Antibiotic Stewardship

Gain perspective on the global importance of antimicrobial resistance
- Key Question: "Why do we care?"
Understand regulations governing antibiotic use in food-producing animals in the US
- Key Question: "What’s our role as vets when it comes to antibiotics?"
Describe the 5 key elements to implementing antibiotic stewardship in food-producing animals
- Key Question: "How can we do our jobs well?"

Definition: When an infectious agent changes in response to therapeutic pressures in the environment.
Intrinsic AMR Example: Mycoplasma spp. lacks a cell wall, making it resistant to antibiotics that target cell walls.
Induced AMR Example: Bacteria can possess DNA that is not normally expressed until exposed to stressors such as antibiotics.

Animals receive antibiotics, leading to the development of resistant bacteria in their gut.
Drug-resistant bacteria can persist on meat from these animals.
If not handled or cooked properly, these bacteria can spread to humans.
Fertilizers or water containing feces from treated animals may contaminate food crops.
In humans:
- Example: George receives antibiotics, develops resistant bacteria, and spreads these in the community.
- Healthcare facilities serve as vectors for resistant bacteria spread through unclean hands of providers.

About 2 million infections yearly.
Approximately 23,000 deaths annually.
Contributes to a $20 billion direct cost and a $35 billion indirect cost burden in healthcare.
50% of all antimicrobial prescriptions in humans are deemed unnecessary, a result of overuse of antimicrobials.

Potential deaths from AMR projected to reach 10 million by 2050.
Growing threats from antimicrobial resistance could surpass cancer deaths.
Recent media highlights include fast-food chains taking action against antibiotic use in livestock.

What is AMR?
- The ability of microorganisms (like bacteria and some viruses) to survive and grow in the presence of an antimicrobial that should effectively eliminate them.
- Leads to ineffective standard treatments and persistent infections.
- Bacteria can become multi-resistant, and some infections may become untreatable.

AMR is partially driven by natural phenomena where selective pressure from antibiotics favors resistant strains.
The excessive use of antibiotics creates additional selection pressure that exacerbates resistance development.
Bacteria can share resistance genes via plasmids, further complicating control efforts.

Contamination vectors in hospitals, clinics, and via food supply.
Waste disposal issues and environmental contamination contribute to AMR dissemination.

Integrated approach linking human health, animal health, and environmental health is crucial in addressing AMR.
Over 60% of human infectious diseases are zoonoses originating from animals.
Resistance genes can cycle between humans, animals, and the environment.

AMR ranked among top health threats globally in reports by WHO.
Recent data indicates significant deaths linked to bacterial AMR, with E. coli, Staph aureus, and others being leading pathogens.

Inappropriate Use: Overuse and incorrect disposal of antibiotics increase selective pressure.
Inaccurate Prescribing: Utilizing last-line antibiotics as first-line therapy and non-completion of treatment courses exacerbate resistance.

In the US, 64% of antibiotics sold are for food animals.
- Use categories defined by WHO: therapeutic, disease prevention, and growth promotion.
The FDA has moved towards phasing out non-therapeutic antibiotics for growth promotion in livestock.

Aimed at ensuring judicious antimicrobial use by limiting medically important drugs to necessary uses and requiring veterinary oversight.

Phasing out non-therapeutic use of medically important antimicrobials for feed efficiency and weight gain.
All use must involve veterinary input.

All in-feed uses of important antimicrobials require valid veterinary-client-patient relationships (VCPR).
Drastic changes are anticipated with numerous drug transitions from over-the-counter to prescription statuses affecting production indicating animals.

California, Maryland, and Oregon legislation focuses on stricter antimicrobial use guidelines in livestock and enhances reporting requirements on antibiotic use in food animals.

Focus on Disease Prevention
- Importance of herd health, vaccinations, deworming, and good nutrition.
Efficient Diagnosis of Disease
- Prioritize quick and accurate diagnostics for better treatment decisions.
Selection of Appropriate Antibiotics
- Consider specific bacteria, the infection site, disease nature, and in vitro susceptibility.
Record Keeping
- Maintain detailed records of treatments, including animal IDs, drugs administered, and withdrawal times.
Veterinary Client Patient Relationship (VCPR)
- Strengthen relationships between vet and producers, ensure knowledge of management practices, and facilitate timely follow-up.
- Develop written treatment protocols for common diseases to improve response and accountability.

Emphasize the necessity for careful antibiotic use to ensure effective treatments in both human and veterinary medicine and reduce the risk of increasing AMR.
Quote highlight: "It’s not about using less antibiotics. It’s about using the right antibiotic for the right diagnosis and for the right duration of time." – Susan Bleasdale, MD.