Drivers of Antimicrobial Use Practices among Tennessee Dairy Cattle Producers.

Nonjudicious antimicrobial use (AMU) and inadequate antimicrobial stewardship are known modifiable factors driving the occurrence of antimicrobial resistance (AMR). A mixed methods approach using a combination of focus groups and survey questionnaires was used to explore the AMU practices of Tennessee (TN) dairy cattle producers. Specifically, the objectives of the study were to determine the following: (1) the most common drivers for using antimicrobials, (2) perceived alternatives to antimicrobials, (3) knowledge of and perceptions regarding AMR, (4) and the appropriate avenues for receiving information on prudent AMU. Two focus groups were conducted, one in July 2017 and the other in March 2018. The questionnaire was simultaneously made available to participants both in print form and online from January 26, 2018, through May 11, 2018. Twenty-three dairy producers participated in the focus groups and 45 responded to the survey. Eight (18.6%) producers never used bacterial culture and sensitivity testing (C/S) to select antimicrobials, more than half (25 producers (58.1%)) sometimes used C/S, four (9.3%) used C/S about half the time, five (11.6%) most of the time, and one (2.3%) always used C/S. The most common drivers for using antimicrobials were disease and animal welfare, pathogen surveillance, economic factors, veterinarian recommendation, producer's experience and judgment, drug attributes, and the Veterinary Feed Directive. Good management practices, vaccination, use of immunomodulatory products, and use of appropriate technology for early disease detection were considered alternatives to AMU. Four (9.1%) dairy producers were very concerned about AMR, 27 (61.4%) moderately concerned, and 10 (22.7%) not concerned. The veterinarian was considered to be a trusted source of information on prudent AMU. Use of C/S test results for antimicrobial selection is widespread among TN dairy producers. There is a need to popularize/promote selective dry cow therapy among TN dairy producers.