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Background  Administration of antimicrobials to food-producing animals is regarded as a major contributor to the overall emergence of resistance in bacteria worldwide. However, few data are available on global antimicrobial use and resistance (AMR) in livestock, especially from low- and middle-income countries.    Methods  We conducted a structured survey of 91 small-scale pig farms in the urban and peri-urban areas of Phnom Penh, Cambodia, to assess the farmers’ knowledge, attitudes and practices related to antimicrobial use in their pig production. Commensal  Escherichia coli  was isolated from three healthy pigs from each farm ( n  = 261) and susceptibility testing was performed against 14 antimicrobials, using broth microdilution. Univariable logistic regression and generalized linear mixed models were used to investigate potential associations between farm characteristics, management factors and resistance to different types of antimicrobials.    Results  We found a widespread and arbitrary use of antimicrobials, often based on the farmer’s own judgment. Around 66% of the farmers reported frequently self-adjusting treatment duration and dosage, and 45% had not heard about the term ‘antimicrobial resistance’. The antimicrobials most commonly mentioned or kept by the farmers were amoxicillin, tylosin, gentamicin and colistin. Around 37% used a feed concentrate that contained antimicrobials, while antimicrobials for humans were used as a last-line treatment by 10% of the farmers. Commensal  E. coli  exhibited high prevalence of resistance to several antimicrobials considered to be of critical importance for human medicine, including ampicillin, ciprofloxacin and colistin, and multidrug-resistance was found in 79% of the samples. Higher prevalence of resistance was observed on farms that administered prophylactic antimicrobials and on farms that treated the entire group or herd in the event of disease.    Conclusion  The widespread and arbitrary use of antimicrobials in pig farming in Cambodia is highly worrisome. Overall, farmers had a low awareness of the risks and consequences related to antimicrobial use and AMR. The results presented in this study confirm the hypothesis that non-rational use of antimicrobials results in higher prevalence of AMR and highlight the need for professional animal health systems that involve medically rational use of antimicrobials in emerging economies such as Cambodia.    Electronic supplementary material  The online version of this article (10.1186/s13756-018-0328-y) contains supplementary material, which is available to authorized users.

Antimicrobials in small-scale urban pig farming in a lower middle-income country – arbitrary use and high resistance levels