This week on HealthConnections discusses World Antimicrobial Awareness Week, held from November 18 through 24, with this year’s focus on preventing antimicrobial drug resistance, or AMR. Dr. Carole Myers, a professor emeritus in the University of Tennessee College of Nursing, talks with Dean David White, the interim dean for the University of Tennessee Herbert College of Agriculture.
WUOT’s Carole Myers: AMR is designated as a top 10 global public health threat. Can you begin by explaining what AMR is and the nature of the threat posed by AMR?
David White: Antimicrobials have transformed modern medicine, but unfortunately overuse and inappropriate use have led to dangerous bacteria and fungi and parasites developing a resistance to these therapeutics. When I mention antimicrobials, they are very inclusive. They include antibiotics, which most people are familiar with, but also antivirals, antifungals, and antiparasitics which are all medicines that are used to prevent and treat infections not only in humans but also in animals and plants. When antimicrobial resistance occurs, or AMR, that is when bacteria, viruses, fungi, and parasites evolve over time and no longer respond to these medicines, making infections harder to treat and, unfortunately, increasing the risk of disease spread, severe illness, and death in many cases unfortunately.
In the past, we have described AMR as a ‘One Health’ problem. Can you please describe why this is the case? Why is AMR considered a One Health threat?
That is a great, great point. To me, believe it or not, antimicrobial resistance is a fantastic example of why we need a One Health approach since use of antimicrobials in all environments, including in humans, animals, and plants all may play a major role in the development of drug resistant infections. So, health industry experts agree an integrated, unified cross-species approach, which is really one health, is necessary for optimizing the health of people, animals, and our ecosystems and for combating the spread of antimicrobial resistance.
What does this look like? What should we be doing?
Absolutely and what one health entails is different stakeholders and groups of professionals getting together that don’t typically talk to each other. So, for example, a plant physiologist needs to talk to a veterinarian who needs to talk to a physician. These are people that don’t typically get together. My analogy is squeezing the balloon. There are antifungals used to treat diseases in plants but what happens if they are leading to antimicrobial resistant fungi that infects humans and then a physician goes to treat that and that antifungal isn’t effective because that fungus has already seen it in the plant environment. So, it is really getting people out of their silos and looking at it at an enterprise approach and making sure we see all the connections and coming at it globally and coming at it together where we have not traditionally done that.
So, each stakeholder or major player has a role? Let’s focus on the roles that some of our listeners might have, the public? Perhaps healthcare providers? Farmers? Could you perhaps say a little more about what addressing AMR might look like with these various players?
There are a lot of actions that need to take place and this is why antibiotic resistance continues to such a problem and its actually been termed the ‘silent pandemic’ because it continues to be there under the surface and we have a lot of talk and action about doing things, but we have not seen a global strategy. First is infection prevention and control. That’s a foundation for preventing infections and if you don’t have an infection, you don’t need an antibiotic. So, if we can even prevent the infection from happening then that’s the priority. Secondly, we need to develop more vaccinations. If we can prevent the disease from happening you don’t ever have to use the antibiotic. So, we are trying to get more research and development into vaccines for different diseases where they can track and see how much the antibiotic is being used to treat. Coming back to your point. Say farmers for example, we need to reduce exposure to antibiotics in environments where they’re not needed and a lot of times in the past this was used in farming where a farmer could use an antibiotic to help with increase feed efficiency. The FDA, the food and drug administration, has really moved recently to change that practice so that antibiotics in animals, in particular food producing animals, are really only used now for therapeutic purposes which is fantastic. It has taken years to get there, but they have really done the lion share and the stakeholders have worked together with the FDA to figure out that policy. Also, I would say education. There is a lot of education that has to happen with practitioners and the public. There was a recent study out of Japan that estimated that about 60% of people in Japan thought antibiotics could treat the common cold and that is not correct. So, I think there is an education campaign needed as well for the general public so if they go and see a physician for something and the physician says ‘it’s a virus and I don’t need to give you an antibiotic’ then they understand that.
Both the World Health Organization as well as the U.S. Center for Disease Control and Prevention are zeroed in on antimicrobial resistance as a major public health threat. Sounds pretty dire. You know we are getting bombarded with this kind of information all the time, you called it the ‘silent pandemic’. Is there any reason for hope? What is on the horizon that might offer us some hope?
That’s a great question and it does seem like the future of antibiotic resistance seems bleak but I do believe there is hope. There is a global strategy being developed and being led by the World Health Organization who recently released its global research agenda for antibiotic resistance and has 40 priorities across prevention and diagnosis and treatment. This agenda will have, I think it has 170 countries signing on to this and it will put a spotlight on areas that require the most attention which is water sanitation, vaccine development, antimicrobial stewardship practices, education, improved surveillance, and believe it or not, rapid point of care diagnostics. So, really what we need is we need diagnostics that I call bedside diagnostics, you come in to a patient, you take a sample and you know within minutes it’s a particular bacterium and maybe it is resistant to a particular antibiotic.
This transcript has been lightly edited for content.
