Association B/w Antimicrobial Consumption and Resistance

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    Recently, a report titled “Antimicrobial Consumption and Resistance in Bacteria from Humans and Animals” has found positive associations between antimicrobial consumption (AMC) in animals and antimicrobial resistance (AMR) in animals as well as in humans.

    About the Report

    • It analysed possible relationships between AMC in humans and food-producing animals and the occurrence of AMR in bacteria from humans and food-producing animals in the European Union (EU)/European Economic Area (EEA).
    • It analysed data for six classes of antibiotics: Third and fourth generation cephalosporins, fluoroquinolones, polymyxins, aminopenicillins, macrolides and tetracyclines.
      • Except tetracyclines, all remaining five classes are Critically Important Antimicrobials (CIA) categorised by the World Health Organization (WHO) as critical for use in human health.
      • Four out of these five CIAs are the Highest Priority CIAs (HPCIA), which are also included in the WHO AWaRe (Access, Watch, Reserve) classification.
    • The report analysed data from three years (2016, 2017 and 2018) for a comparison between AMC in food-producing animals and humans.
    • The data used was collected as part of clinical and epidemiological surveillance/monitoring.
      • Data on AMR in E. coli, K. pneumoniae, S. aureus and C. jejuni were included in this report.
        • E. coli and K. pneumonia are common infection-causing pathogens and S. aureus and C. jejuni are food-borne bacteria.
    • Five different surveillance networks, coordinated by agencies covering EU member states, two EEA countries (Iceland and Norway) and Switzerland, contributed to data sets.
    • The joint inter-agency report was published by the European Centre for Disease Prevention and Control, the European Food Safety Authority and the European Medicines Agency.

    Major Findings

    • Use of Antibodies
      • Penicillins, first- and second-generation cephalosporins and macrolides were the highest selling classes in human medicine.
      • For food-producing animals, tetracyclines and penicillins were the highest selling classes in 2017.
      • The consumption of colistin, a last resort antibiotic and an HPCIA was higher in food-producing animals than in humans across the EU.
    • Correlations between AMU and AMR
      • It established significant correlations between AMU in humans and animals with AMR in humans, animals respectively and also across sectors. 
      • AMU in food-animals is linked to AMR, not only in animals, but also in humans.
      • Major Examples
        • There was a significant positive association between consumption of fluoroquinolones and other quinolones in animals and resistance in E. coli from food-producing animals as well as humans.
        • The consumption of third- and fourth-generation cephalosporins in food-producing animals was seen to be associated with resistance to third-generation cephalosporins in humans.
        • Although the resistance against colistin in isolates from food-producing animals was low, the consumption of colistin in animals had a significant impact on resistance to colistin in E. coli from food-producing animals.
        • Macrolide resistance in C. jejuni from humans was related to macrolide resistance in C. jejuni from poultry as well as turkey.
        • In food-producing animals, statistically significant positive associations between consumption of aminopenicillins and ampicillin resistance were found in E. coli across all years.
        • Similarly, positive association between ampicillin resistance in E. coli from food-producing animals and ampicillin resistance in invasive E. coli from humans was observed for all years.
    • Significance
      • Appropriate data on the use of CIAs in humans and animals and understanding on their linkages to AMR can help inform necessary policy decisions related to restricting the use of CIAs in animals or adoption of preventive measures to reduce dependence on antibiotics in food-animal production.

    Recommendations

    • It suggested that strong interventions to reduce and improve AMC will have a beneficial impact on the occurrence of AMR.
    • It underlined the need to promote prudent use of antimicrobial agents and infection control and prevention in both humans and in food-producing animals, in a One Health approach.
    • Overuse and misuse of antimicrobials, which is one of the main drivers of AMR, should be prevented at any cost or be reduced significantly. 
    • Monitoring AMC becomes more and more relevant because the global AMC in terrestrial and aquatic food animal production is accelerating, which is linked with expanded production to meet increasing demand for animal-source nutrition.
      • In resource constrained settings, where current surveillance systems for AMC are lacking, monitoring can begin with CIAs or HPCIAs, given its relevance and need to preserve them for humans.

    Antimicrobial Consumption

    • It is defined as quantities of antimicrobials used in a specific setting (total, community, hospital) during a specific period of time (e.g. days, months, and year).
    • For global reporting, national estimates of consumption are reported for the calendar year (January to December).

    Antimicrobial Resistance

    • The ability of a microorganism to grow or survive in the presence of an antimicrobial at a concentration that is usually sufficient to inhibit or kill microorganisms of the same species and that exceeds concentrations achievable in the human/animal/patient.
    • It occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.
    • Emergence and Spread
      • It  occurs naturally over time, usually through genetic changes.
      • AMR organisms are found in people, animals, food, plants and the environment (in water, soil and air) and can spread from person to person or between people and animals, including from food of animal origin.
      • The main drivers include the misuse and overuse of antimicrobials, lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals, poor infection and disease prevention and control in healthcare facilities and farms, poor access to quality, affordable medicines, vaccines and diagnostics, lack of awareness and knowledge, and lack of enforcement of legislation.

    (Image Courtesy: Conservation)

    Source: DTE

     

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