antibiotic resistance on farms.april14 - hog watch manitoba
TRANSCRIPT
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AntibioticresistanceJanHajek
InfectiousDiseasesDoctor,VancouverGeneralHospitalClinicalAssistantProfessor,UniversityofBritishColumbia
April14,[email protected]
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Disclosures
• Financialdisclosures• None
• Clinicalinfectiousdiseasesdoctor• Notaveterinarian• Notinvolvedinfarming
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Outlineofpresentation
• Antibioticsandantibioticresistance• Background
• Examplesofantibioticuseonfarmsaffectingpeople1. Levyfarmexperiment2. Ceftiofurstory3. Colistinstory
• Canadianfarmpractices
• Takehomemessage
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Antibiotics
• AntibioticsdiscoveredbyFlemingin1928• Penicilliummoldgrowingnexttobacteriakilledthebacteria”moldjuice”
• Penicillinusestartedin1940sà savedcountlesslives• Deathratesfrompneumonia/skininfectionsplummeted
• FlemingawardedtheNobelprize1943• Hewarnedabouttheemergenceofresistanceifantibioticsaremisused• “Itisnotdifficulttomakemicrobesresistanttopenicillininthelaboratorybyexposingthemtolowconcentrations”
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Antibioticresistance
• https://www.youtube.com/watch?v=plVk4NVIUh8
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Antibioticuseas“growthpromotion”
• 1950’sitwasdiscoveredthatlowlevelsofantibiotics promotesanimalstogainweightfaster
• Usedaspartoftheoverallintensificationandindustrializationofanimalfarming;increasedefficiency
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Levyfarmstudy1976
• Part1• Studiedachickenfarminwhichantibioticswerenotused• Tooksamplesfromchickens,farmfamilymembers,andneighbors
• Part2• Addedtetracyclinetothefoodforchickens• Measuredantibioticresistanceinbacteriaovertime• Samplesfromthechickens,farmfamilymembers,andneighbors
LenardCampbellN.Engl.J.Med. 295, 583–588 (1976)
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Levyfarmstudy1976What%ofstoolbacteriabecomeantibioticresistant?
LenardCampbellN.Engl.J.Med. 295, 583–588 (1976)
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Levyfarmstudy197690%ofchickens,25%offarmfamilymembers…
LenardCampbellN.Engl.J.Med. 295, 583–588 (1976)
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Swannreport,UK1969
• AlarmedbyincreasingantibioticresistanceinSalmonellainfections(cowsà people):
• Calledforastopoftheuseoflowdosesofantibioticsonfarmsforpromotion/prevention–ahazardtohumanandanimalhealth
• “Wearesatisfiedthatthesehazardscanlargelybeavoidedandshouldthereforenotbeallowedtocontinue”
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Canada2004– 2016Theceftiofur story…• Omphalitis– Infectionofthechicken’syolksac– E.coli,andotherbacteria– Riskfactorsincludepoorhygienicconditions
• Somefarmersalsoroutinelyinjectedceftiofur intoeggstoroutinetopreventtheinfection…
“Mushychickendisease”
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Canada2004– 2016Theceftiofur story…• 2004- highratesofceftiofur-resistanceinchickenmeatandpeople• 2005- voluntarysuspensionofceftiofur useineggs
EID.2010Jan;16(1):48–54
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Canada2004– 2016Theceftiofur story…•
Epidemiol andInfection147,e296,1–20.
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Ceftiofurresistance=Ceftriaxoneresistance
https://www.cdc.gov/drugresistance
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Antibiotic-resistanceseriousproblem
• Oneofthemostsignificantthreatstopublichealth
• Eachyear,aroundtheworld:• 700,000peoplediefromantibiotic-resistantbacterialinfections• Couldgoupto10millionperyearby2050
• Concernsaboutreturningtothepre-antibioticera• Medicalversionofglobalwarmingandclimatecrisis
https://www.who.int/antimicrobial-resistance/interagency-coordination-group/final-report/en/
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2commonclinicalexamplesofantibioticresistance1. Infectionsinpersonswithextremelydrug-resistantbacteria• “Hospitalacquired”– after multiplecoursesofantibiotics
• Chroniclungdisease• Burns
• Sometimesresistanttoallavailableantibiotics• Trycombinationsandhighdoses
2. Urinarytractinfections• Communityacquired
• Sometimesresistanttomanyantibiotics• Oftennopreviousantibioticuse….
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27FpreviouslyhealthyBurningwithurinationandfever– senturineforculture…
IVonly– kidneyandhearingtoxicity
IVonly– “3rd lineantibiotics”
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UTIasa“foodborneinfection”Someoftheevidence
• VirtuallyidenticalstrainsofE.coliinanimals/meatandpeoplewithUTI
• AllUTIsareNOTfoodborne• Butsomeare;someE.colicausingUTIhavebeenacquiredthroughfood
FoodbornePathog Dis4(4):419–431;LancetInfect Dis.2019;19:1269-1270
Animalsonfarm
AntibioticusepromotesAntibioticResistantBacteria
AntibioticResistantBacteriacontaminatefoodandcolonizepeople
Hospitalprocedureorotherriskfactors
AntibioticResistantBacteriainfectioninpeople
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Colisitin story
• Colistinisanantibioticoflastresort• Discovered1950s• Rarelyusedbecauseofsideeffects• Forextremelydrugresistantbacteria;personswithrecurrentpneumonias,burns…
• But,commonlyusedinpartsoftheworldforgrowthpromotion• Addedtofoodgiventopigs
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Colistinstory
• China– 2015• Bacteriawithmcr (MobileColistinResistance)werefound:• 20%ofpigsinslaughterhouses• 15%ofretailpigmeat• 1%patientsinhospital
• Globally– 2016on….• MCRfoundinanimalsandpeoplein>30countries• Spreadglobally
.LancetInfectDis. 2016Feb;16(2):161-8
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AntibioticuseinCanada
• ~80%ofallantibioticsinCanadaareusedonfarms
• 1.4xmoreantibioticsperkggiventoanimalsthanpeople
• Mostisfor“offlabeluse”• Growthpromotion• Growthprevention
CIPARSreport2018
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AntibioticuseonfarmsinCanada
CIPARSreport2018
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Canadianresponsetoantibioticuseonfarms
• 2002– HealthCanadaAdvisoryCommittee• Raisedalarms
• Nosystemtomonitortheamountofantibioticsusedonfarms• “Ownusepolicy”– farmercanimportantanyantibioticsfromanywhereintheworld
• 2008– HealthCanadaTaskForcere:ownusepolicyà nochangesrecommended
• 2015– Federalactionplan:• 2017 - Closedthe“ownuse”policy• Dec2018:- Stopusingmedicallyimportantantibioticsfor“growthpromotion”
- Requireavet’sprescriptionforallmedicallyimportantantibiotics
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Antibioticresistanceisoneofthemostsignificantthreatstopublichealth
•
https://www.who.int
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Extraslides
• Antibioticsareanintegratedandroutinelyusedmanagementtool,andinmanycases,farmersmightnotevenbeawarethattheyareusingthemorforwhatpurpose
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Antibiotic-resistantbacteriaonrawsupermarketmeatintheUS:
National Antimicrobial Resistance Monitoring System 2015 Integrated Report, published Oct. 23, 2017.
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“Super-bugs”
• MRSA – MethicillinResistantStaphylococcusAureus
• ESBL – ExtendedSpectrumBeta-lactamase(especiallyE.Coli)
• CPO – Carbapenemase ProducingOrganisms
• MCR – MobilizedColistinResistance– “Antibioticoflastresort”
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Canada2004– 2016Theceftiofur story…•
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MultidrugresistantSalmonellaincattleEngland1977• June1977- SeverediarrheainsouthernEngland• Antibiotic-resistantstrainofSalmonellawasidentified• SpreadtocowsinotherpartsofEngland
• December1977– Humancasesoccurring• Samedrug-resistantstrain
• Callstorestricttheuseofmedicallyimportantantibioticsonfarms
BrMedJii :997(1978)
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CanadianMedicalAssociationJournal
• AccordingtothePublicHealthAgencyofCanada(PHAC),morethanthree-quartersofallantimicrobialsconsumedinCanadaareusedinanimals,andapproximately90%oftheseareusedtopromotegrowthortoprophylacticallyguardagainstdiseaseandinfection.
• PHACisconcernedaboutresistancelevelstothethird-generationcephalosporins suchasceftiofur andceftriaxone,andthefluoroquinolonessuchasenrofloxacin andciprofloxacindetectedinbacteriafoundonretailmeatandpoultry,saysPHACspokesmanStephaneShank.
CMAJ February 18, 2014 186 (3) 173;https://www.cmaj.ca/content/186/3/173
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CanadianMedicalAssociationJournal
• A2016federal surveillancereport indicatedthatHancock’sworriesaboutantimicrobialmisuseandthegrowingthreatofdrug-resistantpathogensarejustified.
• Thereportnotedthatabout82%ofantimicrobialsimportanttohumanmedicinesoldinCanadain2014wereconsumedbyanimals,andthatCanada’sconsumptionofantimicrobialdrugsthatyearwas44timesthatofNorway’s.
https://cmajnews.com/2017/09/13/action-awaits-on-antimicrobial-misuse-cmaj-109-5501/
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Takehomemessage…
•