Alternatives to antibiotics in a One Health context and the role genomics can play in reducing antimicrobial use

Approaching any issue from a One Health perspective necessitates looking at the interactions of people, domestic animals, wildlife, plants, and our environment. For antimicrobial resistance this includes antimicrobial use (and abuse) in the human, animal and environmental sectors. More importantly, the spread of resistant bacteria and resistance determinants within and between these sectors and globally must be addressed. Better managing this problem includes taking steps to preserve the continued effectiveness of existing antimicrobials such as trying to eliminate their inappropriate use, particularly where they are used in high volumes. Examples are the mass medication of animals with critically important antimicrobials for humans, such as third generation cephalosporins and fluoroquinolones, and the long term, in-feed use of antimicrobials, such colistin, tetracyclines and macrolides, for growth promotion. In people it is essential to better prevent infections, reduce over-prescribing and over-use of antimicrobials and stop resistant bacteria from spreading by improving hygiene and infection control, drinking water and sanitation. Pollution from inadequate treatment of industrial, residential and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have now included a One Health Approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use, better regulation and policy, as well as improved surveillance, stewardship, infection control, sanitation, animal husbandry, and finding alternatives to antimicrobials.

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A framework for improved one health governance and policy making for antimicrobial use

BMJ Global Health ◽

10.1136/bmjgh-2019-001807 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001807 ◽

Cited By ~ 2

Author(s):

Dominic Moran

Keyword(s):

Greenhouse Gas ◽

Market Failure ◽

One Health ◽

Global Climate ◽

Animal Health ◽

Evaluation Framework ◽

Greenhouse Gas Mitigation ◽

Antimicrobial Use ◽

Intrinsic Resistance ◽

Environmental Pollution Problem

There is a need to develop an evaluation framework to identify intervention priorities to reduce antimicrobial use (AMU) across clinical, agricultural and environmental settings. Antimicrobial resistance (AMR) can be conceptualised and therefore potentially managed in the same way as an environmental pollution problem. That is, over-use of antimicrobial medicines as inputs to human and animal health leads to unintended leakage of resistance genes that further combine with natural or intrinsic resistance in the environment. The diffuse nature of this leakage means that the private use decision is typically neither cognisant, nor made responsible for the wider social cost, which is the depletion of wider antibiotic effectiveness, a common pool resource or public good. To address this so-called market failure, some authors have suggested a potential to learn from similar management challenges encountered in the sphere of global climate change, specifically, capping use of medically important drugs analogous to limits set on greenhouse gas emissions. Drawing on experience of the economics of greenhouse gas mitigation, this paper explores a potential framework to develop AMU budgets based on a systematic comparative appraisal of the technical, economic, behavioural and policy feasibility of AMU reduction interventions across the One Health domains. The suggested framework responds to a call for global efforts to develop multi-dimensional metrics and a transparent focus to motivate research and policy, and ultimately to inform national and global AMR governance.

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920. Use of the Web by State and Territorial Health Departments to Promote the Dissemination of State Antimicrobial Resistance Surveillance Data, United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1108 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S494-S495

Author(s):

Xin Yin ◽

Keith W Hamilton ◽

Heather Tate ◽

Nkuchia M M’ikanatha

Keyword(s):

Public Health ◽

United States ◽

Antimicrobial Resistance ◽

Health Professionals ◽

One Health ◽

Antimicrobial Use ◽

Web Survey ◽

Related Information ◽

Appropriate Antimicrobial Use ◽

The Web

Abstract Background Antimicrobial resistant (AMR) bacteria pose a serious threat to public health. The national response to this threat includes calls for promoting judicious use of antibiotics in humans and animals and strengthening integrated One Health surveillance of AMR bacteria in humans, animals, and environment. However, the extent to which public health jurisdictions are disseminating surveillance findings to promote judicious use of antimicrobials is unclear. Methods We used a standardized web audit tool to manually review and document the presence of AMR-related information on the websites of all public health jurisdictions that participate in national notifiable disease surveillance in the United States. We also emailed a survey to representatives in the 54 jurisdictions that participate in the National Antimicrobial Resistance Monitoring System (NARMS) activities coordinated by the Centers for Disease Control and Prevention. The survey asked questions about AMR-related information on their public health department website. Results Of the 37 (68.5%) jurisdictions that responded to the email survey, 26 (70.3%) indicated that their websites have information on appropriate antibiotic use for health professionals, veterinarians and general public, compared to 89.3% from the web survey (Figure). Eleven (29.7%) indicated that they have data on antimicrobial susceptibility for pathogens, or antibiograms, on their websites, compared to 48.2% from the web survey. While 11 (29.7%) jurisdictions indicated that they have highlighted appropriate antimicrobial use on the homepage, the web survey found no reference on the homepage. Comparison of results from email and web survey on public health jurisdictions’ website, United States - 2020 Conclusion Public health jurisdictions have begun to use websites to increase awareness about the threat of antimicrobial resistance. However, the limited presence of information on appropriate antimicrobial use for the public, health professionals and veterinarians suggest the need for improvement. Gaps exist between the awareness of the epidemiologists and laboratorians and the information reported on public health jurisdictions’ websites. Websites can be expanded and better leveraged to increase visibility of AMR and appropriate antimicrobial prescribing across One Health domains. Disclosures All Authors: No reported disclosures

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Evaluating the Integration of One Health in Surveillance Systems for Antimicrobial Use and Resistance: A Conceptual Framework

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.611931 ◽

2021 ◽

Vol 8 ◽

Author(s):

Cécile Aenishaenslin ◽

Barbara Häsler ◽

André Ravel ◽

E. Jane Parmley ◽

Sarah Mediouni ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Conceptual Framework ◽

Surveillance System ◽

One Health ◽

Specific Aspect ◽

Evaluation Framework ◽

Public Health Issue ◽

Antimicrobial Use ◽

Surveillance Systems ◽

Global Public Health

It is now widely acknowledged that surveillance of antimicrobial resistance (AMR) must adopt a “One Health” (OH) approach to successfully address the significant threats this global public health issue poses to humans, animals, and the environment. While many protocols exist for the evaluation of surveillance, the specific aspect of the integration of a OH approach into surveillance systems for AMR and antimicrobial Use (AMU), suffers from a lack of common and accepted guidelines and metrics for its monitoring and evaluation functions. This article presents a conceptual framework to evaluate the integration of OH in surveillance systems for AMR and AMU, named the Integrated Surveillance System Evaluation framework (ISSE framework). The ISSE framework aims to assist stakeholders and researchers who design an overall evaluation plan to select the relevant evaluation questions and tools. The framework was developed in partnership with the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). It consists of five evaluation components, which consider the capacity of the system to: [1] integrate a OH approach, [2] produce OH information and expertise, [3] generate actionable knowledge, [4] influence decision-making, and [5] positively impact outcomes. For each component, a set of evaluation questions is defined, and links to other available evaluation tools are shown. The ISSE framework helps evaluators to systematically assess the different OH aspects of a surveillance system, to gain comprehensive information on the performance and value of these integrated efforts, and to use the evaluation results to refine and improve the surveillance of AMR and AMU globally.

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Antimicrobial use and production system shape the fecal, environmental, and slurry resistomes of pig farms

Microbiome ◽

10.1186/s40168-020-00941-7 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Oscar Mencía-Ares ◽

Raúl Cabrera-Rubio ◽

José Francisco Cobo-Díaz ◽

Avelino Álvarez-Ordóñez ◽

Manuel Gómez-García ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Production System ◽

One Health ◽

Farming System ◽

Antimicrobial Use ◽

Sample Type ◽

Swine Production ◽

Pig Farming ◽

Antimicrobial Resistance Genes ◽

Global Threat

Abstract Background The global threat of antimicrobial resistance (AMR) is a One Health problem impacted by antimicrobial use (AMU) for human and livestock applications. Extensive Iberian swine production is based on a more sustainable and eco-friendly management system, providing an excellent opportunity to evaluate how sustained differences in AMU impact the resistome, not only in the animals but also on the farm environment. Here, we evaluate the resistome footprint of an extensive pig farming system, maintained for decades, as compared to that of industrialized intensive pig farming by analyzing 105 fecal, environmental and slurry metagenomes from 38 farms. Results Our results evidence a significantly higher abundance of antimicrobial resistance genes (ARGs) on intensive farms and a link between AMU and AMR to certain antimicrobial classes. We observed differences in the resistome across sample types, with a higher richness and dispersion of ARGs within environmental samples than on those from feces or slurry. Indeed, a deeper analysis revealed that differences among the three sample types were defined by taxa-ARGs associations. Interestingly, mobilome analyses revealed that the observed AMR differences between intensive and extensive farms could be linked to differences in the abundance of mobile genetic elements (MGEs). Thus, while there were no differences in the abundance of chromosomal-associated ARGs between intensive and extensive herds, a significantly higher abundance of integrons in the environment and plasmids, regardless of the sample type, was detected on intensive farms. Conclusions Overall, this study shows how AMU, production system, and sample type influence, mainly through MGEs, the profile and dispersion of ARGs in pig production.

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Assessment of Evaluation Tools for Integrated Surveillance of Antimicrobial Use and Resistance Based on Selected Case Studies

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.620998 ◽

2021 ◽

Vol 8 ◽

Author(s):

Marianne Sandberg ◽

Ayla Hesp ◽

Cécile Aenishaenslin ◽

Marion Bordier ◽

Houda Bennani ◽

...

Keyword(s):

One Health ◽

Assessment Tool ◽

Antimicrobial Use ◽

Surveillance Systems ◽

Complex Data ◽

Evaluation Tools ◽

Food And Agriculture ◽

Food And Agriculture Organization ◽

Pathway Tool ◽

Eu Project

Regular evaluation of integrated surveillance for antimicrobial use (AMU) and resistance (AMR) in animals, humans, and the environment is needed to ensure system effectiveness, but the question is how. In this study, six different evaluation tools were assessed after being applied to AMU and AMR surveillance in eight countries: (1) ATLASS: the Assessment Tool for Laboratories and AMR Surveillance Systems developed by the Food and Agriculture Organization (FAO) of the United Nations, (2) ECoSur: Evaluation of Collaboration for Surveillance tool, (3) ISSEP: Integrated Surveillance System Evaluation Project, (4) NEOH: developed by the EU COST Action “Network for Evaluation of One Health,” (5) PMP-AMR: The Progressive Management Pathway tool on AMR developed by the FAO, and (6) SURVTOOLS: developed in the FP7-EU project “RISKSUR.” Each tool was scored using (i) 11 pre-defined functional aspects (e.g., workability concerning the need for data, time, and people); (ii) a strengths, weaknesses, opportunities, and threats (SWOT)-like approach of user experiences (e.g., things that I liked or that the tool covered well); and (iii) eight predefined content themes related to scope (e.g., development purpose and collaboration). PMP-AMR, ATLASS, ECoSur, and NEOH are evaluation tools that provide a scoring system to obtain semi-quantitative results, whereas ISSEP and SURVTOOLS will result in a plan for how to conduct evaluation(s). ISSEP, ECoSur, NEOH, and SURVTOOLS allow for in-depth analyses and therefore require more complex data, information, and specific training of evaluator(s). PMP-AMR, ATLASS, and ISSEP were developed specifically for AMR-related activities—only ISSEP included production of a direct measure for “integration” and “impact on decision making.” NEOH and ISSEP were perceived as the best tools for evaluation of One Health (OH) aspects, and ECoSur as best for evaluation of the quality of collaboration. PMP-AMR and ATLASS seemed to be the most user-friendly tools, particularly designed for risk managers. ATLASS was the only tool focusing specifically on laboratory activities. Our experience is that adequate resources are needed to perform evaluation(s). In most cases, evaluation would require involvement of several assessors and/or stakeholders, taking from weeks to months to complete. This study can help direct future evaluators of integrated AMU and AMR surveillance toward the most adequate tool for their specific evaluation purpose.

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