the johns hopkins center for a livable future capitol hill briefing: antibiotic resistance: a...
DESCRIPTION
On 12/2/09 on Capitol Hill, leading experts in economics, public health and public policy and Rep. Louise Slaughter (D-NY), a leading voice on antibiotic resistance, discussed the impact of resistant infections on the U.S. healthcare system and the need to phase out inappropriate use of antibiotics as growth promoters in the production of food animals. The Johns Hopkins Center for a Livable Future (CLF) hosted the event with Rep. Slaughter. This is a complication of the panelists' presentations.TRANSCRIPT
Congressional Briefing
Antibiotic Resistance: A Multi-Billion Dollar Healthcare
Crisis
Congressional Briefing
Antibiotic Resistance: A Multi-Billion Dollar Healthcare
Crisis
The cost of losing antibiotic effectiveness
Ramanan LaxminarayanCenter for Disease Dynamics, Economics & Policy (CDDEP)
Resources for the Future
Burden of resistance: Lower quality of care
Resistant infections result in more deaths and disability
Odds of dying of MRSA are nearly twice as large as for sensitive Staph
Burden of resistance: Lower quality of care
The estimated number of people developing a serious MRSA infection (i.e., invasive) in 2005
was about 94,360 (CDC)Approximately 18,650 persons died during a
hospital stay related to serious MRSA infections (CDC)
Burden of resistance: Higher cost of care
Methicillin resistance was associated with an increase in length of hospital stay (increased
1.29 fold) and hospital charges (increased 1.36 fold) after the bacteremia (Cosgrove 2005)
Resistance is leading to the use of more powerful antibiotics…
…that are also more costly.
Overall societal costs
Between $378 million to $18.6 billion annual cost of increased resistance in community-
acquired infections (Elbasha 2001)$30 billion a year (Institute of Medicine)
Difficulty in measuring burden
No DRG for resistance-related hospitalizationCorrelation between disease severity and
colonization with resistant pathogenNot all antibiotic use is bad
Who bears the cost?
Where do resistant bacteria come from?
Antibiotic use in healthcarePoor infection control
Older, sicker patients undergoing more complex procedures
Antibiotic use in animals
Congressional Briefing
Antibiotic Resistance: A Multi-Billion Dollar Healthcare
Crisis
Dr. Lance PriceDirector, Center for Metagenomics and Human Health, Translational Genomics
Research Institute
Bacteria become resistant to antibiotics
People become infected with antibiotic resistant bacteria
Key Concepts
Antibiotic Selection
RIP
Anytime you use antibiotics you are potentially selecting for antibiotic
resistant bacteria
Antibiotic use in food-animal production
Single greatest use of antibioticsMillions of pounds every year
Most of the antibiotics are classes important to human medicine
Selects for cross-resistant bacterial populationsMost antibiotics are fed to animals in the
absence of disease!
If an animal production system requires routine antibiotic inputs to keep the
animals from becoming sick, then that system is broken!
Johnson 2007
What happens if you remove the antibiotics from food animal production?
Preservation of Antibiotics for Medical Treatment Act (PAMTA)
H.R. 1549/S. 619
We must eliminate non-therapeutic and routine antibiotic use in food animal
production in order to preserve the utility of our life-saving antibiotics for treating
sick people!
PAMTAH.R. 1549/S. 619
Congressional Briefing
Antibiotic Resistance: A Multi-Billion Dollar Healthcare
Crisis
Combating Antimicrobial Resistance: Veterinary Medicine’s Role
Michael J. Blackwell, DVM, MPH
The Broadest Medical Profession: Veterinary Medicine• Three medical professions
– Physicians, Dentists, and Veterinarians• Only veterinarians have comparative medicine training, making it the
broadest– Multiple species (including those in the food supply)– Broadest prescription authority
• Ensures public health by addressing diseases in animals before they affect humans– Food-borne disease agents affecting humans, that are also found in animals
include, Salmonella, and E. coli– Infectious diseases in humans that originated in animals include, HIV/AIDS,
SARS, West Nile Virus, Avian Influenza, and ?Swine Influenza?
Uses of Antimicrobials in Food Animals (i.e., food supply)• Therapeutic (treatment)
– Diagnosed microbial disease
• Prophylactic (prevention)– After an exposure, but before clinical onset – In advance of expected exposure
Uses of Antimicrobials in Food Animals (i.e., food supply)
• Non-therapeutic (routine)– Absence of disease, or exposure, or expected exposure (i.e., healthy
animals)– Weight gain, growth promotion, feed efficiency– Many drugs are available directly to lay persons
• veterinary oversight not required
To Reduce Antimicrobial Resistance
• Stop non-therapeutic (routine) uses
• Require veterinary oversight of all uses of antimicrobials in animals, especially if the drug is used in human medicine– Veterinarians are the best trained and the only ones licensed to decide
appropriate uses
To Reduce Antimicrobial Resistance
• Use options other than antimicrobials as a first line of defense– More focus on husbandry practices
• waste management, less crowding, better ventilation
• Improve surveillance, monitoring, and reporting– Better drug use data– Risk Assessments
• More public funding of resistance research– Less bias and less of a conflict of interest
Thank You!
Congressional Briefing
Antibiotic Resistance: A Multi-Billion Dollar Healthcare
Crisis
Pew Commission on Industrial Farm Animal Production
Bob Martin
Commission Membership
• 16 Commissioners from diverse background
• Animal agriculture producers, human medicine, public health, animal health, ethics, religion, state and federal policy represented
• Academic contributors from major universities
Charge to Commission
• Commission charged with developing solutions to the public health, environmental, rural community, and animal welfare problems caused by industrial animal feeding operations
• Commission found, generally, industrial animal operations presented an unacceptable threat to the public health, damage to the environment and rural communities and was harmful to the animals
Commission Process
• 11 meetings held in all regions of the United States, including two public hearings
• 250 hours of deliberations, including more than 50 hours with animal ag representatives
• 8 technical reports, thousands of pages of stakeholder comments, Commissioner expertise, staff papers informed the Commission
• Thousands of pages of information, including 170 peer reviewed reports
Recommendations
• Commission recommendations adopted by consensus
• 24 primary recommendations dealing with public health, animal welfare, the environment, and rural communities.
• 12 of those concerned public health• Five of those focused on antibiotic use in industrial
animal agriculture
Antimicrobial Resistance Recommendations
• Phase out and ban non-therapeutic use of antibiotics in food animal production
• Ban new approvals of non-therapeutic use of antibiotics for food animals and retroactively investigate previously approved antimicrobials
• Strengthen Guidance #152• Commission defines therapeutic as the use of
antimicrobials with a diagnosed microbial disease
Antimicrobial Recommendations (continued)
• Non-therapeutic use is defined as use in the absence of microbial disease or known microbial disease exposure, such as for growth promotion, weight gain, or routine disease prevention
• Prophylactic use is defined as use in a healthy animal in advance of expected exposure or after an exposure but before onset of confirmed clinical disease
Antimicrobial recommendations (continued)
• Improve monitoring and reporting of antimicrobial use in food animal production
• Improve monitoring and surveillance of antimicrobial resistance in the food supply, the environment, and animal and human populations
• Increase veterinary oversight of all antimicrobial use in food animal production to prevent overuse and misuse
Public Health Recommendations
• Implement a disease monitoring program and a fully integrated and robust national database for food animals to allow 48 hour trace back
• Increase monitoring of possible public health effects of CAFOs on people who live and work in or near facilities
• Fully enforce current state and federal regulations and legislation
Public Health Recommendations(continued)
• Strengthen relationships between physicians, veterinarians, and public health professionals to deal with CAFO public health risks
• Create a Food Safety Administration combining food inspection and safety responsibilities of USDA, FDA, and EPA
• Develop a flexible, risk-based food safety system from farm to fork
• More aggressive mitigation of production diseases
Environmental Recommendations
• Improve enforcement of existing federal, state, and local regulations to improve the siting of facilities and to protect the health of those living near them
• Develop new system to deal with farm waste• Increase and improve monitoring and research of
farm waste to hasten new treatment methods
Environmental Recommendations(continued)
• Increase funding for research to improve waste handling systems and to standardize measurements for better comparison between systems
Animal Welfare Recommendations
• Implement federal performance-based standards to improve animal health and well-being
• Implement better animal husbandry practices• Phase out most restrictive confinement systems
within 10 years• Improve animal welfare practices and conditions• Improve animal welfare research
Rural Community Recommendations
• States, counties, and local governments should implement zoning and siting guidance for new facilities that fairly and effectively evaluate the suitability of a site
• Implement policies to promote a competitive marketplace
Additional Research Recommendation
• Expand public funding for, and reform, animal agriculture research
Congressional Briefing
Antibiotic Resistance: A Multi-Billion Dollar Healthcare
Crisis