1 December 2014 Working across sectors: a public health approach to to antimicrobial resistance
1December 2014
Working across sectors:a public health approach to to antimicrobial resistance
2December 2014
Antibiotic use: use in plants, fish Antibiotic use: use in plants, fish and animalsand animals
Washington,11 Oct. (IPS) –
More than half of the antibiotics used in the United States are estimated to be used in animal feed for poultry, hogs, and cattle. In 80 percent of cases, the drugs are used to fatten the animals faster.
Between 40,000 and 50,000 pounds of tetracycline and streptomycin - both used to treat infections in humans - are sprayed to control bacterial disease among fruit trees.
In the United States nearly 150 pounds of antibiotic are applied per acre of salmon
US: OVER-USE OF ANTIBIOTICS THREATENS HUMANS by Danielle Knight
Source: Inter Press Service
3December 2014
Antibiotic consumption in Antibiotic consumption in animals, 2000animals, 2000
Source: Follet,G (2000) Agbioforum
4December 2014
Primary effects sought from antibiotic growth promoters
• increased growth
• improved feed efficiency
• lower incidence of certain diseases
Source. Doyle E, Food Research Institute, University of Wisconsin
5December 2014
European ban on the use of antibiotic European ban on the use of antibiotic growth promoters, 1998 - 2006growth promoters, 1998 - 2006
6December 2014
Antibiotics: therapeutic use and growth Antibiotics: therapeutic use and growth promotion, pigs, Denmark 1992 - 2008promotion, pigs, Denmark 1992 - 2008
Mg/kg
Source: Aarestrup F. Danish Government
7December 2014
Annual antibiotic use for human and Annual antibiotic use for human and veterinary practice in Denmarkveterinary practice in Denmark
8December 2014
Success factors, Danish ban on growth Success factors, Danish ban on growth promoterspromoters
9December 2014
Estimated antimicrobial use to produce Estimated antimicrobial use to produce on kilogram of meaton kilogram of meat
Source: Grave K, Torren-Edo J, Mackay D. Comparison of the sales of veterinary antibacterial agents between 10 European countries. Journal of Antimicrobial Chemotherapy, 2010, 65(9):2037-40.
10December 2014
Antibiotic use in animal husbandry Antibiotic use in animal husbandry
Source: New England Journal of Medicine, 1999
11March 2013
Antimicrobial resistance at animal/human Antimicrobial resistance at animal/human interface: US awareness campaigninterface: US awareness campaign
12December 2014
Macrolide use and enterococcal Macrolide use and enterococcal resistance in pigs, Denmarkresistance in pigs, Denmark
Source: Statens Serum Institut, Danish Veterinary and Food Administration, Danish Medicines Agency, NationalVeterinary Institute and National Food Institute, Technical University of Denmark.
13December 2014
Cephalosporin resistance after stopping Cephalosporin resistance after stopping use in poultry, Quebec, Canadause in poultry, Quebec, Canada
Source: Dutil L et al. Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada. Emerging Infectious Diseases, 2010, 16(1):48-54.
14December 2014
Fireblight (Fireblight (Erwinia amylovora), fruit trees, ), fruit trees, USA 1994USA 1994
Source: McManus L, American Phytological Society, 1994
15December 2014
Microbial-resistant plant agricultureMicrobial-resistant plant agriculture
16December 2014
*Bacterial resistance, aquaculture *Bacterial resistance, aquaculture sludge, Puget Sound, 1992sludge, Puget Sound, 1992
Aquaculture Puget Sound*pseudomonads, E.coli,enterobacter,enterococci, other
17December 2014
Vaccination in aquaculture, Vaccination in aquaculture, US and NorwayUS and Norway
18December 2014
Antimicrobial use and salmon/trout production, Antimicrobial use and salmon/trout production, Norway, after introduction of vaccination, 1994Norway, after introduction of vaccination, 1994
0
100 000
200 000
300 000
400 000
500 000
600 000
700 000
1981 1984 1987 1990 1993 1996 1999 2002
Vo
lum
e
(to
ns
wfe
)
0
10 000
20 000
30 000
40 000
50 000
60 000
An
tib
ioti
cs
(kg
ac
tiv
e s
ub
sta
nce
)
Volume salmon and trout Consumption antibiotics
Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006
19December 2014
Complexity of the antimicrobial webComplexity of the antimicrobial web
Source:Cantas l.Front. Microbiol., 14 May 2013 |
20December 2014
Antimicrobial resistance: two Antimicrobial resistance: two independent mechanisms independent mechanisms
Selection pressure: over/under-use of antimicrobials
Plasmid exchange: environmental exposure to other organisms
21December 2014
Principal transfer pathways, antibiotic resistance genes: humans, animals, food and the environment
Source: DARC/ARHAI joint report, UKI
Plants
22December 2014
Risks at animal/animal and animal/human interface
23December 2014
Reservoirs of bacteria causing human Reservoirs of bacteria causing human infectionsinfections
Source: WHO
24December 2014
Multidrug-resistant Definitive Type (DT) 104 Multidrug-resistant Definitive Type (DT) 104 Salmonella Typhimurium, Europe, 1982-1996Salmonella Typhimurium, Europe, 1982-1996
Salmonella Typhimurium isolates from both cattle and humans
%
0
10
20
30
40
50
1982-85 1986-90 1991-94 1995-96
cattle humans
Source: WHO from published data
25December 2014
Clinician-perceived contribution(%) of Clinician-perceived contribution(%) of individual bacteria species, EU 2000individual bacteria species, EU 2000
Source: Bywater and Casewell: J Antimicrobial Chemotherapy, 2000
26December 2014
Possible alternatives to growth promotersPossible alternatives to growth promoters
• Alternative husbandry practices leading to cleaner agriculture
• Probiotics (e.g. lactic acid bacteria) and competitive exclusion of other organisms
• Organic acids (Acidifers) to acidify feed and encourage growth of lactobacilli – PH monitoring/rumen chip technology
• Gastrointestinal enzymes to increase digestability of feed
• Immune modulators to enhance resistance to infection
• Feed supplements (vitamins, protein supplements and minerals)
• Nitric Oxide and respiratory disease - stressed animals
Source. Doyle E. Food Research Institute, University of Wisconsin
December 2014 27
Putting it all together: antimicrobial resistance in animals, plants and fish
• Increased public awareness
• Clean agriculture
• Use existing vaccines
• Work across sectors
• Regulation with enforcement
• Monitoring effectiveness of above and other interventions
• Research and development - newer technologies, point of care diagnostics, vaccines
• Select/hybridise/engineer microbial-resistant plants
• Consider an international treaty
• Do the bottom line mathematics
28December 2014
The bottom line: do the mathsThe bottom line: do the maths
Human + antibiotic = saved life
Food animal, fish and plant + antibiotic = saved life
+ rapid growth, and equal or increased profit
29December 2014
Leading infectious causes of mortality, Leading infectious causes of mortality, 2008 estimates, 2008 estimates, with smallpox 1967with smallpox 1967
Dea
ths
(mill
ions
)
< 5 years old > 5 years old
0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
ARI AIDSDiarrhoea TB Malaria Measles
Smal
lpox
196
7