The Johns Hopkins Center for a Livable Future Capitol Hill Briefing: Antibiotic Resistance: A Multi-Billion Dollar Health Care Crisis

Congressional Briefing
Antibiotic Resistance:
A Multi-Billion Dollar Healthcare Crisis

The cost of losing antibiotic effectiveness
RamananLaxminarayan
Center for Disease Dynamics, Economics & Policy (CDDEP)
Resources for the Future

Burden of resistance: Lower quality of care
Resistant infections result in more deaths and disability

Odds of dying of MRSA are nearly twice as large as for sensitive Staph

Burden of resistance: Lower quality of care
The estimated number of people developing a serious MRSA infection (i.e., invasive) in 2005 was about 94,360 (CDC)
Approximately 18,650 persons died during a hospital stay related to serious MRSA infections (CDC)

Burden of resistance: Higher cost of care
Methicillin resistance was associated with an increase in length of hospital stay (increased 1.29 fold) and hospital charges (increased 1.36 fold) after the bacteremia (Cosgrove 2005)

Resistance is leading to the use of more powerful antibiotics…

…that are also more costly.

Overall societal costs
Between $378 million to $18.6 billion annual cost of increased resistance in community-acquired infections (Elbasha 2001)
$30 billion a year (Institute of Medicine)

Difficulty in measuring burden
No DRG for resistance-related hospitalization
Correlation between disease severity and colonization with resistant pathogen
Not all antibiotic use is bad

Who bears the cost?

Where do resistant bacteria come from?
Antibiotic use in healthcare
Poor infection control
Older, sicker patients undergoing more complex procedures
Antibiotic use in animals

Dr. Lance Price
Director, Center for Metagenomics and Human Health, Translational Genomics Research Institute

Key Concepts
Bacteria become resistant to antibiotics
People become infected with antibiotic resistant bacteria

Antibiotic
RIP
Antibiotic Selection

Anytime you use antibiotics you are potentially selecting for antibiotic resistant bacteria

Antibiotic use in food-animal production
Single greatest use of antibiotics
Millions of pounds every year
Most of the antibiotics are classes important to human medicine
Selects for cross-resistant bacterial populations
Most antibiotics are fed to animals in the absence of disease!

If an animal production system requires routine antibiotic inputs to keep the animals from becoming sick, then that system is broken!

Antibiotic

Johnson 2007

Antibiotic

What happens if you remove the antibiotics from food animal production?
Preservation of Antibiotics for Medical Treatment Act (PAMTA)H.R. 1549/S. 619

We must eliminate non-therapeutic and routine antibiotic use in food animal production in order to preserve the utility of our life-saving antibiotics for treating sick people!
PAMTAH.R. 1549/S. 619

Combating Antimicrobial Resistance:
Veterinary Medicine’s Role
Michael J. Blackwell, DVM, MPH

The Broadest Medical Profession: Veterinary Medicine
Three medical professions
Physicians, Dentists, and Veterinarians
Only veterinarians have comparative medicine training, making it the broadest
Multiple species (including those in the food supply)
Broadest prescription authority
Ensures public health by addressing diseases in animals before they affect humans
Food-borne disease agents affecting humans, that are also found in animals include, Salmonella, and E. coli
Infectious diseases in humans that originated in animals include, HIV/AIDS, SARS, West Nile Virus, Avian Influenza, and ?Swine Influenza?

Uses of Antimicrobials in Food Animals (i.e., food supply)
Therapeutic (treatment)
Diagnosed microbial disease
Prophylactic (prevention)
After an exposure, but before clinical onset
In advance of expected exposure

Uses of Antimicrobials in Food Animals (i.e., food supply)
Non-therapeutic (routine)
Absence of disease, or exposure, or expected exposure (i.e., healthy animals)
Weight gain, growth promotion, feed efficiency
Many drugs are available directly to lay persons
veterinary oversight not required

To Reduce Antimicrobial Resistance
Stop non-therapeutic (routine) uses
Require veterinary oversight of all uses of antimicrobials in animals, especially if the drug is used in human medicine
Veterinarians are the best trained and the only ones licensed to decide appropriate uses

To Reduce Antimicrobial Resistance
Use options other than antimicrobials as a first line of defense
More focus on husbandry practices
waste management, less crowding, better ventilation
Improve surveillance, monitoring, and reporting
Better drug use data
Risk Assessments
More public funding of resistance research
Less bias and less of a conflict of interest

Thank You!

Pew Commission on Industrial
Farm Animal Production
Bob Martin

Commission Membership
16 Commissioners from diverse background
Animal agriculture producers, human medicine, public health, animal health, ethics, religion, state and federal policy represented
Academic contributors from major universities

Charge to Commission
Commission charged with developing solutions to the public health, environmental, rural community, and animal welfare problems caused by industrial animal feeding operations
Commission found, generally, industrial animal operations presented an unacceptable threat to the public health, damage to the environment and rural communities and was harmful to the animals

Commission Process
11 meetings held in all regions of the United States, including two public hearings
250 hours of deliberations, including more than 50 hours with animal ag representatives
8 technical reports, thousands of pages of stakeholder comments, Commissioner expertise, staff papers informed the Commission
Thousands of pages of information, including 170 peer reviewed reports

Recommendations
Commission recommendations adopted by consensus
24 primary recommendations dealing with public health, animal welfare, the environment, and rural communities.
12 of those concerned public health
Five of those focused on antibiotic use in industrial animal agriculture

Antimicrobial Resistance Recommendations
Phase out and ban non-therapeutic use of antibiotics in food animal production
Ban new approvals of non-therapeutic use of antibiotics for food animals and retroactively investigate previously approved antimicrobials
Strengthen Guidance #152
Commission defines therapeutic as the use of antimicrobials with a diagnosed microbial disease

Antimicrobial Recommendations (continued)
Non-therapeutic use is defined as use in the absence of microbial disease or known microbial disease exposure, such as for growth promotion, weight gain, or routine disease prevention
Prophylactic use is defined as use in a healthy animal in advance of expected exposure or after an exposure but before onset of confirmed clinical disease

Antimicrobial recommendations (continued)
Improve monitoring and reporting of antimicrobial use in food animal production
Improve monitoring and surveillance of antimicrobial resistance in the food supply, the environment, and animal and human populations
Increase veterinary oversight of all antimicrobial use in food animal production to prevent overuse and misuse

Public Health Recommendations
Implement a disease monitoring program and a fully integrated and robust national database for food animals to allow 48 hour trace back
Increase monitoring of possible public health effects of CAFOs on people who live and work in or near facilities
Fully enforce current state and federal regulations and legislation

Strengthen relationships between physicians, veterinarians, and public health professionals to deal with CAFO public health risks
Create a Food Safety Administration combining food inspection and safety responsibilities of USDA, FDA, and EPA
Develop a flexible, risk-based food safety system from farm to fork
More aggressive mitigation of production diseases
Public Health Recommendations(continued)

Environmental Recommendations
Improve enforcement of existing federal, state, and local regulations to improve the siting of facilities and to protect the health of those living near them
Develop new system to deal with farm waste
Increase and improve monitoring and research of farm waste to hasten new treatment methods

Environmental Recommendations(continued)
Increase funding for research to improve waste handling systems and to standardize measurements for better comparison between systems

Animal Welfare Recommendations
Implement federal performance-based standards to improve animal health and well-being
Implement better animal husbandry practices
Phase out most restrictive confinement systems within 10 years
Improve animal welfare practices and conditions
Improve animal welfare research

Rural Community Recommendations
States, counties, and local governments should implement zoning and siting guidance for new facilities that fairly and effectively evaluate the suitability of a site
Implement policies to promote a competitive marketplace

Additional Research Recommendation
Expand public funding for, and reform, animal agriculture research

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The Johns Hopkins Center for a Livable Future Capitol Hill Briefing: Antibiotic Resistance: A Multi-Billion Dollar Health Care Crisis

by Johns Hopkins University on Dec 02, 2009

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The Johns Hopkins Center for a Livable Future Capitol Hill Briefing: Antibiotic Resistance: A Multi-Billion Dollar Health Care Crisis — Presentation Transcript