The Johns Hopkins Center for a Livable Future Capitol Hill Briefing: Antibiotic Resistance: A...

Congressional Briefing

Antibiotic Resistance: A Multi-Billion Dollar Healthcare

Crisis

Congressional Briefing

Antibiotic Resistance: A Multi-Billion Dollar Healthcare

Crisis

The cost of losing antibiotic effectiveness

Ramanan LaxminarayanCenter 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 hospitalizationCorrelation between disease severity and

colonization with resistant pathogenNot all antibiotic use is bad

Who bears the cost?

Where do resistant bacteria come from?

Antibiotic use in healthcarePoor infection control

Older, sicker patients undergoing more complex procedures

Antibiotic use in animals

Congressional Briefing

Antibiotic Resistance: A Multi-Billion Dollar Healthcare

Crisis

Dr. Lance PriceDirector, Center for Metagenomics and Human Health, Translational Genomics

Research Institute

Bacteria become resistant to antibiotics

People become infected with antibiotic resistant bacteria

Key Concepts

Antibiotic Selection

RIP

Anytime you use antibiotics you are potentially selecting for antibiotic

resistant bacteria

Antibiotic use in food-animal production

Single greatest use of antibioticsMillions of pounds every year

Most of the antibiotics are classes important to human medicine

Selects for cross-resistant bacterial populationsMost 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!

Johnson 2007

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

Congressional Briefing

Antibiotic Resistance: A Multi-Billion Dollar Healthcare

Crisis

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!

Congressional Briefing

Antibiotic Resistance: A Multi-Billion Dollar Healthcare

Crisis

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

Public Health Recommendations(continued)

• 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

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

Congressional Briefing

Antibiotic Resistance: A Multi-Billion Dollar Healthcare

Crisis