Newsletter Vol. 29 No. 3


Coalition letter to the U.S. Congress on the state of the science
NIAA symposium on animal agriculture instigates dialogue among stakeholders
APUA co-sponsors symposium "Building Stewardship: A Team Approach"
APUA poster on African research
APUA partners with CDC for Get Smart Week 2011
 



Coalition letter to the U.S. Congress on the state of the science

On September 6, 2011, a coalition of public health organizations led by the Pew Health Group wrote a letter to Congress on the state of the science regarding the use of antibiotics in food animals. Assertively titled “Sound Science: Antibiotic Use in Food Animals Leads to Drug Resistant Infections in People,” the letter repudiated claims made on the House floor that there is a lack of “hard” scientific evidence for a link between inappropriate antibiotic use in food animals and human antibiotic resistance.

The coalition cited repeated testimonies from the USDA, FDA, and CDC stating that the use of antibiotics in food animals is resulting in the presence of resistant strains in the food supply that can be readily transmitted to consumers. The organizations also referred to reports by the Government Accountability Office, the Institute of Medicine, WHO, the World Organization for Animal Health, and the Food and Agriculture Organization of the UN that affirmed “clear evidence of adverse human health consequences” from the use – especially at subtherapeutic levels such as those used in growth promotion – of antibiotics in animal agriculture. They also cited examples of the scientific studies conducted as early as 1984 and as recently as 2010 that provided this evidence.

Organizations that signed on to this letter with the Pew Health Group included APUA, the American Medical Association, the American Public Health Association, the Infectious Diseases Society of America, the Johns Hopkins School of Public Health, and many other leaders in the fields of public health and epidemiology. APUA was also proud to canvass individual support for the letter at the 49th annual meeting of the IDSA held in Boston, MA from October 20 to October 23, 2011. Find the full text of the letter and the complete list of coalition members at saveantibiotics.org, or here. (Back to top)
 



NIAA symposium on animal agriculture instigates dialogue among stakeholders

The National Institute for Animal Agriculture (NIAA) conducted a symposium entitled “Antibiotic Use in Food Animals: A Dialogue for a Common Purpose” from October 26 to October 27, 2011, in Chicago, IL. The stated goal of the symposium was “One Health: Healthy People, Healthy Animals, Healthy Food,” and it convened 13 animal health and human health scientists to speak on four main topics: 1) human health implications relative to antibiotic use, 2) regulatory oversight and risk mitigation, 3) livestock-associated MRSA (understanding and communicating the risks), and 4) connecting with consumers. For each topic, the dialogue focused on finding areas of consensus and discussing science-based vs. value-based agreements and disagreements. Carol Cogliani (APUA Public Policy Director) was present, and 151 participants (representatives of animal agriculture, veterinary medicine, the pharmaceutical industry, and the media) attended.

On one side of the dialogue, some representatives of animal agriculture and pharmaceutical representatives claimed that antibiotic use in food animals is already sufficiently regulated by the FDA Center for Veterinary Medicine to ensure that no harmful residues enter the food supply. They stated that the risk to human health from on-farm antibiotic use was lower than the alternative risk of having sub-optimal animal health, and that the measurable adverse consequences to human health from antibiotic use in food animals (e.g. days of hospitalization due to antibiotic-resistant infection) are either unknown or very low. Food animal producers also denied that livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) contributes significantly to the overall presence of MRSA in humans, or is a foodborne pathogen at all. Rather than the use of antibiotics in food animals, they cited large hospitals, the co-hospitalization of children and the elderly, and increasing travel as factors that might be responsible for rising levels of antibiotic-resistant bacteria.
Some factors that food animal producers brought up in the dialogue to defend their on-farm antibiotic use practices were that livestock farms consult closely with veterinarians on health management decisions, that sick animals must be treated with antibiotics to restore their health and ensure that their milk and meat is safe for consumption, and that once undergoing antibiotic treatment the animal or animal product is not allowed to enter the food supply until the drug has sufficiently cleared the animal’s system. They acknowledged that biosecurity measures and the use of vaccines could help minimize the need for antibiotics, and that medically important antibiotics should only be used as drugs of last resort under the supervision of a veterinarian on a case-by-case basis.

The opposing viewpoint, from clinical microbiologists and other public health representatives, stated that dosage and duration of antibiotic therapies (such as administering antibiotics at low doses in animal feed over long periods as a growth promoter) do alter the selective pressure on bacteria that cause some strains to become resistant. They cited globally increasing resistance rates of many pathogens to many classes of antibiotics, including the tetracyclines, cephalosporins, and carbapenems (currently the “last line” of antibiotic drugs). Microbiologists also brought up the issue of the horizontal transfer of genetic resistance elements between bacteria via transposons, which highlights the danger of antibiotic resistance passing from food animals to industry personnel and from there into the populace, even if the resistant bacteria is not found on retail meat and the general population never comes into contact with the live animal.

Food animal producers stated that as industry grows, farms are forced to produce more animals and thus use more antibiotics to ensure the health of large herds, In response, some farmers of smaller farms advocated that there is a niche market in which consumers will pay for local animals raised by alternative animal husbandry practices rather than by antibiotic use. They suggested a focus on vaccines and probiotics to ensure profitability instead of the continued use of antibiotics as growth promoters.

The concluding speaker for the symposium was Dr. Mike Lormore of Pfizer Animal Health. While he maintained that the risk to human health from antibiotic use in animals is still unknown, he did emphasize the need for food animal producers to maintain standards and lower antibiotic residues in food products. He also recommended that producers take on more protocols ensuring appropriate antibiotic use and a greater degree of veterinary oversight.  In addition, he stressed the need for producers to communicate truthfully with consumers about why antibiotics are being used and how much. (Back to top)
 




 



APUA co-sponsors conference “Building Stewardship: A Team Approach”

“Building Stewardship: A Team Approach” was an educational conference held on September 14, 2011, to educate healthcare professionals about the implementation and optimization of antibiotic stewardship in acute care hospitals. Held in Shrewsbury, MA, the conference was co-sponsored by APUA, the Massachusetts Department of Public Health, the Massachusetts Coalition for the Prevention of Medical Errors, Tufts Medical Center, UMass Memorial Medical Center, and Brigham and Women’s Hospital. The conference featured presentations on strategies for building and implementing antibiotic stewardship programs, followed by smaller group sessions on pharmacodynamics and kinetics, hospital team planning, business plans, and models for program evaluation and IT metrics.

A follow-up audioconference was held on November 10, 2011, in which representatives from the 38 healthcare facilities that had attended the conference were invited to report on the efforts they had made since the conference to create or improve antibiotic stewardship programs at their hospitals. Many representatives described great strides in creating and updating antibiograms and antibiotic audit reports to document all relevant data about an antibiotic therapy (such as type, dose, duration, and mode of administration), often making use of software such as Vitek and WHONET. They also expanded the stewardship programs at their institutions to include not only infectious disease physicians but also ID nurses, pharmacists, and microbiology labs, all vital elements to an effective program. There was also great interest from hospitals in acquiring PCR capability to rapidly identify pathogens such as MRSA and C. difficile, and get their resistance and susceptibility data.

For the future, representatives suggested implementing formularies at their hospitals to restrict the use of certain antibiotics. They were also all in favor of better interdepartmental communication, in which close collaboration between physicians and pharmacists will facilitate appropriate selection and dosing of antibiotics and streamline the labor-intensive processes of IV to PO transition and de-escalation. Another strategy was establishing a decentralized committee of ID physicians or pharmacists who can be scattered throughout a hospital, so that each expert is responsible for fewer patients and has higher accountability.

The audioconference generated many practical guidelines to help hospitals develop the best possible antibiotic stewardship programs for their circumstances. Gathering representatives after the conference to talk about their progress and give each other suggestions was very effective, and provided insights that were reiterated later in the month during the national campaign Get Smart About Antibiotics Week. (Back to top)
 



APUA poster on African research

The 49th Annual Meeting of the Infectious Disease Society of America (IDSA) and the HIV Medicine Association were held in Boston, Massachusetts on October 20-23, 2011. The APUA poster featured research from Dr. Susan Foster, Dr. Anibal Sosa, and Dorothy Ochieng in a poster based on findings from an African field study funded by the Gates Foundation, entitled “Antibiotic Resistance Situation Analysis and Needs Assessment in Uganda and Zambia.”

In Uganda, APUA researchers found that many children diagnosed with pneumonia in an outpatient setting were prescribed the antibiotic cotrimoxazole (to which the rate of resistance approaches 80% in that country), multiple antibiotics, or no antibiotic at all. As a result, antibiotic therapy was potentially ineffective or absent in about 37% of cases. In addition, children with a pneumonia diagnosis were almost as likely to receive an antimalarial (58%) as an effective antibiotic (63%). Rising rates of resistance to benzyl penicillin and amoxicillin were also observed.

In Zambia, despite lack of surveillance and reliable diagnostics, APUA researchers identified S. pneumoniae as a primary pediatric pathogen for acute respiratory infections. Based on antibiotic resistance trends, ampicillin plus gentamicin were recommended as the best treatment option for severe pneumonia, and Short-Course Home Oral Therapy (NO-SHOTS) of pneumonia with amoxicillin seemed to be a better option than injectable penicillin.

The goal of this and other IDSA presentations was to increase awareness of rising levels of antibiotic resistance, and the global need for new antibiotics. APUA representatives Jennie Choe, Samantha Graham, and Alison Moore staffed the APUA exhibit, distributed educational material, and networked with interested health professionals.

Summaries of the reports can be found here:
Uganda: http://www.tufts.edu/med/apua/research/gates_2_3643739441.pdf
Zambia: http://www.tufts.edu/med/apua/research/gates_2_1388265035.pdf
(Back to top)
 



APUA partners with CDC for Get Smart Week 2011

APUA was an active strategic partner in the U.S. CDC’s annual Get Smart About Antibiotics Week (held from November 14 to November 20, 2011), collaborated with the CDC by posting educational brochures, podcasts, and other materials on the APUA website. APUA also contributed expert opinions to CDC's live Twitter chat, hosted by ABC’s Dr. Richard Besser, about upper respiratory tract infections, appropriate antibiotic use, and antibiotic resistance.

The goal of the event was to raise public awareness about the importance of appropriate antibiotic use in community and healthcare settings. The event coordinated messages from the CDC's Get Smart: Know When Antibiotics Work campaign, state-based appropriate antibiotic use campaigns, non-profit partners, and for-profit partners during this one week observance.

The CDC developed a variety of print and electronic materials on their website to help promote the observance and educate target audiences during the event week. (Back to top)
 




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