(The systematic literature review was conducted by members of a multidisciplinary research team at the Medical University of South Carolina. Authors are Bernadette P. Marriott, Ph.D.; Kristi Helke, D.V.M., Ph.D.; M.A. McCrackin, D.V.M., Ph.D.; Cassandra Salgado, M.D., M.S.; Ann Z. Poole, M.Ed., and Ashley Galloway, M.S., R.D. Their review was supported in full by Award Number 01834-002 from the Animal Health Institute. The interpretations of the literature and findings are those of the authors.) It’s a universal truth: We want antibiotics to be available and effective to treat our patients, families and friends. Even the farm animals we rely on for our food occasionally require antibiotics to ward off disease and illness. Antibiotic resistance is a public health threat that is receiving global, national and local attention and one that drove the Obama administration to release a National Action Plan to Combat Antibiotic-Resistant Bacteria this past March. In the U.S., CDC estimates that 2 million illnesses and 23,000 deaths are caused by antimicrobial-resistant bacteria and fungi annually. As veterinary and nutrition scientists, and an infectious disease doctor, we know first-hand the tremendous value of antibiotics to treat illness. Lives depend on antibiotic therapy, and effective treatment options are needed for both humans and animals. Although the landscapes for use in humans and animals are different, solutions can, and, in some cases, must be collaborative to have the greatest impact on public health. Earlier this year, we participated in a cross-sector meeting hosted by the Animal Health Institute where human health and animal health leaders engaged in a level-headed, thoughtful discussion, shared best practices, discussed existing science and research gaps, and began to envision a collaborative course forward to better manage antibiotic resistance. We left the meeting with an increased understanding of each health community’s challenges in antibiotic resistance management and learned about new animal health stewardship efforts. Drug-resistant Campylobacter and non-typhoidal Salmonella have been classified as microorganisms with a serious level of threat related to foodborne illness in CDC’s report, Antibiotic Resistance Threats in the United States, 2013. This means that prompt, sustained action is required to ensure the antibiotic resistance problem does not grow. We learned during the meeting that, based on recent data released by the National Antimicrobial Resistance Monitoring System (NARMS), 23 percent of Campylobacter isolates are now resistant to ciprofloxacin and approximately 2-3 percent are now resistant to macrolides, while 5 percent of non-typhoidal Salmonella isolates are resistant to five or more classes of antibiotics. Similar to the human health sector, we learned that the animal agriculture community is taking specific steps in the right direction. Industry is enforcing on-farm judicious antibiotic use programs and implementing FDA guidance 209 and 213, which respectively phase out growth promotion claims on medically important antibiotic compounds and phase in veterinary oversight over these compounds. In addition, there are efforts underway by regulatory agencies and industry stakeholders, including the FDA approval process for antibiotics; risk assessment requirements; support for enhanced surveillance and on-farm data collection by FDA and USDA, and, in particular, implementation of the veterinary feed directive (VFD), which will require food animal producers to obtain veterinarian approval for antibiotics used in animal feed. As part of the meeting, we shared the results of a systematic review we conducted as a team at the Medical University of South Carolina, which focused on non-typhoidal Salmonella and Campylobacter to determine what is known and not known about the relationship between food animal processing and production practices and the emergence and spread of antibiotic resistance. The results were surprising. There are a limited number of properly conducted studies which directly link antibiotics used in agriculture to drug-resistant foodborne illness in humans. We concluded that there is a need for these types of studies that follow both Salmonella and Campylobacter along the entire pathway, from farm to fork. We found value in learning what others are doing to be better stewards, and our perceptions have been confronted by our research results. In the wake of these things, we will be participating in an online learning community (togetherABX) where thought leaders in both human and animal health can share key learnings, best practices, and research ideas and discuss how to move forward collaboratively. We commend the thoughtful dedication and diligence of both health communities in seeking and implementing solutions to safeguard public health. It is going to take all of us — a global, One Health approach, involving teamwork among veterinarians, human healthcare professionals, agricultural industry, government and public health officials, microbiologists, nutritionists, ecologists, and scientists with expertise in molecular evolution — to find workable and unique solutions to the challenges of antibiotic resistance.
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