Combating Antimicrobial Resistance Through One Health Approach
PARUL
Assistant Professor ,Dept of Veterinary Public Health , U.P. Pandit Deen Dayal Upadhyay Veterinary University (DUVASU), Mathura-281001
Abstract
Antimicrobial resistance (AMR) is a complex issue that threatens human, animal and environmental health besides the global economy and security. The main drivers of antimicrobial resistance are over use, misuse and under use of antimicrobials in human, animal, and environmental sectors for therapeutic and prophylactic purpose. Followed by the spread of resistant bacteria and resistance determinants within and between these sectors and around the globe. AMR issue can be resolve with One Health approach that is collaborative effort of multiple health science professions to attain optimal health for human, animals and our environment. This includes taking steps to preserve the continued effectiveness of existing antimicrobials by eliminating their inappropriate use and by limiting the spread of infection.
Introduction
Antimicrobial resistance (AMR) best illustrates the One Health approach among global health problems. One Health approach is a joint effort of various disciplines that come together to provide solutions for human, animal, and environmental health. AMR is a global public health crisis that threatens our ability to successfully treat bacterial infections. Many infectious agents that could once be successfully treated with any one of several drug classes have acquired resistance virtually all of these drugs. The threat is most acute for antibiotics especially synthetic antibacterial agents, so now is the time to monitor resistance for antifungals, antiparasitics, and antivirals. The journey was started from antimicrobial that were truly “wonder drugs” and acted upon wide range of life-threatening infections of human and animals (1). But now a days resistance to most antimicrobials is widely prevalent and there is no invention of new classes of drugs to cope up with AMR. Over use of antimicrobials in human, animal and plant is the measure factor for AMR.
Indiscriminate Use of Antimicrobials in Humans, Animals and Plants
Majority of antimicrobial classes are used in human, animals as well plants with few exceptions that are exclusively used for treatments like flavophospholipols, ionophores, which are used in veterinary purposes as they cause toxicity in human. Likewise, isoniazid that is particularly used for the treatment of tuberculosis in human but not used in bovine tuberculosis. Antimicrobial used in treatment of clinical infection and prophylaxis in companion animals are broadly similar to those that used in humans. In veterinary medicine there are notable differences in the ways that antimicrobials are used in companion animals compared to food-producing animals. The use antibiotics in group of animals either for threaputeic or prophylactic purpose that are at high risk of infection is called “Metaphylaxis”(2). Usually in the context of mass administration of therapeutic doses of an antimicrobial to a group of animals at high risk of infection, e.g., administration of an injectable antimicrobial to groups of calves upon arrival at a feedlot because of a high risk of bovine respiratory disease. Beside antimicrobial prophylaxis in groups of people is uncommon and is usually limited to the management of serious, highly communicable infections such as meningococcal diseases. Long-term and low-dose mass medication for purposes of growth promotion is the most controversial type of group treatment in food animals. Antimicrobial growth promoters are important contributors to antimicrobial resistance because they are administered to entire groups of animals, usually for prolonged periods of time and often at subtherapeutic doses conditions which favours the selection and spread of resistant bacteria within and between groups of animals, as well as to humans through food or other environmental pathways. That’s why the World Health Organization (WHO) advocates for the termination of the use of antimicrobials for growth promotion and the practice has been banned in Europe and phased out in some other countries, such as the United States and Canada.
Risks Associated with AMR
Antimicrobial resistance reduces the effectiveness of antimicrobial therapy and increase the severity, incidence and cost of infection. Ample reports indicates that use of antimicrobial resistance in animals is a considerable source of antimicrobial resistance against enteric pathogen in human such as E. coli, Salmonella spp., Campylobacter spp., Enterococcus spp. Continuous use of disinfectants at animal farm and food processing plants also trigger to antimicrobial resistance. Animals are the reservoir host for nontyphoidal Salmonella and main source of infection to human being. Fecal shedding by carrier animals is an important source of antimicrobial-resistant Salmonella contamination of meat and poultry products and may also be responsible for fruit and vegetable contamination through fecal contamination of the environment. Salmonella resistance to any medically important antimicrobial is a public health concern, but particularly to those critically important to human health, such as cephalosporins and fluoroquinolones for which therapeutic options can be limited. Similarly, Methicillin resistant S. aureus (MRSA) is an important pathogen of humans as well animals causing skin, wound, bloodstream, and other types of infection in humans and mastitis in animals. WHO reports that beta-lactam resistance (i.e., MRSA) is a global problem, with rates of resistance of up to 80 to 100% in Africa, up to 90% in the Americas, and up to 60% in Europe and also an important contributor to global burden of diseases (3).
One Health Strategies to Combat Antimicrobial Resistance
Around the globe to cope up with antimicrobial resistance issue main international agencies concerning with human, animal and plant like WHO, FAO and OIE come forward to make an action plan to fight with the issue of AMR (5). The WHO Global Action Plan seeks to address five major objectives that embraces a One Health approach to address antimicrobial resistance, and it calls on member countries to do the same when developing their own action plans.
- To improve awareness and understanding of antimicrobial resistance through effective communication, education and training
- Strengthen the knowledge and evidence base through surveillance and research
iii. Reduce the incidence of infection through effective sanitation, hygiene, and infection prevention measures
- Optimize the use of antimicrobial medicines in human and animal health
- Develop the economic case for sustainable investment that takes account of the needs of all countries and increase investment in new medicines, diagnostic tools, vaccines, and other interventions
Execution of One Health concept to resolve AMR issue
One Health approach to resolve antimicrobial resistance is now working at the international level and action plans are executed in many countries around the world. Besides, integrated antimicrobial resistance system and antimicrobial use surveillance systems also established to monitor the use of antibiotics in medical as well veterinary fields (6). In spite of all the efforts problem of antimicrobial resistance still seems big and alarming. Much more efforts are needed to fight with these issues in the human and animal sectors on a global basis, in both developed and developing countries. Number of research agencies are encouraged and funded so that plans of one health integration for AMR can be executed, monitored and evaluated at different levels. This One Health research agenda should acknowledge that multiple sectors play a role in the development and spread of AMR and focus efforts on actionable, impact driven research. We urge countries and networks at the forefront of AMR efforts to engage these additional stakeholders in developing such an agenda, recognizing that an effective strategy will have far-reaching benefits in minimizing the impact of this urgent problem on human and animal health, the environment the global economy, national and global security (7).
Conclusion
Antimicrobial resistance (AMR) which refers to the property of microorganisms like bacteria and fungi that develop the ability to defeat the drugs used to kill them, is a One Health issue affecting not only people, but also animals, plants, and the environment. The use of antimicrobials in hospitals, on a farms, on plants can contribute to AMR by which both people and animals are difficult to treat. Antimicrobial use and overuse are important drivers of the resistance phenomenon and the other main drivers are factors that promote the spread of resistant bacteria and their genes locally and globally. So, the challenge for One Health is to ensure that the use of these drugs is optimal overall in case of all three main components of one health.
REFERENCES
1 World Health Organization (WHO). 2014. Antimicrobial Resistance: Global Report on Surveillance. WHO, Geneva, Switzerland.
2 Centers for Disease Control (CDC). 2013. Antibiotic Resistance Threats in the United States. Centers for Disease Control and Prevention, Atlanta, GA.
3 One Health Commission. 2018. What is One Health? https://www.onehealthcommission.org/en/why_one_health/what_is_one_health/. Accessed January 3, 2017.
4 Food and Agriculture Organization (FAO). 2016. Drivers, Dynamics and Epidemiology of Antimicrobial Resistance in Animal Production. FAO, Rome, Italy. http://www.fao.org/publications/card/en/c/d5f6d40d-ef08-4fcc-866b-5e5a92a12dbf/.
5 ECDC (European Centre for Disease Prevention and Control), EFSA (European Food Safety Authority), EMA (European Medicines Agency). 2015. ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals. EFSA J 13:4006.
6 World Organisation for Animal Health (OIE). 2018. OIE annual report on the use of antimicrobial agents in animals. Second report. http://www.oie.int/fileadmin/Home/eng/Our_scientific_expertise/docs/pdf/AMR/Annual_Report_AMR_2.pdf
7 WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR). 2016. Critically Important Antimicrobials for Human Medicine, 4th revision. WHO, Geneva, Switzerland.
