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Friday, 2 September 2011

AMR and livestock – When you won’t take the blame yourself, just kick the cat.

I’ve heard eloquent physicians over the years state that the problem with antimicrobial resistance (AMR) is the tons of antimicrobials used in the agri-food sector where resistance breeds.  The US National Academy of Sciences once estimated that the agri-food sector only contributed about 8% to the AMR problem, I suspect that is a good estimate.   In Canada, that proportion is likely even less. Canadian cautiousness actually protected against AMR trasnmissable to humans from animals through at least three significant and appropriate decisions. 
1.  Not approving enrofloxacin use in poultry sector as a routine therapy as occurred in the US resulting in resistance to fluoroquinolone resistance in humans. 
2.  Avoparcin was never approved in Canada but achieved widespread use in Europe before it was noted to be associated with VRE (vancomycin resistant enterococcus) development.  
3.  Virginiamycin was not approved in Canada, an antibiotic which led to aminoglycoside resistance, predominately south of the border.
This is not to say that the veterinary industry is not without an ability to improve its practice.  There efforts are something that perhaps human medicine and dentistry should took a lesson from. Veterinary schools collaborated in Canada on a unified antimicrobial stewardship curriculum as an expectation of new graduates - driven by the concerns of AMR 
Another approach has been the policy restriction on use of antibiotics in the livestock industry as led by Denmark - with successful reduced utilization and antibiotic resistance.  Other Scandinavian countries have followed suit.
While the Canadian regulatory environment remains rather lax and predominately supportive of the livestock industry, the veterinary community has responded in a constructive fashion to the challenge.   It is not surprising that the little antimicrobial resistance work in humans to be found currently, still rests with CFIA colleagues in Guelph who have championed the general issues about antibiotic resistant organisms.
Yes there are a few recorded cases of antimicrobial resistance directly linked between companion animals (pets, horses…) and humans, but for every case reported nationally, there is likely a similar human to human transmission that occurred in your local hospital sometime in the last few weeks.
AMR is a human problem.  Rather than blame the livestock industry, perhaps there are some things that the industry has successful accomplished without regulation from which human health professionals can learn.

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