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Working across sectors: a public health approach to to antimicrobial resistance December 2014 1 Antibiotic use: use in plants, fish and animals US: OVER-USE OF ANTIBIOTICS THREATENS HUMANS by Danielle Knight 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 Source: Inter Press Service December 2014 2 Antibiotic consumption in animals, 2000 Source: Follet,G (2000) Agbioforum December 2014 3 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 December 2014 4 European ban on the use of antibiotic growth promoters, 1998 - 2006 December 2014 5 Mg/kg Antibiotics: therapeutic use and growth promotion, pigs, Denmark 1992 - 2008 Source: Aarestrup F. Danish Government December 2014 6 Annual antibiotic use for human and veterinary practice in Denmark December 2014 7 Success factors, Danish ban on growth promoters December 2014 8 Estimated antimicrobial use to produce on 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. December 2014 9 Antibiotic use in animal husbandry Source: New England Journal of Medicine, 1999 December 2014 10 Antimicrobial resistance at animal/human interface: US awareness campaign March 2013 11 Macrolide use and enterococcal resistance 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. December 2014 12 Cephalosporin resistance after stopping use 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. December 2014 13 Fireblight (Erwinia amylovora), fruit trees, USA 1994 Source: McManus L, American Phytological Society, 1994 December 2014 14 Microbial-resistant plant agriculture December 2014 15 *Bacterial resistance, aquaculture sludge, Puget Sound, 1992 Aquaculture Puget Sound *pseudomonads, E.coli,enterobacter,enterococci, other December 2014 16 Vaccination in aquaculture, US and Norway December 2014 17 700 000 60 000 600 000 50 000 500 000 400 000 30 000 300 000 20 000 200 000 Antibiotics (tons wfe) Volume 40 000 (kg active substance) Antimicrobial use and salmon/trout production, Norway, after introduction of vaccination, 1994 10 000 100 000 0 0 1981 1984 1987 1990 1993 1996 1999 2002 Volume salmon and trout Consumption antibiotics Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006 December 2014 18 Complexity of the antimicrobial web Source:Cantas l.Front. Microbiol., 14 May 2013 | December 2014 19 Antimicrobial resistance: two independent mechanisms Selection pressure: over/under-use of antimicrobials December 2014 Plasmid exchange: environmental exposure to other organisms 20 Principal transfer pathways, antibiotic resistance genes: humans, animals, food and the environment Plants Source: DARC/ARHAI joint report, UKI December 2014 21 Risks at animal/animal and animal/human interface December 2014 22 Reservoirs of bacteria causing human infections Source: WHO December 2014 23 Multidrug-resistant Definitive Type (DT) 104 Salmonella Typhimurium, Europe, 1982-1996 Salmonella Typhimurium isolates from both cattle and humans cattle humans % 50 40 30 20 10 0 1982-85 Source: WHO from published data December 2014 1986-90 1991-94 1995-96 24 Clinician-perceived contribution(%) of individual bacteria species, EU 2000 Source: Bywater and Casewell: J Antimicrobial Chemotherapy, 2000 December 2014 25 Possible 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 26 Putting it all together: antimicrobial resistance in animals, plants and fish • • • • • • • • • • December 2014 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 27 The bottom line: do the maths Human + antibiotic = saved life Food animal, fish and plant + antibiotic = saved life + rapid growth, and equal or increased profit December 2014 28 Leading infectious causes of mortality, 2008 estimates, with smallpox 1967 3.5 3.0 2.5 2.0 Smallpox 1967 Deaths (millions) > 5 years old < 5 years old 1.5 1.0 0.5 0 December 2014 ARI Diarrhoea AIDS TB Malaria Measles 29