Use of Antimicrobials in Animals and International Organizations - PowerPoint PPT Presentation

Use of Antimicrobials in Animals and International Organizations Concern on Antimicrobial Resistance Dr Kruy Sun Lay, Head of Food microbiology Unit Thailand Workshop 17-19/09/2012

Plan  Background on public health concern by AMR  Food as a source of AMR  Some bacteria harboring resistant genes  Adrressing the public health impact of AMU  Global strategy for prevention and control of foodborne AMR 2 Workshop 30/01/2012

Antimicrobial resistance: a public Health concern  Antimicrobials are essential drugs for treatment of infectious diseases in Human and Animals, and must be preserved  Discovery of antibiotics is one of the most important achievements of the 20 th century  Resistance has developed soon after and new drugs has been developed to replace older ones as resistance emerged…  BUT today, Resistance is emerging and spreading faster than new drugs are being developed  AMR a priority for WHO and was the topic of World Health Day 2011 on April 7 th 2011 Thailand Workshop 17-19/09/2012 3

AMR and Animal Husbandry  Widespread use of antimicrobials in livestock production ….not only from therapeutic purposes  Same classes of antimicrobials are used both in humans and food- producing animals…  Food is generally considered to be the most important vector for spread of resistance between humans and animals  Globalization of food trade, need for international action Thailand Workshop 17-19/09/2012 4

WHD 2011 slogan 5

Health consequences of AMR transmitted through the food chain  Increased number of infections  Increased frequency of treatment failures  Increased severity of infections  Prolonged duration of illness  Increased frequency of bloodstream infections  Increased hospitalization  Increased morbidity and mortality  Staphylococcus, Salmonella, Campylobacter, E coli……….  Increased costs to society Thailand Workshop 17-19/09/2012 6

Food as a source of AMR  Antimicrobial resistant bacteria: direct hazard  Humans can be infected after food ingestion or handling  Zoonotic bacteria e.g. Salmonella , Campylobacter  Associated with antimicrobial use in animals  Non-zoonotic bacteria e.g. Shigella, Vibrio  Associated with antimicrobial use in humans  Antimicrobial resistance genes: indirect hazard  Transfer of resistance genes from a resistant bacterium to a pathogenic bacterium, directly, or via another commensal microorganism ( E coli, Enterococcus spp)  Mobile genetic elements harboring resistance determinants can readily be transferred horizontally between bacteria from terrestrial animals, fish and humans  Can also take place in natural environments e.g the kitchen  E. coli and Enterococcus spp . Thailand Workshop 17-19/09/2012 7

AMR bacteria: MRSA - I  Community-acquired methicillin resistant Staphylococcus aureus (MRSA) infections are an emerging problem  MRSA has recently also become a zoonotic issue  MRSA detected in companion and food producing animals  A particular MRSA strain, ST398 (MLST-type), has increasingly been isolated from pigs and pig farmers  Use of antibiotics a risk factor  EU, 2008: 22.8% of breeding pigs holdings MRSA pos.  92.5% ST398  Dutch study: MRSA in 11% of various meat samples  84% ST398, mostly from poultry Thailand Workshop 17-19/09/2012 Thailand Workshop 17-19/09/2012 8

Resistant Salmonella  Foodborne disease caused by resistant Salmonella well documented  Through beef, pork, poultry, dairy products, eggs, fresh produce  The most common resistances observed are typically to those antibiotics that are frequently used in animal husbandry  Antibiotic use in animals selects for antibiotic resistant non-typhoid Salmonella serotypes  Transmitted to humans in food, or through direct contact with animals  ESBL resistant Salmonella from humans has been associated with ceftiofur use in poultry Thailand Workshop 17-19/09/2012 9

Resistant Campylobacter  Food, in particular poultry meat, is considered the most common infection route for Campylobacter , including resistant strains  Resistance emergence and its increase in Campylobacter from animals and humans linked to the introduction of the antibiotic in food animal  Campylobacter from poultry meat is frequently resistant, in many countries also to fluoroquinolones Thailand Workshop 17-19/09/2012 10

E. coli  Commensal E. coli can be a source of resistance genes for human pathogenic strains  Exchange of resistance genes between bacterial clones has been demonstrated experimentally in water, soil, on kitchen towels, on cutting boards, and on the surface of food  A substantial proportion of resistant E. coli in human intestines is derived from food and water  Human pathogenic E. coli strains resistant to ciprofloxacin and 3rd generation cephalosporins (ESBL's) are associated with the use of antimicrobials similar to ciprofloxacin and ceftriaxone (enrofloxacin and ceftiofur) in food animals and especially poultry Thailand Workshop 17-19/09/2012 11

Addressing the public health impact of use of antimicrobials in food-producing animals and International Achievements 1990-2012  International collaboration established  Codex, FAO, OIE, WHO  Codex Ad Hoc Intergovernmental task Force on Antimicrobial resistance (2007-2010)  18+ expert meetings and consultations  WHO list of Critically Important Antimicrobials for Human Heath developed  Establishment of an Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR)  WHD 2011 : Joint WHO and OIE Call for reduction of use of AMU in Animal Husbandry Thailand Workshop 17-19/09/2012 12

Global strategy for Prevention and Control of Foodborne Antimicrobial Resistance-1  National and international interdisciplinary cooperation  Prudent use of antimicrobial agents in all sectors  Phase out use of antimicrobial agents for growth promotion  EU already banned all growth promoters as of January 1, 2006  A good regulatory system for approval and licensing  Prescription-only  Practitioners not having economic profit from prescription  Routine prophylactic use of antimicrobials should be never be used as a substitute for health management  Accurate diagnosis and antimicrobial susceptibility testing  Appropriate antimicrobial product and administration route  Infection control  Successful disease control relies on an approach encompassing hygiene, animal husbandry and management, nutrition, animal welfare, and vaccination Thailand Workshop 17-19/09/2012 13

Global strategy for Prevention and Control of Foodborne Antimicrobial Resistance-2  Antimicrobials identified as critically important in human medicine ( 1998, 2005, 2007) to be used in animals only if justified  Fluoroquinolones, 3 + 4 generation cephalosporins  Monitoring of antimicrobial resistance and antimicrobial usage in human and animals  Useful information on prevalence and trends  Input for risk assessment and risk management  A basis for choosing, implementing and evaluating interventions Thailand Workshop 17-19/09/2012 14

Advisory Group on Integrated Surveillance of Antimicrobial Resistance- AGISAR-WHO  31 Members, FAO and OIE participation To support international  Subcommittees commitments to  Usage Monitoring minimize the public  Antimicrobial Resistance Surveillance List health impact of  Capacity Building antimicrobial resistance  Software Development associated with the use of antimicrobials in food  1st meeting: Copenhagen, Denmark, June 2009. animals.  2nd meeting: Guelph, Canada June, 2010.  3 rd meeting : Oslo, Norway, June 2011 15

Conclusion A continuing problem… but urgent action needed.  New challenges will arise, including food safety, trade issues  Need harmonization of methods and reliable data on antimicrobial  use and antimicrobial resistance (capacity building, pilot studies in developing countries) Need for approaches   AGISAR -WHO  Proper prevention and control measures Basic and applied research   Mechanisms, trends and risk factors  New antimicrobials, alternatives to antimicrobials, vaccines Need for audacity in solutions – end unnecessary use!  Thailand Workshop 17-19/09/2012 16

Thanks Dr AWA Aidara-Kane, Coordinator, Department of Food Safety and  Zoonoses, WHO Dr Victorio Fattori, Dr Renata Clarke ( Nutrition and Consumer  Protection Division) Dr Patrick Otto, Animal Production and Health Division  Food and Agriculture Organization of the United Nation (FAO) Thailand Workshop 17-19/09/2012 17

Thank you for your attention 18