequently detected in hospital settings due to staff movement and shared equipment Recognition of increased CRO isolated at CWM hospital prompted detailedcaseinvestigationandenhancedmicrobiologicaltesting.

Methods: All isolates underwent routine antimicrobial susceptibility testing (AST) at CWM laboratory with those displaying first-line resistances undergoing meropenem susceptibility disc test (subject to availability). Where CROs were confirmed, epidemiological surveillance data was collected to investigate similar isolates detected in patients with geographical or temporal links. One hundred and ninety-seven isolates were referred to Doherty Institue for enhanced AST and whole genome sequencing (WGS).

Results: Between June 2022 and March 2023, 196 patients at CWM Hospital had isolates of CRO confirmed, reaching a peak of 40 cases detected in January 2023. CROs were almost exclusively Acinetobacter baumannii, Escherichia coli and Pseudomonas aeruginosa, and many were from patients with clinical infections. Epidemiologic investigation revealed a concentration of patients with admissions to ICU, burns ward, acute medical ward and acute surgical ward; with disproportionate clustering of different gramnegative species in these wards. WGS of isolates indicated a dominance (487%) of NDM-7 E. coli (n=50) and NDM-1/OXA-23 A. baumannii (n=46).

Discussion: Support to ensure laboratories are capable of extended antimicrobial resistance (AMR) testing and hospital staff can collect epidemiologic information will facilitate the accurate detection and investigation of suspected hospital outbreaks of resistant pathogens. Targeted policies aimed at infection prevention control measures for CRO case management, alongside ensuring availability of a suite of appropriate antimicrobials for treatment, are needed. Outbreak characterization and the investigation of putative transmission clusters may benefit from the use of WGS, with extended AST to inform empiric treatment guidelines.

SPEAKER: DrTraceyYoung-Sharma

Tracey Young Sharma is a Consultant General Medicine Physician at ColonialWarMemorialHospital(CWMH),Fiji.Herinterestisininfectious diseases, microbiology and research in antimicrobial resistance. She is currentlytheInfectionPreventionControlCommitteeChairandinvolved in antimicrobialstewardshipactivitiesinCWMH.