The Hy-Plains Education and Research Center near Montezuma, Kansas, hosted its One Health Initiative meeting in late June and the meeting explored science-based solutions to reduce antibiotic use in food animal production. Speakers ranged from veterinarians versed in antibiotic specifics to Centers for Disease Control and Prevention professionals.
Dr. Bob Smith, a veterinarian with Veterinary Research and Consulting Services, said the meeting of such minds should give attendees “a perspective on this issue, because we know that antibiotics are a life saving and very necessary tool to control and to treat infectious diseases.”
Antibiotics have been around long enough, Smith said, and there have recently been some concerns about the long-term sustainability of the antibiotics available to veterinarians.
“The term that we would use would be antibiotic resistance,” Smith said.
Veterinary side
Kansas State University Professor, Production Medicine/Clinical Pharmacology, Mike Apley said the talk about resistance and whether it’ll have an effect clinically or if a population of bacteria could suddenly take a lot more antibiotic to affect their growth is merited.
Every subject requires some context, and Apley said, more than 100 years ago when antibiotics were discovered, if a person developed an infection, doctors gave patients a potent cocktail of meds.
“So 108 years ago, you go to the hospital with an infection, we treated you with an arsenic derivative,” he said. “The thought process was hopefully we kill the bacteria before we kill you. A rather crude hammer.”
Animal health responsibility
“Bacteria and their ability to spread resistance genes are amazing,” Apley said, adding those who treat animals on a daily basis have a tremendous responsibility when deciding to utilize antibiotics.
Antimicrobial stewardship has been a buzzword recently, and it’s important to understand exactly what’s being said. For veterinarians, the focus has been on infection prevention more often than not. For Apley, stewardship includes having a responsibility for appropriate diagnostics and establishment of an accurate and functional case definition.
“This means we know what we’re treating, we know if it’s present, we understand the pressure and we also understand how we diagnose it,” he said. “That’s the first thing we’ve got is a responsibility then you enter a cycle.”
Next, ask if there’s a non-antibiotic alternative, which will appropriately prevent, control or treat this disease challenge. Apley said that includes environment, husbandry and nutrition.
Apley said there are two types of antibiotic use—effective and ineffective. Why would one ever choose ineffective? Possibly, they don’t know what else to use? If the ineffectives are discontinued the outcome can’t be good.
“The ultimate antibiotic failure that we can cause equals bacterial population exposure without achieving the desired effect,” Apley said. “So we have to make sure we’re not using things out of habit. That what we’re using is still effective and we’ve got some of these labels especially in feed that are 40 to 50 years old.”
For Apley, a defining moment for him about antibiotics was reflection. Growing up on a farm, producers are creative to get machinery up and running, often tightening the baling wire until it breaks and then backing it off a quarter turn.
“I’m telling you we might have tightened it enough to break it and we need to look at optimum use with a long term view—realizing we’re going to get very limited tools and the way we set things up in the 80s and 90s thinking we had beat infectious disease,” Apley said. “That isn’t the way I’m thinking today.”
Human side
Dawn Sievert, associate director of antimicrobial resistance, Division of Foodborne, Waterborne and Environmental diseases at the Centers for Disease Control and Prevention, provided insight on how the CDC views microbial resistance—its perspective, interactions and collaboration. The One Health Initiative is how the CDC is dealing with antimicrobial resistance.
“There is no other way to effectively and successfully deal with it. We are all in this together,” Sievert said. “It is constantly emerging and changing and we are having a hard time keeping up with it because it keeps moving and we have all these gaps that we’re identifying that we have to deal with.”
Antimicrobial resistance has become global, and affects everyone.
“It’s people, it’s animals, it’s environment and it’s international and it’s domestic,” she said. “And it’s all tied together the way we live in the world together. It’s complex.”
Expectedly, assumptions are made the CDC only cares about the human aspect, and “everything else doesn’t matter.” But that’s not the case Sievert said.
“If you’re only taking care of one piece of that triangle or the circle, and something else isn’t right that is just going to feed back and it’s going to under cut the advances you’ll be making on one side,” she said. “Under the One Health umbrella the health of all animals, humans and the environment matter.”
Each piece matters because of the interaction.
Since the CDC deals with the human aspect of antimicrobial resistance, Sievert explained a little bit of their process. She said they care about antimicrobial resistance in humans because of the threat to human health.
“Each year in the U.S. at least 2 million people—just in the U.S.—get infected with an antibiotic resistant bacteria, and at least 23,000 of those people die as a result,” Sievert said.
Projections show by 2050, there will be 10 million people dying from antimicrobial resistant infections. This number exceeds cancer and many other illnesses.
The CDC also believes outbreak response is important as far as the One Health aspect goes.
“It’s impossible to figure things out enough to be able to get to a point where we can take it to our next step of improving something or responding effectively to keep everybody—animals, the environment, people healthy and stop that individual spread,” Sievert said.
By furthering the process to find out how an outbreak happened or what went wrong, findings can help determine what the next step will be.
The prevention effort of CDC—identifying the problem—really is working to get people healthy. It’s not useful if they don’t take it one step further and say, how do we stop it from happening again or reduce the chances of it happening again by changing something that’s in their control. Then they try to innovate.
“So those immediate responses for the prevention come out of that response and identify a problem,” Sievert said. “Then we try to think ahead of the game. And that’s the way were going to beat antimicrobial resistance.”
How does one get two steps ahead of the pathogens or how do they figure out before the organism does how to stay alive, survive and spread? Sievert said the CDC is trying to figure this out.
We’re trying to figure out new innovative ways to not have to be in the position of giving an antimicrobial,” she said. “We’re all working on trying to move that together. Again, under the One Health umbrella—every one working in their space sort of closes those gaps.”
Kylene Scott can be reached at 620-227-1804 or [email protected].
