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

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On 12/2/09 on Capitol Hill, leading experts in economics, public health and public policy and Rep. Louise Slaughter (D-NY), a leading voice on antibiotic resistance, discussed the impact of resistant …

On 12/2/09 on Capitol Hill, leading experts in economics, public health and public policy and Rep. Louise Slaughter (D-NY), a leading voice on antibiotic resistance, discussed the impact of resistant infections on the U.S. healthcare system and the need to phase out inappropriate use of antibiotics as growth promoters in the production of food animals. The Johns Hopkins Center for a Livable Future (CLF) hosted the event with Rep. Slaughter. This is a complication of the panelists' presentations.

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  • 1. Congressional Briefing
    Antibiotic Resistance:
    A Multi-Billion Dollar Healthcare Crisis
  • 2. 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
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8. Burden of resistance: Lower quality of care
    Resistant infections result in more deaths and disability
  • 9. Odds of dying of MRSA are nearly twice as large as for sensitive Staph
  • 10. 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)
  • 11. 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)
  • 12. Resistance is leading to the use of more powerful antibiotics…
  • 13. …that are also more costly.
  • 14. 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)
  • 15. 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
  • 16. Who bears the cost?
  • 17. Where do resistant bacteria come from?
    Antibiotic use in healthcare
    Poor infection control
    Older, sicker patients undergoing more complex procedures
    Antibiotic use in animals
  • 18. Congressional Briefing
    Antibiotic Resistance:
    A Multi-Billion Dollar Healthcare Crisis
    Dr. Lance Price
    Director, Center for Metagenomics and Human Health, Translational Genomics Research Institute
  • 19. Key Concepts
    Bacteria become resistant to antibiotics
    People become infected with antibiotic resistant bacteria
  • 20. Antibiotic
    RIP
    Antibiotic Selection
  • 21. Anytime you use antibiotics you are potentially selecting for antibiotic resistant bacteria
  • 22. 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!
  • 23.
  • 24. If an animal production system requires routine antibiotic inputs to keep the animals from becoming sick, then that system is broken!
  • 25. Antibiotic
  • 26.
  • 27.
  • 28. Johnson 2007
  • 29. Antibiotic
  • 30. What happens if you remove the antibiotics from food animal production?
    Preservation of Antibiotics for Medical Treatment Act (PAMTA)H.R. 1549/S. 619
  • 31.
  • 32. 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
  • 33. Congressional Briefing
    Antibiotic Resistance:
    A Multi-Billion Dollar Healthcare Crisis
    Combating Antimicrobial Resistance:
    Veterinary Medicine’s Role
    Michael J. Blackwell, DVM, MPH
  • 34. 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?
  • 35. 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
  • 36. 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
  • 37. 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
  • 38. 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
  • 39. Thank You!
  • 40. Congressional Briefing
    Antibiotic Resistance:
    A Multi-Billion Dollar Healthcare Crisis
    Pew Commission on Industrial
    Farm Animal Production
    Bob Martin
  • 41. 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
  • 42. 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
  • 43. 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
  • 44. 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
  • 45. 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
  • 46. 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
  • 47. 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
  • 48. 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
  • 49. 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)
  • 50. 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
  • 51. Environmental Recommendations(continued)
    Increase funding for research to improve waste handling systems and to standardize measurements for better comparison between systems
  • 52. 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
  • 53. 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
  • 54. Additional Research Recommendation
    Expand public funding for, and reform, animal agriculture research
  • 55. Congressional Briefing
    Antibiotic Resistance:
    A Multi-Billion Dollar Healthcare Crisis