World Antibiotic Awareness Week and the One Health concept

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Monday, 13 November 2017

Laura H Kahn is a physician and research scholar for the Programme on Science and Global Security at the Woodrow Wilson School of Public and International Affairs at Princeton University. She is also the Co-Founder of the One Health Initiative

This week is World Antibiotic Awareness Week sponsored by the World Health Organization.

Antibiotics are the foundation of modern medicine and they have saved countless lives. In his Nobel Prize acceptance speech, Dr Alexander Fleming, the discoverer of penicillin, warned about the dangers of improperly using the drug causing the rise of resistant bacteria.

Antibiotic resistance is increasing

Sadly, his words have proved prescient and today bacteria are becoming increasingly resistant to many antibiotics. It is estimated that at least 700,000 people die from antimicrobial-resistant infections each year.

If the problem isn’t resolved over the next 30 years, around 10 million deaths could occur annually.

As the problem worsens, a blame game has developed between medicine and agriculture as to who is most at fault.

The medical community blames those in agriculture for indiscriminate antibiotic use, especially the use of low doses of antibiotics to promote growth in food animals. The agriculture community blames those in medicine for inappropriate prescribing practices and widespread overuse.

The One Health concept

The truth is far more complex than what many people believe. Because antimicrobial resistance (AMR) is such a complicated, multi-disciplinary issue, the best way to approach it is with a One Health lens.

One Health is the simple concept that human, animal and environmental health are linked. The term is new, but the concept is ancient. Hippocrates, the Greek physician (460-370 BC), recognised that people who went to low lying swampy areas would get sick. Indeed, malaria literally means “bad air.”

Around 2,000 years would pass before scientists discovered that insects spread disease.

A One Health approach, examining human, animal and environmental health, provides unexpected findings in the antimicrobial resistance conundrum.

The importance of whole genome sequencing

The medical and public health communities have assumed that many of the resistant bacteria have come from food animals such as cattle, pigs, and chickens. After all, many of the bacteria cultured from them possess the same resistant genes as the ones isolated from people.

But focusing solely on resistant genes is problematic. It is akin to trying to figure out how people with red hair are related to each other based on their hair colour. Yes, they all have the genes for red hair. But that doesn’t mean they belong to the same families.

Whole genome sequencing (WGS) is required to definitely identify relationships between people, animals and bacteria. After 2008, the cost of WGS dramatically decreased allowing researchers to use it in studying resistant bacteria.

The surprising role of dogs in AMR

The rise of one particular antibiotic resistant bacteria called vancomycin resistant Enterococcus faecium (VRE) was very concerning because there weren’t many drugs left to treat it. There was compelling evidence that VRE in hospitals came from farm animals.

Whole genome sequencing told another story. One clone, VRE CC 17, appears to have evolved from dogs. Dogs do not receive vancomycin, but they do get ampicillin. Several studies have shown that dogs carried ampicillin resistant Enterococcus faecium CC17, which is the genetic precursor to VRE CC17.  

Companion animals have been completely ignored in the debate regarding antimicrobial resistance. They might be playing a key role that must be examined.

Read the full article by Laura H Kahn, “Antimicrobial resistance: a One Health perspective” in our One Health issue of Transactions.

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