antibiotic resistance on farms.april14 - hog watch manitoba

AntibioticresistanceJanHajek

InfectiousDiseasesDoctor,VancouverGeneralHospitalClinicalAssistantProfessor,UniversityofBritishColumbia

April14,[email protected]

Disclosures

• Financialdisclosures• None

• Clinicalinfectiousdiseasesdoctor• Notaveterinarian• Notinvolvedinfarming

Outlineofpresentation

• Antibioticsandantibioticresistance• Background

• Examplesofantibioticuseonfarmsaffectingpeople1. Levyfarmexperiment2. Ceftiofurstory3. Colistinstory

• Canadianfarmpractices

• Takehomemessage

Antibiotics

• AntibioticsdiscoveredbyFlemingin1928• Penicilliummoldgrowingnexttobacteriakilledthebacteria”moldjuice”

• Penicillinusestartedin1940sà savedcountlesslives• Deathratesfrompneumonia/skininfectionsplummeted

• FlemingawardedtheNobelprize1943• Hewarnedabouttheemergenceofresistanceifantibioticsaremisused• “Itisnotdifficulttomakemicrobesresistanttopenicillininthelaboratorybyexposingthemtolowconcentrations”

Antibioticresistance

• https://www.youtube.com/watch?v=plVk4NVIUh8

Antibioticuseas“growthpromotion”

• 1950’sitwasdiscoveredthatlowlevelsofantibiotics promotesanimalstogainweightfaster

• Usedaspartoftheoverallintensificationandindustrializationofanimalfarming;increasedefficiency

Levyfarmstudy1976

• Part1• Studiedachickenfarminwhichantibioticswerenotused• Tooksamplesfromchickens,farmfamilymembers,andneighbors

• Part2• Addedtetracyclinetothefoodforchickens• Measuredantibioticresistanceinbacteriaovertime• Samplesfromthechickens,farmfamilymembers,andneighbors

LenardCampbellN.Engl.J.Med. 295, 583–588 (1976)

Levyfarmstudy1976What%ofstoolbacteriabecomeantibioticresistant?


Levyfarmstudy197690%ofchickens,25%offarmfamilymembers…


Swannreport,UK1969

• AlarmedbyincreasingantibioticresistanceinSalmonellainfections(cowsà people):

• Calledforastopoftheuseoflowdosesofantibioticsonfarmsforpromotion/prevention–ahazardtohumanandanimalhealth

• “Wearesatisfiedthatthesehazardscanlargelybeavoidedandshouldthereforenotbeallowedtocontinue”

Canada2004– 2016Theceftiofur story…• Omphalitis– Infectionofthechicken’syolksac– E.coli,andotherbacteria– Riskfactorsincludepoorhygienicconditions

• Somefarmersalsoroutinelyinjectedceftiofur intoeggstoroutinetopreventtheinfection…

“Mushychickendisease”

Canada2004– 2016Theceftiofur story…• 2004- highratesofceftiofur-resistanceinchickenmeatandpeople• 2005- voluntarysuspensionofceftiofur useineggs

EID.2010Jan;16(1):48–54

Canada2004– 2016Theceftiofur story…•

Epidemiol andInfection147,e296,1–20.

Ceftiofurresistance=Ceftriaxoneresistance

https://www.cdc.gov/drugresistance

Antibiotic-resistanceseriousproblem

• Oneofthemostsignificantthreatstopublichealth

• Eachyear,aroundtheworld:• 700,000peoplediefromantibiotic-resistantbacterialinfections• Couldgoupto10millionperyearby2050

• Concernsaboutreturningtothepre-antibioticera• Medicalversionofglobalwarmingandclimatecrisis

https://www.who.int/antimicrobial-resistance/interagency-coordination-group/final-report/en/

2commonclinicalexamplesofantibioticresistance1. Infectionsinpersonswithextremelydrug-resistantbacteria• “Hospitalacquired”– after multiplecoursesofantibiotics

• Chroniclungdisease• Burns

• Sometimesresistanttoallavailableantibiotics• Trycombinationsandhighdoses

2. Urinarytractinfections• Communityacquired

• Sometimesresistanttomanyantibiotics• Oftennopreviousantibioticuse….

27FpreviouslyhealthyBurningwithurinationandfever– senturineforculture…

IVonly– kidneyandhearingtoxicity

IVonly– “3rd lineantibiotics”

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

Colisitin story

• Colistinisanantibioticoflastresort• Discovered1950s• Rarelyusedbecauseofsideeffects• Forextremelydrugresistantbacteria;personswithrecurrentpneumonias,burns…

• But,commonlyusedinpartsoftheworldforgrowthpromotion• Addedtofoodgiventopigs

Colistinstory

• China– 2015• Bacteriawithmcr (MobileColistinResistance)werefound:• 20%ofpigsinslaughterhouses• 15%ofretailpigmeat• 1%patientsinhospital

• Globally– 2016on….• MCRfoundinanimalsandpeoplein>30countries• Spreadglobally

.LancetInfectDis. 2016Feb;16(2):161-8

AntibioticuseinCanada

• ~80%ofallantibioticsinCanadaareusedonfarms

• 1.4xmoreantibioticsperkggiventoanimalsthanpeople

• Mostisfor“offlabeluse”• Growthpromotion• Growthprevention

CIPARSreport2018

AntibioticuseonfarmsinCanada

CIPARSreport2018

Canadianresponsetoantibioticuseonfarms

• 2002– HealthCanadaAdvisoryCommittee• Raisedalarms

• Nosystemtomonitortheamountofantibioticsusedonfarms• “Ownusepolicy”– farmercanimportantanyantibioticsfromanywhereintheworld

• 2008– HealthCanadaTaskForcere:ownusepolicyà nochangesrecommended

• 2015– Federalactionplan:• 2017 - Closedthe“ownuse”policy• Dec2018:- Stopusingmedicallyimportantantibioticsfor“growthpromotion”

- Requireavet’sprescriptionforallmedicallyimportantantibiotics

Antibioticresistanceisoneofthemostsignificantthreatstopublichealth

•

https://www.who.int

Extraslides

• Antibioticsareanintegratedandroutinelyusedmanagementtool,andinmanycases,farmersmightnotevenbeawarethattheyareusingthemorforwhatpurpose

Antibiotic-resistantbacteriaonrawsupermarketmeatintheUS:

National Antimicrobial Resistance Monitoring System 2015 Integrated Report, published Oct. 23, 2017.

“Super-bugs”

• MRSA – MethicillinResistantStaphylococcusAureus

• ESBL – ExtendedSpectrumBeta-lactamase(especiallyE.Coli)

• CPO – Carbapenemase ProducingOrganisms

• MCR – MobilizedColistinResistance– “Antibioticoflastresort”

Canada2004– 2016Theceftiofur story…•

MultidrugresistantSalmonellaincattleEngland1977• June1977- SeverediarrheainsouthernEngland• Antibiotic-resistantstrainofSalmonellawasidentified• SpreadtocowsinotherpartsofEngland

• December1977– Humancasesoccurring• Samedrug-resistantstrain

• Callstorestricttheuseofmedicallyimportantantibioticsonfarms

BrMedJii :997(1978)

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

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/

Takehomemessage…

•

antibiotic resistance on farms.april14 - hog watch manitoba

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