Abstract
Approaching any issue from a One Health perspective necessitates looking at the interactions of people, domestic animals, wildlife, plants, and our environment. For antimicrobial resistance this includes antimicrobial use (and abuse) in the human, animal and environmental sectors. More importantly, the spread of resistant bacteria and resistance determinants within and between these sectors and globally must be addressed. Better managing this problem includes taking steps to preserve the continued effectiveness of existing antimicrobials such as trying to eliminate their inappropriate use, particularly where they are used in high volumes. Examples are the mass medication of animals with critically important antimicrobials for humans, such as third generation cephalosporins and fluoroquinolones, and the long term, in-feed use of antimicrobials, such colistin, tetracyclines and macrolides, for growth promotion. In people it is essential to better prevent infections, reduce over-prescribing and over-use of antimicrobials and stop resistant bacteria from spreading by improving hygiene and infection control, drinking water and sanitation. Pollution from inadequate treatment of industrial, residential and farm waste is expanding the resistome in the environment. Numerous countries and several international agencies have now included a One Health Approach within their action plans to address antimicrobial resistance. Necessary actions include improvements in antimicrobial use, better regulation and policy, as well as improved surveillance, stewardship, infection control, sanitation, animal husbandry, and finding alternatives to antimicrobials.
Highlights
Antimicrobial resistance is a global public health problem [1,2]
The colistin case demonstrates that using large quantities antimicrobials for group treatments or growth promotion in animals can lead to significant antimicrobial resistance problems for human health, even if the drug class is initially believed to be of lesser importance, because the relative importance of antimicrobials to human health can change
This is the same problem that arose from using avoparcin as a growth promoter until it was banned; it selected for resistance to another glycopeptide, vancomycin, which is used for the treatment of life-threatening Methicillin-resistant Staphylococcus aureus (MRSA) and for treating serious enterococcal infections [81,82]
Summary
Antimicrobial resistance is a global public health problem [1,2]. Most bacteria that cause serious infections and could once be successfully treated with several different antibiotic classes, have acquired resistance—often to many antibiotics. Using antimicrobials for growth promotion is highly controversial because instead of treating sick animals they are administered to healthy animals, usually for prolonged periods of time, and often at sub-therapeutic doses in order to improve production These conditions favor selection and spread of resistant bacteria within animals and to humans through food or other environmental pathways [38,39]. These data strongly suggest that there are other very important factors influencing antimicrobial resistance over and above antibiotic usage. The following examples illustrate antimicrobial resistance problems that arise when the same classes of antimicrobials are used in humans and animals, and the challenges that arise from competing interests and imbalances of risk and benefit in various sectors
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