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One healthoct17 slideshare
- 1. Antimicrobial Resistance: From Patient to World Nicola Fawcett, MRC Clinical Research Fellow, Nuffield Department of Medicine
- 2. "Veterinary medicine and human medicine complement each other and should be considered as one medicine" –Dr. William Osler ‘...the collaborative effort of multiple disciplines – working locally, nationally, and globally – to attain optimal health for people, animals and our environment…’
- 3. Professor Tim Walsh, University of Cardiff, Falling Walls 2017 One Health and Antimicrobial Resistance
- 5. Sugawara et al PlosOne 2017 The agent of our doom (in one guise) Resistance genes to: • Carbapenems • Aminoglycosides • Sulphonamides • Tetracyclines • Chloramphenicol • Macrolides • Trimethoprim All in one handy,transferrable packet: • Addiction system (once you’ve got it you can’t get rid of it) • Elements which increase transfer and mutation
- 6. Source: CDC
- 7. How do antibiotics affect the gut bacteria? >Reduced diversity of bacteria >Increase in antibiotic resistance x x x x x CDC Infographic 2014
- 8. Ying Taur et al. Clin Infect Dis. 2012;55:905-914 Antibiotic use alters the gut environment and encourages predominance of resistant strains
- 9. Ying Taur et al. Clin Infect Dis. 2012;55:905-914
- 10. Ying Taur et al. Clin Infect Dis. 2012;55:905-914
- 11. Epstein et al JAMA 2014
- 12. Kantele 2015 CID Risk of colonisation with ESBL with travellers diarrhea +/- antibiotic use
- 13. Kotay, Mathers, AEM 2017 Subterfuge spread: drains and sinks?
- 14. Kotay, Mathers, AEM 2017 Subterfuge spread: drains and sinks?
- 16. Graphic by Peg Dirckx and David Davies 2003 Center for Biofilm Engineering Montana State University.
- 17. Can hospital wastewater be used to monitor CPE? Conclusion: All 17 sites sampled had CPE growth
- 19. mcr-1 gene (colistin resistance) First described 2015 Within 6 months of publication, worldwide dissemination found in animals, retail meat and humans based on reanalysis of existing genomic data 1980 chicken in China 2005 veal calf in France 2008 Shigella human infection, Vietnam mcr-1 A case study of worldwide resistance spread Infographic: Bloomberg, Mar2016
- 20. Global antimicrobial consumption in livestock in milligrams per 10 km2 pixels (Top) and average SD of estimates of milligrams per PCU (Bottom). Thomas P. Van Boeckel et al. PNAS 2015;112:5649-5654 ©2015 by National Academy of Sciences
- 21. Largest five consumers of antimicrobials in livestock in 2010 and projected 2030. Thomas P. Van Boeckel et al. PNAS 2015;112:5649-5654 ©2015 by National Academy of Sciences
- 25. Ashton , Perspectives in Agric. Vet Sci Nutr and Nat Res 2010 Aquaculture
- 26. Stockstad 2010, Science One Planet, Many People: Atlas of Our Changing Environment
- 28. Rule et al 2008
- 29. Antibiotics in the agricultural soils from the Yangtze River Delta, China Sun, Chemosphere 2017
- 30. Ciprofloxacin levels in effluent exceeds serum therapeutic levels Larrson et al J Haz Mat. 2007
- 31. The environmental REsistome: confluence of Human and Animal Biota in antibiotic resistance spread (REHAB) Nicole Stoesser
- 32. Wide-scale Antimicrobial Resistance is an anthropogenic environmental disaster
- 33. You the consumerYou the healthcare professional
- 34. Take home messages to combat AMR? • Consider your patient an ecosystem, and respect their gut! • Avoid Delhi belly • Don’t pour coke down the sinks • Get used to eating less meat • Become an Antibiotic Guardian!
- 35. Armordstudy.wordpress.com Studying resistance gene carriage in the gut in response to antibiotics Recruiting patients due to have a course of antibiotics Serial sampling of gut microbiome before,during and after treatment
- 36. Acknowledgements MRC UK University of Oxford Modernising Medical Microbiology Derrick Crook, Sarah Walker, Tim Peto Nicole Stoesser, Amy Mathers, Anna Sheppard Leon Peto Resources @drnjfawcett Livinginamicrobialworld.wordpress.com MicrobiomeDigest @microbiomdigest Jonathan Eisen @phylogenomics Jack Gilbert @gilbertjacka Ed Yong @edyong209 ‘Apocalypse pig’ ‘India’s drugged chickens’ ‘
- 37. Develop your senses- especially learn how to see. Realize that everything connects to everything else.” – Leonardo da Vinci
Editor's Notes
- American Veterinary association William Osler, Father of Veterinary Pathology vice president and later president of the Veterinary Medical Association. William Osler, MD, was a Canadian physician who is considered the father of veterinary pathology in North America. Dr. Osler had a deep interest in the linkages between human and veterinary medicine. He trained with many well-known physicians and veterinarians, including Dr. Virchow. One of his first publications was titled, "The Relation of Animals to Man." While serving on the medical faculty of McGill University, Dr. Osler lectured to medical students and veterinary students from nearby Montreal Veterinary College. Following his time at McGill, Dr. Osler became the Chair of Clinical Medicine at the University of Pennsylvania in Philadelphia. In 1889, he became the first Physician-in-Chief of Johns Hopkins Hospital and played an instrumental role in establishing the Johns Hopkins University School of Medicine.
- 430 adults recruited 90 (21%) picked up ESBL carriage in stool 75/90(83%) had TD vs 213/340 (63%)
- Spread from the Sink to the Patient: in situ Study Using Green Fluorescent Protein 2 (GFP) Expressing- Escherichia coli to Model Bacterial Dispersion from Hand 3 Washing Sink Trap Reservoirs
- Spread from the Sink to the Patient: in situ Study Using Green Fluorescent Protein 2 (GFP) Expressing- Escherichia coli to Model Bacterial Dispersion from Hand 3 Washing Sink Trap Reservoirs
- Global antimicrobial consumption in livestock in milligrams per 10 km2 pixels (Top) and average SD of estimates of milligrams per PCU (Bottom).
- (A) Largest five consumers of antimicrobials in livestock in 2010. (B) Largest five consumers of antimicrobials in livestock in 2030 (projected). (C) Largest Increase in antimicrobial consumption between 2010 and 2030. (D) Largest relative increase in antimicrobial consumption between 2010 and 2030. CHN, China; USA, United States; BRA, Brazil; DEU, Germany; IND, India; MEX, Mexico; IDN, Indonesia; MMR, Myanmar; NGA, Nigeria; PER, Peru; PHL, Philippines.
- 1990 50% of mangrove forests in Thailiand converted to shrimp farms. By 1995 24% had been abandoned The over 45 million metric tons of fish, crustaceans, and mollusks produced by aquaculture in China in 2014 far surpass the nearly 15 million metric tons of these animals captured by Chinese fisheries n Chile at least, aquaculture rather than human and other veterinary medical activities would seem to be the most important source for passage of antimicrobials into the aquatic environment where they select for antimicrobial-resistant bacteria Millanao et al., 2011
- “farmer’s flock record,” shows they were instructed to begin a series of antibiotic regimens on Oct. 25, the day after the couple took delivery of the newly hatched chicks. A solution combining enrofloxacin, ciprofloxacin and colistin was started on Nov. 19 and continued for six days. The bottle’s label says it’s an “animal feed supplement” that should be mixed in drinking water for the “prevention of respiratory infections.” On Dec. 1, the Bal Reddys were instructed to use two more antibiotics to help sanitize their shed after the chickens were collected for slaughter. An additional antibiotic, gentamicin, was delivered on Nov. 16, though there is no record of it being used. SR group boiler company None of the farms visited had treatment systems for managing effluent from their chicken coops, with the liquid waste typically running freely into gardens growing vegetables that were consumed by their families, with surplus sold to the public. n a country with twice as many meat-eaters as vegetarians, chicken consumption is now 14 times higher than in 1985.
- John Hopkins University
- 2mg/l