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It is not difficult to make microbes resistant to penicillin in the laboratory, and the same has occasionally happened in the body. Alexander Fleming, 1945 Nobel Prize Acceptance Speech 1 The End of Modern Medicine? Epidemiology of AMR AQUACULTURE Drinking water Farm effluents & manure spreading Rendering Seas & lakes Drinking water Rivers & streams Soil Sewage Vegetables, seed crops, fruits & vegetables Offal Animal feeds Irrigation water Antibiotics WILDLIFE Dead stock Swim Industrial & household antimicrobial chemicals Swine Hospital FOOD Cattle ANIMALS Sheep Antibiotics Poultry Commercial abattoirs & processing plants Meat & fish Handling, preparation, consumption COMPANION ANIMALS HUMANS Urban areas Others Care facilities Rural areas Food processing antimicrobials Direct contact 2 Antimicrobial resistance Diagram based on Linton (1977), as adapted by Rebecca Irwin, Health Canada (Prescott 2000) and IFT Economic costs Europe – cost of AMR €1.5bn and 600m lost days of productivity per year Russia UK – cost of AMR 83% of families use unnecessary antibiotics at home £10bn/yr societal costs plus £20k per patient episode USA – cost of AMR Healthcare costs alone $21-34bn/yr Japan and Antarctica Resistant bacteria found in water samples 3 Antimicrobial resistance Map and statistics from World Economic Forum “Global Risks 2013” except UK statistics, which are based on work published by Richard Smith of LSHTM THE GLOBAL PICTURE 4 Antimicrobial resistance Can we make a difference? 5 Antimicrobial resistance Public information and education http://bit.ly/CMObook 6 Antimicrobial resistance http://bit.ly/CMOatTEDx