AMR Framework Flashcards
What is the global burden of bacterial AMR in humans?
Estimated 4.95 million deaths associated with bacterial AMR, including 1.27 million that are directly attributable
Significant regional variation in attributable deaths ( western sub saharan africa > high income N america > australiasia
AMR genes are found in…
pathogenic AND non-pathogenic species of bacteria throughout the enviornment
Resistome
The collection of all genes that directly or indirection contribute to AMR
What are the main mechanisms of the emergence of AMR?
- Genetic mutations
- Horizontal gene transfer (mobile genetic elements (MGEs) such as transposons, phages, and plasmids)
- Transformation, transduciton, conjugation
AMR requires a ____ approach
One Health
Direct AMR transmission pathways from animals to humans
Focuses on AMR pathogens that develop in animals and are transmitted to people through food, water, or direct contact.
Indirect AMR transmission pathways from animals to humans
Occurs through envirnmental mediation: AMR bacteria (not necessarily pathogens) are shed from animals into the environment through various pathways. These bacteria severe as a source of AMR genes that can be shared between bacteria in the environment. Humans are exposed, not necessarily to the original animal-origin bacteria, but to bacteria in the environment that now contain the animal-orign resistance genes.
What is the national burder of AMR in humans?
- 2.8 million antibiotic resistant infections in the US each year - 0-40% reduction in certain types since original 2013 report but 50-315% increase in others
- 35,000 deaths
- Resistant hospital-onset infection and deaths both increased 15% in 2020
What are the categories of human AMR threats and what are the 7 criteria used to evaluate them?
Urgent > serious > concerning
1. Clinical impact
2. Economic impact
3. Incidence
4. 10-year projection of incidence
5. Transmissibility
6. Availability of effective antibiotics
7. Barrier to prevention
What are the two most common zoonotic foodborne AMR pathogens in the US?
Salmonella and campylobacter
What is the relative contribution of salmonella and campylobacter to total AMR infections in the US?
Combined are responsible for 400,000 illnesses and 60 deaths. They make up 14% of AMR illnesses (high) and 0.17% of AMR-related deaths (low).
What are the trends in antibiotic sales data for food-producing animals?
Sales have been declining since the VFD went into effect in October of 2015.
What are the AMR monitoring systems in place in the US (5)?
- National Antimicrobial Resistance Monitoring System (NARMS)
- Antimicrobial sales for food producing animals
- Antimicrobial use data for food producing animals
- Veterinary Laboratory Investigation and Response Network (Vet-LIRN)
- National Animal Health Laborator Network (NAHLN) = AMR pilot project
What is the purpose of NARMS?
- Monitor trends in AMR among common foodborne bacteria for humas, retail meats, and food producing animals
- Disseminate timely information on AMR to promote interventions that reduce resistance among foodborne bacteria.
- Conduct research to better understand the emergence, persistence, and spread of AMR
- Assist the FDA in making decisions relateed to the approval of safe and effective antimicrobial drugs for animals
What agencies oversee data colleciton and analysis for NARMS? What samples do they collect?
- FDA - retail meats (salmonella all meats included seafood, cmapy in retain poultry)
- USDA-FSIS - food animal isolates (cecal sampling from swine, cattle, chicke, turkeys for Salmonella, Campy, E. coli and Enterococcus)
- CDC - human data (Salmonells, Shigella, Vibrio, E.coli , campy
What is the purpose of tracking antimicrobial sales in food-producing animals?
- Enacted by congrss to assit FDA in analyzing interactions, efficacy, and safety of antimicrobials approved for use in both humans and food-producing animals
- Pharmaceutical companies must report to the FDA the amount of each antimicrobial active ingredient in drug products sold or distributed for use in food-producing animals
- FDA summarizes the informaiton and makes it available to the public in annual summary reports.
Which antimicrobials approved for use in food-animals were sold the most?
Tetracyclines, then penicillins, macrolide,s aminoglycosides, sulfonamides
Antimicrobial use in food-producing animals
Sales are not equivalent to use!
Data harder to collect
2017 summaries from USDA offer insight but not to changing nature of use patterns
FDA CVM - two cooperative aggreements to support collection (poultry and swine industries, dairy and feedlot industries) … 2024-2025
Similar initiative in companion animals….>2026
NLVRN
- Established in 2010 by FDA to investigate potential problems with animal feed and animal drugs
- 2017 started collecting data on antimicrobial susceptibility of clinical relevant bacterial isolates from different animals hosts, including companion animals
- Goal is to monitor AMR profiles in animal pathogens routinely isolated in vet clinics and diagnostic labs across the US
NAHLN
- Includes 60 state and university laboratoris
- Overseen by USDA-APHIS
AMR pilot project initiated in 2018:
* Goal is to monitor AMr profiles in animal pathogens routinely isolated
* 30 diff labs across US invovled as of 2021
* Monitors AMr isolates from cattle, swine, poultry, and horses…recently added cats and dogs
AMR pathogens affecting animal health in US publication
- AVMA committee + species experts as volunteers
- Technical report on resistance threats by species
Monitoring data on AMR in animals is collected via _____, ____, and ________.
NARMS, Vet-LIRN, NAHLN
