The ongoing explosion of antimicrobial-resistant infections continues to plague global health care. Our inability to mount significant countermeasures to resistance, while at the same time enduring the decline in research and development of new antibiotics creates a “perfect storm” and the fear we may be on final approach to a pre-antibiotic era of serious and uncontrollable infections in animals and man.
Despite rigorous public relations and lobbying by the medical community in North America for over 20 years, enactment of meaningful and robust legislation is just starting to emerge. In the meantime, microbial resistance grows, the antibiotic pipeline continues to diminish, and the majority of the public remains unaware of the crisis. The movement to control antimicrobial resistance is underfunded and resources are often applied in an unco-ordinated, often ineffectual manner. The misguided regulation of antibiotics in agriculture has undergone strict scrutiny and needed reform is just underway. Self-regulated control of antimicrobials in human medicine is also evolving. Prudent-use guidelines sprung from the recognition by veterinarians and physicians that solutions to AMR required more. Missing at the grassroots level is a common understanding of why change is needed in the first place and how individual responsibility will effect change.
Antimicrobial resistance has been under critical scrutiny by the scientific community for over two decades. In 2001, for instance, the Federal Interagency Task Force on Antimicrobial Resistance (U.S.) released the Action Plan to Combat Antimicrobial Resistance. The Infectious Diseases Society of America (IDSA) followed in 2004 with its own report, Bad Bugs, No Drugs: As Antibiotic Discovery Stagnates, A Public Health Crisis Brews, which proposed incentives to reinvigorate pharmaceutical investment in antibiotic research and development. Promising legislation addressing antimicrobial resistance was introduced in the 109th U.S. Congress (2006) and failed. In 2007 a group of distinguished scientists representing the Infectious Diseases Society of America published a report, The Epidemic of Antibiotic-Resistant Infections: A Call to Action for the Medical Community, but little became of it.
With few exceptions, professional organizations, producer groups and governments at all levels in North America and Europe took a cut at antimicrobial resistance/antimicrobial use (AMR/AMU). They respectfully filed their accusations and offered solutions. Most died on the table. Though some still question the significance of the issues involved, the pool of naysayers slowly withers. Unfortunately, today’s solutions become faint-hearted echoes tendered by prognosticators of the past, things like common sense practices that reduce antimicrobial demand, enhancing immunity and decreasing stress. More often than not, the wise and judicious retreat from the pressure to resolve problems and initiate action, glad they have miraculously supplied the grand solution, expecting different results though doing the same things.
Several watermarks of more recent vintage should pull the medical and veterinary medical communities out of the stall they experience in the search for answers, and spur both along with an accompanying host of regulatory agencies to take meaningful action. For one, the animal food industry must move beyond its fixation that resistance is a function of food residues: no residues, no significant involvement in the antimicrobial issue problem. What often gets missed when promoting food quality is how far the bounds of antimicrobial use and resistance extend beyond basic meat and milk production. Often overlooked is the interaction between minute amounts of antimicrobials in soil, water, air, manure and waste that result in the genetic exchange between microorganisms that ultimately creates resistance. The theatre of plasmid transfer between micro-organisms leading to the emergence of resistance is global in nature.
An alarming new superbug gene that makes bacteria resistant to a last-resort antibiotic has been detected in Canada and the U.S. The gene, called MCR-1, produces an enzyme that makes bacteria invincible to colistin, a highly toxic antibiotic reserved for use when all other drugs have failed. Scientists in China first reported MCR-1 in November (2015) in common E. coli from meat, farm animals and a human patient. But the news that really sent a shudder through the scientific community was that MCR-1 is located on a plasmid, a free-floating snippet of DNA that bacteria easily share. The simple transfer spreads resistance to other organisms. The nightmare scenario is that MCR-1 can potentially spread to more virulent bacterial strains that carry resistance genes against other antimicrobials, thus creating a “pan-resistant” superbug capable of defeating every antibiotic in the medicine cabinet.
According to the Center for Disease Control and Prevention in the U.S., at least two million people are infected with antibiotic-resistant infections each year, 23,000 of whom die as a result.
Seagulls, birds with enormous “migratory reach,” heighten the risk of transferring genes like MCR-1 internationally. The authors of a new study published in the Journal of Antimicrobial Chemotherapy found highly drug-resistant E. coli in gull droppings.
A linkage between copper supplementation and colistin resistance has also been identified, implying that use of copper in animal husbandry may select for colistin resistance, even in the absence of colistin usage.
In October 2014, the Government of Canada released its report Antimicrobial Resistance and Use in Canada: A Federal Framework for Action. The framework outlines a co-ordinated, collaborative federal approach to responding to the threat of antimicrobial resistance. For the most part it mimics what was said in 2001 and now, as then, proactive steps languish in a world of missed target dates, underfunding and political somnolence. The World Economic Forum concluded in 2013 that the greatest risk to human health comes in the form of antibiotic-resistant bacteria. They recognized that humans live in a bacterial world where they will never stay ahead of the mutation curve. A test of human resilience is how far behind the curve we allow ourselves to fall.