Chapter 25 : Antimicrobial Resistance: a One Health Perspective

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Antimicrobial resistance is a global public health crisis that threatens our ability to successfully treat bacterial infections ( ). Microbiologists and infectious disease specialists have long recognized the problem—the discoverer of penicillin Sir Alexander Fleming himself drew attention to the threat of resistance from underdosing ( )—but realization of the vast scale of the resistant threat is only now reaching wider audiences. Many infectious agents that could once be successfully treated with any one of several drug classes have acquired resistance to most, and in some cases, virtually all of these drugs ( ). The threat is most acute for antibiotics and synthetic antibacterial antimicrobial agents, the focus of this paper, but also threatened are antifungals, antiparasitics, and antivirals ( ). How did we get from the point where antimicrobials were truly “wonder drugs” that could be relied upon to cure a wide range of life-threatening infections to the point today, where resistance to most antimicrobials is widely prevalent and the supply of new classes of drugs has dwindled to a trickle? The complete answer is not simple, nor unfortunately, is the solution. One thing seems certain: that overuse of these precious drugs in multiple sectors (human, animal, agriculture) is the main problem and one that must be addressed ( ).

Citation: McEwen S, Collignon P. 2018. Antimicrobial Resistance: a One Health Perspective, p 521-547. In Schwarz S, Cavaco L, Shen J (ed), Antimicrobial Resistance in Bacteria from Livestock and Companion Animals. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.ARBA-0009-2017
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Figure 1

Diagrammatic representation of the routes of transmission of antimicrobial resistance between farm animals, the wider environment, and humans. Reprinted from ( ) with permission of the publisher.

Citation: McEwen S, Collignon P. 2018. Antimicrobial Resistance: a One Health Perspective, p 521-547. In Schwarz S, Cavaco L, Shen J (ed), Antimicrobial Resistance in Bacteria from Livestock and Companion Animals. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.ARBA-0009-2017
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Figure 2

Ceftiofur resistance in chicken and human Heidelberg and chicken . Reprinted from the Public Health Agency of Canada ( ) with permission of the publisher.

Citation: McEwen S, Collignon P. 2018. Antimicrobial Resistance: a One Health Perspective, p 521-547. In Schwarz S, Cavaco L, Shen J (ed), Antimicrobial Resistance in Bacteria from Livestock and Companion Animals. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.ARBA-0009-2017
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Figure 3

Schematics of the hotspots and drivers of antimicrobial resistance. The environmental compartments that are currently monitored or regulated by the Environmental Agency (EA; England) are denoted by an asterisk in red. WDF, Water Framework Directive. Reprinted from ( ) with permission of the publisher.

Citation: McEwen S, Collignon P. 2018. Antimicrobial Resistance: a One Health Perspective, p 521-547. In Schwarz S, Cavaco L, Shen J (ed), Antimicrobial Resistance in Bacteria from Livestock and Companion Animals. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.ARBA-0009-2017
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Figure 4

Role of modifiable drivers for antimicrobial resistance: a conceptual framework. Reprinted from Lancet ( ) with permission of the publisher.

Citation: McEwen S, Collignon P. 2018. Antimicrobial Resistance: a One Health Perspective, p 521-547. In Schwarz S, Cavaco L, Shen J (ed), Antimicrobial Resistance in Bacteria from Livestock and Companion Animals. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.ARBA-0009-2017
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Table 1

Classification of importance of antimicrobial classes for human health and animal health

Citation: McEwen S, Collignon P. 2018. Antimicrobial Resistance: a One Health Perspective, p 521-547. In Schwarz S, Cavaco L, Shen J (ed), Antimicrobial Resistance in Bacteria from Livestock and Companion Animals. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.ARBA-0009-2017

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