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UKZN INSPIRING GREATNESS
One Health Approach to Antibiotic
Resistant Infections
Sabiha Y. Essack
B. Pharm., M. Pharm., PhD
South African Research Chair in Antibiotic Resistance and One Health
Antimicrobial Research Unit, College of Health Sciences, UKZN
UKZN INSPIRING GREATNESS
Overview
• Antimicrobial Resistance
• One Health
• AMR at the Human, Animal & Environmental Interface
• Global Commitment to AMR & One Health
• Tripartite Alliance of the WHO, FAO & OiE
UKZN INSPIRING GREATNESS
www.jpiamr.eu/wp-content/uploads/2014/12/AMR-Review-Paper-Tackling-a-crisis-for-the-health-and-wealth-of-nations_1-2.pdf
http://www3.weforum.org/docs/WEF_GlobalRisks_Report_2013.pdf
Antimicrobial Resistance
UKZN INSPIRING GREATNESS
One Health
https://www.youtube.com/watch?v=TG0pduAYESA
UKZN INSPIRING GREATNESS
One Health (2)
http://www.phac-aspc.gc.ca/cipars-picra/gfx/2b_e.gif
UKZN INSPIRING GREATNESS
Courtesy of Paula Cray
One Health (3)
UKZN INSPIRING GREATNESS
AMR at the Human-Animal-
Environmental Interface
There is fluidity of antibiotic resistant
clones, antibiotic resistance genes and
mobile genetic elements at the human-
animal-environmental interface.
UKZN INSPIRING GREATNESS
Fluidity of Antibiotic Resistant Clones
• All LA-MRSA (CC398) cases from humans and pigs in Norway from 2008 -
2014 were subjected to WGS as part of an outbreak investigation.
• Three outbreak clusters were identified amongst 26 pig farms, 2 abattoirs
and 36 humans.
• Primary introductions likely occurred by human transmission to 3 sow farms.
• Secondary transmission to other pig farms likely occurred through animal
trade and, to a lesser extent, via humans or livestock trucks.
HUMAN-ANIMAL INTERFACE
Grontvedt et al., Clin Infect Dis 2016; 63: 1431-1438
UKZN INSPIRING GREATNESS
Fluidity of Antibiotic Resistant Clones and
Antibiotic Resistance Genes
• 86% of slurry samples, 29% of boot swabs taken from various surfaces in
surrounding areas of the farms & 7.5% of the exhaust air samples were positive.
• Two isolates from farm G2 (slurry and boot swab 50 m downwind), two isolates
from farm G3 (slurry and individual animal swab) and two isolates from farm G6
(air sample in the barn and air sample 50 m downwind) showed 100% similarity
by PFGE analysis.
• ESBL/ AmpC-producing E. coli were widespread in broiler farms, as well as in
surrounding emissions.
ANIMAL-ENVIRONMENTAL INTERFACE
Laube et al., Vet Microbiol 2014; 172: 519-527
UKZN INSPIRING GREATNESS
Fluidity of Antibiotic Resistance
Genes & MGEs
Poirel et al., Antimicrob Agents Chemother 2016; 60 (7): 4394-4397
Perreten et al., Antimicrob Agents Chemother 2016; 60 (7): 4414-4415
UKZN INSPIRING GREATNESS
Fluidity of Clones, Genes and MGEs
• Six ESBL genes were identified & occurred in 35%of human isolates.
• 19% were found on IncI1 plasmids identical to those from poultry meat.
• Of the ESBL genes, 86%, 78% and 75% were blaCTX-M-1 and
blaTEM-52 genes in human, poultry & retail chicken meat samples
respectively.
• Of the retail meat samples, 39% belonged to E. coli genotypes also
present in human samples.
HUMAN-ANIMAL INTERFACE
Leverstein-van Hall et al., Clin Microbiol Infect 2011; 17: 873-880
UKZN INSPIRING GREATNESS
One Health Conceptual Framework
UKZN INSPIRING GREATNESS
Global Commitment to AMR & One Health
UKZN INSPIRING GREATNESS
Tripartite Alliance
UKZN INSPIRING GREATNESS
• Whole-of-society
engagement
• Prevention first
• Access not excess
• Sustainability
• Incremental targets
for implementation
Tripartite Alliance (2)
http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_20-en.pdf
UKZN INSPIRING GREATNESS
Tripartite Alliance: WHO
WHO efforts on antimicrobial resistance2
01
4
20
15
20
01
20
03
20
11
20
13
20
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20
16
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1. Improve awareness and understanding
of AMR
Risk communication
Education
2. Strengthen knowledge
through surveillance and
research
National AMR surveillance
Laboratory capacities
Research and development
3. Reduce the incidence of
infection through effective
hygiene & IPC
IPC in health care
Community level
prevention
Animal health:
prevention and control
4. Optimize the use of
antimicrobial medicines in
human & animal health
Access to qualified
antimicrobial medicines, regulation,
AMS
Use in veterinary
and agriculture
5. Ensure sustainable investment
through research &
development
Measuring the burden of
AMR
Assessing investment
needs
Establishing procedures
for participation
Tripartite Alliance: WHO (2)
http://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/
UKZN INSPIRING GREATNESS
Tripartite Alliance: FAO
• Improve awareness on
AMR and related threats;
• Develop capacity for
surveillance and monitoring
of AMR and AMU in food &
agriculture;
• Strengthen governance
related to AMU and AMR in
food and agriculture;
• Promote good practices in
food and agricultural
systems and the prudent
use of antimicrobials.
http://www.fao.org/3/a-i5996e.pdf
UKZN INSPIRING GREATNESS
Tripartite Alliance: FAO (2)
http://www.fao.org/3/a-i5996e.pdf
UKZN INSPIRING GREATNESS
Tripartite Alliance:
OIE
http://www.oie.int/fileadmin/Home/eng/Media_Center/docs/pdf/
PortailAMR/EN_OIE-AMRstrategy.pdf
UKZN INSPIRING GREATNESS
Centre for Science & Environment: India
• Responsible antibiotic
use in food animals
• Surveillance of antibiotic
use, residues and
resistance
• Environmental
management to contain
antimicrobial resistance
http://www.cseindia.org/userfiles/strategic-and-operational-guidance-final.pdf
UKZN INSPIRING GREATNESS
Conclusion
Antibiotic resistance is a tragedy of the commons:
When individuals act independently and in self-interest
to the detriment of the best interests of a whole group
by depleting a common resource.
Antibiotic conservation requires coordinated, multi-
pronged, multi-stakeholder, multi-disciplinary
partnerships underpinned by national and international
policies that suspend sectoral interests for public
good.
One Health Approach
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Hardin, G Science 1968. 162 (3859): 1243–1248.
