scholarly journals One Health drivers of antibacterial resistance: quantifying the relative impacts of human, animal and environmental use and transmission

2020 ◽  
Author(s):  
Ross D. Booton ◽  
Aronrag Meeyai ◽  
Nour Alhusein ◽  
Henry Buller ◽  
Edward Feil ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
One Health ◽  
Transmission Rate ◽  
Action Plan ◽  
Resistant Bacteria ◽  
Antibacterial Resistance ◽  
Security Threat ◽  
Human Use ◽  
Long Term Impact

AbstractIntroductionAntimicrobial resistance (AMR), particularly antibacterial resistance (ABR) is a major global health security threat projected to cause over ten million human deaths annually by 2050. There is a disproportionate burden of ABR within lower- and middle-income countries (LMICs), but it is not well understood how ‘One Health’ drivers, where human health is co-dependent on the health of animals and environmental factors, might also impact the burden of ABR in different countries. Thailand’s “National Strategic Plan on Antimicrobial Resistance in Thailand” (NSP-AMR) aims to reduce AMR morbidity by 50% through a reduction of 20% in human antibacterial use and a 30% reduction in animal use starting in 2017. There is a need to understand the implications of such a plan within a One Health perspective that mechanistically links humans, animals and the environment.MethodsA mathematical model of antibacterial use, gut colonisation with extended-spectrum beta-lactamase (ESBL)-producing bacteria and faecal/oral transmission between populations of humans, animals and the environment was calibrated using estimates of the prevalence of ESBL-producing bacteria in Thailand, taken from published studies. This model was used to project the reduction in human ABR (% reduction in colonisation with resistant bacteria) over 20 years (2020-2040) for each potential One Health driver, including each individual transmission rate between humans, animals and the environment, exploring the sensitivity of each parameter calibrated to Thai-specific data. The model of antibacterial use and ABR transmission was used to estimate the long-term impact of the NSP-AMR intervention and quantify the relative impacts of each driver on human ABR.ResultsOur model predicts that human use of antibacterials is the most important factor in reducing the colonisation of humans with resistant bacteria (accounting for maximum 72.3 – 99.8% reduction in colonisation over 20 years). The current NSP-AMR is projected to reduce the human burden of ABR by 7.0 – 21.0%. If a more ambitious target of 30% reduction in antibacterial use in humans were set, a greater (9.9 – 27.1%) reduction in colonisation among humans is projected. We project that completely limiting antibacterial use within animals could have a lower impact (maximum 0.8 – 19.0% reductions in the colonisation of humans with resistant bacteria over 20 years), similar to completely stopping animal-to-human transmission (0.5 – 17.2%). Entirely removing environmental contamination of antibacterials was projected to reduce the percentage colonisation of humans with resistant bacteria by 0.1 – 6.2%, which was similar to stopping environment-human transmission (0.1 – 6.1%).DiscussionOur current understanding of the interconnectedness of ABR in a One Health setting is limited and precludes the ability to generate projected outcomes from existing ABR action plans (due to a lack of fit-for-purpose data). Using a theoretical approach, we explored this using the Thai AMR action plan, using the best available parameters to model the estimated impact of reducing antibacterial use and transmission of resistance between populations. Under the assumptions of our model, human use of antibacterials was identified as the main driver of human ABR, with slightly more ambitious reductions in usage (30% versus 20%) predicted to achieve higher impacts within the NSP-AMR programme. Considerable long-term impact may be also achieved through increasing the rate of loss of resistance and limiting One Health transmission events, particularly human-to-human transmission. Our model provides a simple framework to explain the mechanisms underpinning ABR, but further empirical evidence is needed to fully explain the drivers of ABR in LMIC settings. Future interventions targeting the simultaneous reduction of transmission and antibacterial usage would help to control ABR more effectively in Thailand.

scholarly journals Country Income Is Only One of the Tiles: The Global Journey of Antimicrobial Resistance among Humans, Animals, and Environment

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 473
Author(s):  
Angela Pieri ◽  
Richard Aschbacher ◽  
Giada Fasani ◽  
Jole Mariella ◽  
Lorenzo Brusetti ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Infection Control ◽  
One Health ◽  
Action Plan ◽  
Animal Health ◽  
Animal Husbandry ◽  
Resistant Bacteria ◽  
International Agencies ◽  
Control And Prevention ◽  
Infection Control And Prevention

Antimicrobial resistance (AMR) is one of the most complex global health challenges today: decades of overuse and misuse in human medicine, animal health, agriculture, and dispersion into the environment have produced the dire consequence of infections to become progressively untreatable. Infection control and prevention (IPC) procedures, the reduction of overuse, and the misuse of antimicrobials in human and veterinary medicine are the cornerstones required to prevent the spreading of resistant bacteria. Purified drinking water and strongly improved sanitation even in remote areas would prevent the pollution from inadequate treatment of industrial, residential, and farm waste, as all these situations are expanding the resistome in the environment. The One Health concept addresses the interconnected relationships between human, animal, and environmental health as a whole: several countries and international agencies have now included a One Health Approach within their action plans to address AMR. Improved antimicrobial usage, coupled with regulation and policy, as well as integrated surveillance, infection control and prevention, along with antimicrobial stewardship, sanitation, and animal husbandry should all be integrated parts of any new action plan targeted to tackle AMR on the Earth. Since AMR is found in bacteria from humans, animals, and in the environment, we briefly summarize herein the current concepts of One Health as a global challenge to enable the continued use of antibiotics.

scholarly journals Updated research agenda for water, sanitation and antimicrobial resistance

2020 ◽  
Vol 18 (6) ◽  
pp. 858-866
Author(s):  
Daisuke Sano ◽  
Astrid Louise Wester ◽  
Heike Schmitt ◽  
Mohan Amarasiri ◽  
Amy Kirby ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Resistance Genes ◽  
One Health ◽  
Action Plan ◽  
Geographical Area ◽  
Health Surveillance ◽  
World Health ◽  
Resistant Bacteria ◽  
Relative Role ◽  
Human Waste

Abstract The emergence and spread of antimicrobial resistance (AMR), including clinically relevant antimicrobial-resistant bacteria, genetic resistance elements, and antibiotic residues, presents a significant threat to human health. Reducing the incidence of infection by improving water, sanitation, and hygiene (WASH) is one of five objectives in the World Health Organization's (WHO) Global Action Plan on AMR. In September 2019, WHO and the Health-Related Water Microbiology specialist group (HRWM-SG) of the International Water Association (IWA) organized its third workshop on AMR, focusing on the following three main issues: environmental pathways of AMR transmission, environmental surveillance, and removal from human waste. The workshop concluded that despite an increase in scientific evidence that the environment may play a significant role, especially in low-resource settings, the exact relative role of the environment is still unclear. Given many antibiotic-resistant bacteria (ARB) can be part of the normal gut flora, it can be assumed that for environmental transmission, the burden of fecal-oral transmission of AMR in a geographical area follows that of WASH-related infections. There are some uncertainties as to the potential for the propagation of particular resistance genes within wastewater treatment plants (WWTPs), but there is no doubt that the reduction in viable microbes (with or without resistance genes) available for transmission via the environment is one of the goals of human waste management. Although progress has been made in the past years with respect to quantifying environmental AMR transmission potential, still more data on the spread of environmental AMR within human communities is needed. Even though evidence on AMR in WWTPs has increased, the reduction in the emergence and spread of AMR by basic sanitation methods is yet unresolved. In order to contribute to the generation of harmonized One Health surveillance data, WHO has initiated an integrated One Health surveillance strategy that includes the environment. The main challenge lies in rolling it out globally including to the poorest regions.

scholarly journals Unsafe “crossover-use” of chloramphenicol in Uganda: importance of a One Health approach in antimicrobial resistance policy and regulatory action

2021 ◽  
Author(s):  
Kayley D. McCubbin ◽  
John W. Ramatowski ◽  
Esther Buregyeya ◽  
Eleanor Hutchinson ◽  
Harparkash Kaur ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Focus Group ◽  
Low Income ◽  
One Health ◽  
Antibiotic Use ◽  
Regulatory Action ◽  
Health Concern ◽  
Drug Shop ◽  
Human Consumption ◽  
Human Use

AbstractSince the introduction of antibiotics into mainstream health care, resistance to these drugs has become a widespread issue that continues to increase worldwide. Policy decisions to mitigate the development of antimicrobial resistance are hampered by the current lack of surveillance data on antibiotic product availability and use in low-income countries. This study collected data on the antibiotics stocked in human (42) and veterinary (21) drug shops in five sub-counties in Luwero district of Uganda. Focus group discussions with drug shop vendors were also employed to explore antibiotic use practices in the community. Focus group participants reported that farmers used human-intended antibiotics for their livestock, and community members obtain animal-intended antibiotics for their own personal human use. Specifically, chloramphenicol products licensed for human use were being administered to Ugandan poultry. Human consumption of chloramphenicol residues through local animal products represents a serious public health concern. By limiting the health sector scope of antimicrobial resistance research to either human or animal antibiotic use, results can falsely inform policy and intervention strategies. Therefore, a One Health approach is required to understand the wider impact of community antibiotic use and improve overall effectiveness of intervention policy and regulatory action.

scholarly journals Resistance and Adaptation of Bacteria to Non-Antibiotic Antibacterial Agents: Physical Stressors, Nanoparticles, and Bacteriophages

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 435
Author(s):  
Sada Raza ◽  
Kinga Matuła ◽  
Sylwia Karoń ◽  
Jan Paczesny
Keyword(s):  
Antimicrobial Resistance ◽  
Antibacterial Agents ◽  
Uv Light ◽  
Resistance Mechanisms ◽  
Resistant Bacteria ◽  
Physical Factors ◽  
Defense Systems ◽  
Drug Resistant Bacteria

Antimicrobial resistance is a significant threat to human health worldwide, forcing scientists to explore non-traditional antibacterial agents to support rapid interventions and combat the emergence and spread of drug resistant bacteria. Many new antibiotic-free approaches are being developed while the old ones are being revised, resulting in creating unique solutions that arise at the interface of physics, nanotechnology, and microbiology. Specifically, physical factors (e.g., pressure, temperature, UV light) are increasingly used for industrial sterilization. Nanoparticles (unmodified or in combination with toxic compounds) are also applied to circumvent in vivo drug resistance mechanisms in bacteria. Recently, bacteriophage-based treatments are also gaining momentum due to their high bactericidal activity and specificity. Although the number of novel approaches for tackling the antimicrobial resistance crisis is snowballing, it is still unclear if any proposed solutions would provide a long-term remedy. This review aims to provide a detailed overview of how bacteria acquire resistance against these non-antibiotic factors. We also discuss innate bacterial defense systems and how bacteriophages have evolved to tackle them.

scholarly journals Aquatic environments in the One Health context: modulating the antimicrobial resistance phenomenon

2020 ◽  
Vol 32 ◽  
Author(s):  
Juliana Alves Resende ◽  
Vânia Lúcia da Silva ◽  
Claudio Galuppo Diniz
Keyword(s):  
Antimicrobial Resistance ◽  
One Health ◽  
Anthropogenic Activities ◽  
Treatment Strategies ◽  
Chemical Pollution ◽  
Resistant Bacteria ◽  
Aquatic Environments ◽  
Antimicrobial Substances ◽  
Antimicrobial Resistance Genes ◽  
The One

Abstract: From an anthropocentric perspective, aquatic environments are important to maintain health and survival, however, as they are sometimes managed based on misconception, they are considered a convergent pathway for anthropogenic residues and sanitation. Thus, it is observed that these ecosystems have been threatened by chemical pollution due to xenobiotics, especially from a more contemporary approach, by the selective pressure associated with antimicrobials. There are several studies that report the enrichment of antimicrobial resistant bacteria and mobilizable antimicrobial resistance genes in aquatic and adjacent ecosystems. From the perspective of the emerging and reemerging number of diseases related to the interplay of human, animal, and environmental factors, a new conception arose to address these issues holistically, which is known as the One Health approach. Scientific and political discourse on this conception should lead to effective action plans for preventing and controlling the spread of infectious diseases in open environment, including those impacted by anthropogenic activities. Therefore, nowadays, discussions on antimicrobial resistance are becoming broader and are requiring a multi-disciplinary view to address health and environmental challenges, which includes aquatic environment management. Water may represent one of the most important ecosystems for the in antimicrobial resistance phenomenon that arises when a dynamic and singular microbial community may be influenced by several characteristics. As antimicrobial substances do not all degrade at the same time under the same treatment, strategies concerning their removal from the environment should consider their individualized chemical characteristics.

scholarly journals Improving educator’s knowledge and confidence to teach infection prevention and antimicrobial resistance

2020 ◽  
pp. 001789692094959
Author(s):  
Catherine Hayes ◽  
Charlotte Eley ◽  
Carla Brown ◽  
Rowshonara Syeda ◽  
Neville Q Verlander ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Infection Prevention ◽  
Action Plan ◽  
Service Evaluation ◽  
Infection Prevention And Control ◽  
Post Intervention ◽  
Logistic Regression Models ◽  
Train The Trainer ◽  
The Uk

Objective: e-Bug is a teaching resource that addresses the UK 5-year National Action Plan on antimicrobial resistance (AMR) that pledges to work with educators and local authorities to ensure young people understand infection prevention and control (IPC) and AMR. This study aimed to evaluate the effectiveness and acceptability of the e-Bug face-to-face train-the-trainer intervention with school and community educators. Design: Service evaluation of an educational intervention via surveys. Setting: Workshops were organised by Public Health England (PHE) and collaborators in seven regions of the UK during 2018–2019. Method: Pre- and post-intervention surveys measured satisfaction with training, knowledge of IPC and AMR, and confidence to teach others. Statistical analyses included multilevel and ordinal logistic regression models to measure change in educator knowledge and confidence. Results: In all, 262 educators participated: primary (46%), secondary (17%), college (2%), healthcare (29%) and community (7%). Educators had high pre-intervention knowledge of topics, with significant improvement ( p < .05) in confidence to teach all topics and some significant IPC knowledge improvement, post-intervention. There was strong evidence for a difference in confidence change between educator types, with primary educators improving the most. Ninety-five percent of educators rated the train-the-trainer workshop positively, valued the interactive workshops and felt confident to use the resources. Conclusion: Confident and knowledgeable educators, achieved via e-Bug train-the-trainer workshops, will enhance education of IPC and AMR topics in schools and communities, and therefore support the UK 5-year AMR action plan. The intervention will be monitored with long-term follow-up surveys to explore how training has been disseminated and to evaluate long-term benefits.

scholarly journals Towards a research agenda for water, sanitation and antimicrobial resistance

2017 ◽  
Vol 15 (2) ◽  
pp. 175-184 ◽  
Author(s):  
Susanne Wuijts ◽  
Harold H. J. L. van den Berg ◽  
Jennifer Miller ◽  
Lydia Abebe ◽  
Mark Sobsey ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Research Agenda ◽  
Human Exposure ◽  
Action Plan ◽  
Genetic Resistance ◽  
World Health ◽  
Low Income Countries ◽  
Resistant Bacteria ◽  
Surveillance Strategy

Clinically relevant antimicrobial resistant bacteria, genetic resistance elements, and antibiotic residues (so-called AMR) from human and animal waste are abundantly present in environmental samples. This presence could lead to human exposure to AMR. In 2015, the World Health Organization (WHO) developed a Global Action Plan for Antimicrobial Resistance with one of its strategic objectives being to strengthen knowledge through surveillance and research. With respect to a strategic research agenda on water, sanitation and hygiene and AMR, WHO organized a workshop to solicit input by scientists and other stakeholders. The workshop resulted in three main conclusions. The first conclusion was that guidance is needed on how to reduce the spread of AMR to humans via the environment and to introduce effective intervention measures. Second, human exposure to AMR via water and its health impact should be investigated and quantified, in order to compare with other human exposure routes, such as direct transmission or via food consumption. Finally, a uniform and global surveillance strategy that complements existing strategies and includes analytical methods that can be used in low-income countries too, is needed to monitor the magnitude and dissemination of AMR.

scholarly journals Building the European Antimicrobial Resistance Surveillance network in veterinary medicine (EARS-Vet)

2021 ◽  
Vol 26 (4) ◽  
Author(s):  
Rodolphe Mader ◽  
Peter Damborg ◽  
Jean-Philippe Amat ◽  
Björn Bengtsson ◽  
Clémence Bourély ◽  
...  
Keyword(s):  
Veterinary Medicine ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
One Health ◽  
Action Plan ◽  
Animal Health ◽  
World Health ◽  
European Economic Area ◽  
Surveillance Network ◽  
Antimicrobial Resistance Surveillance

Antimicrobial resistance (AMR) should be tackled through a One Health approach, as stated in the World Health Organization Global Action Plan on AMR. We describe the landscape of AMR surveillance in the European Union/European Economic Area (EU/EEA) and underline a gap regarding veterinary medicine. Current AMR surveillance efforts are of limited help to veterinary practitioners and policymakers seeking to improve antimicrobial stewardship in animal health. We propose to establish the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet) to report on the AMR situation, follow AMR trends and detect emerging AMR in selected bacterial pathogens of animals. This information could be useful to advise policymakers, explore efficacy of interventions, support antimicrobial stewardship initiatives, (re-)evaluate marketing authorisations of antimicrobials, generate epidemiological cut-off values, assess risk of zoonotic AMR transmission and evaluate the burden of AMR in animal health. EARS-Vet could be integrated with other AMR monitoring systems in the animal and medical sectors to ensure a One Health approach. Herein, we present a strategy to establish EARS-Vet as a network of national surveillance systems and highlight challenges of data harmonisation and bias. Strong political commitment at national and EU/EEA levels is required for the success of EARS-Vet.

scholarly journals ANTIMICROBIAL RESISTANCE PROGRAMS IN THE EUROPEAN UNION

2018 ◽  
Vol 6 ◽  
pp. 978-985
Author(s):  
Ana Maria Zorlescu ◽  
Stelian Baraitareanu ◽  
Doina Danes
Keyword(s):  
European Union ◽  
Antimicrobial Resistance ◽  
One Health ◽  
Action Plan ◽  
Animal Health ◽  
Good Practice ◽  
The European Union ◽  
Member States ◽  
Animal Populations ◽  
The One

INTRODUCTION: Antimicrobial resistance is one of the topical issues that is part of the “One Health” concept with implications for animal health, human health, and even environmental “health”. At the European Commission (EC) level, legislation has been issued for the monitoring of antimicrobial resistance and these rules are applicable by each Member State (MS). For the proper implementation of the above legislation, audits are carried out in Member States that have developed programs on antimicrobial resistance that go beyond the EC's requests.OBJECTIVES: The aim of the study was the analysis of existing data reports, legislation and recommendations on antimicrobial resistance through which surveillance and monitoring is carried out in the European Union (EU).  METHODS: The audit reports issued between 2015 and 2017 by the Food Veterinary Office (FVO), as well as the articles and studies issued by the EC through the antimicrobial resistance institutes were analysed.RESULTS: The FVO conducted audits to “evaluate the monitoring and reporting of antimicrobial resistance in zoonotic and commensal bacteria in certain food-producing animal populations and food” in 12 MS, and audits to “gather information on the prudent use of antimicrobials in animals” in 8 MS. These are countries that have very well implemented the EC's requests and included the “One Health” perspective in antimicrobial resistance programs. Some Member States have risk management strategies for reducing antimicrobial resistance for more than 20 years. They have carried out research projects on antimicrobial resistance. There is an action plan on antimicrobial resistance at the EC level, but their implementation and understanding up to the level of all actors involved in this issue varies from MS to MS. Antimicrobial resistance in the animal population is a topical issue, notoriety among the actors involved, as well as an interdisciplinary problem with indirect results. The same principle of antimicrobial resistance in animals is applicable to humans and the environment as such, this problem can be embedded in the concept of “One Health”. The overall objective of the MS is to generate knowledge and tools to “combat” antimicrobial resistance in animals, humans and even the environment.CONCLUSION: As a conclusion, in order to improve and optimize antimicrobial resistance programs, a “good practice guide” can be achieved by MS with extensive experience in this area, to be used by MS with a more precarious application and over time to harmonize antimicrobial resistance programs within the EU.

scholarly journals One Health—Its Importance in Helping to Better Control Antimicrobial Resistance

2019 ◽  
Vol 4 (1) ◽  
pp. 22 ◽  
Author(s):  
Peter Collignon ◽  
Scott McEwen
Keyword(s):  
Antimicrobial Resistance ◽  
Infection Control ◽  
One Health ◽  
Growth Promotion ◽  
Animal Husbandry ◽  
Resistant Bacteria ◽  
Antimicrobial Use ◽  
Inappropriate Use ◽  
International Agencies ◽  
Better Regulation

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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