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