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Antimicrobial Resistance (AMR) is a global threat to both animal and human health. In this blog, APHA's Tom Chisnall explains what AMR is and how antibiotic resistant bacteria found in migratory birds, could affect farm livestock.

"Antimicrobial Resistance as a Global Health Crisis" published on by Oxford University Press.

In animal husbandry, antimicrobial agents have been administered as supplements to increase production over the last 60 years. Large-scale animal production has increased the importance of antibiotic management because it may favor the evolution of antimicrobial resistance and select resistant strains. Brazil is a significant producer and exporter of animal-derived food. Although Brazil is still preparing a national surveillance plan, several changes in legislation and timely programs have been implemented. Thus, Brazilian data on antimicrobial resistance in bacteria associated with animals come from official programs and the scientific community. This review aims to update and discuss the available Brazilian data on this topic, emphasizing legal aspects, incidence, and genetics of the resistance reported by studies published since 2009, focusing on farm animals and derived foods with the most global public health impact. Studies are related to poultry, cattle, and pigs, and mainly concentrate on non-typhoid Salmonella, Escherichia coli, and Staphylococcus aureus. We also describe legal aspects of antimicrobial use in this context ; and the current occurrence of genetic elements associated with resistance to beta-lactams, colistin, and fluoroquinolones, among other antimicrobial agents. Data here presented may be useful to provide a better understanding of the Brazilian status on antimicrobial resistance related to farm animals and animal-derived food products.

Abstract
The global spread of antimicrobial resistance (AMR) is an existential threat to humanity, one that has generated a macrosecuritizing response by states and international organizations. Since the turn of the century, China has been a source of numerous infectious disease outbreaks. It is also the origin of the MCR-1 gene, which confers resistance to colistin, a "last-line" antibiotic deployed against multidrug-resistant infections. With the largest population in the world, coupled with its status as a major supplier of agricultural produce, evaluating Chinese responses to AMR is critical to understanding the efficacy of the global response. Drawing on knowledge of both Chinese politics and health security, this article analyzes how Chinese actors have responded to the threat in the public and animal health sectors as well as the domestic and international implications of these responses. Based on interviews with key Chinese and international officials, scientists, and public health specialists, as well as farmers and consumers, we argue that the securitization of AMR in China is currently more concerned with domestic policy and resource competition than with addressing the existential health threat. Without a greater alignment of AMR strategies within China, macrosecuritizing efforts to address the threat globally cannot succeed.

In 2001, the Task Force developed an initial Action Plan, outlining specific issues, goals, and actions important for addressing the problem of AR. This document, entitled A Public Health Action Plan to Combat Antimicrobial Resistance, Part I: Domestic Issues, reflected a broad- based consensus of participating federal agencies, which was reached with individual input from state and local health agencies, universities, professional societies, pharmaceutical companies, healthcare delivery organizations, agricultural producers, consumer groups, and other members of the public. Continued collaboration with these partners has been vital to achieving successful implementation of the Action Plan. This revised Action Plan is based in part on individual input obtained at a consultants' meeting held in Atlanta, Georgia, in December 2007. Present at the public meeting were consultants with wide-ranging expertise in areas such as human and veterinary medicine, pharmaceutical and diagnostics manufacturing, animal husbandry, clinical microbiology, epidemiology, infectious diseases and infection control, and state and local public health officials. The Action Plan includes action items organized into four focus areas: Surveillance, Prevention and Control, Research, and Product Development. ; Executive summary -- Introduction and overview -- The Focus Areas -- Focus Area I: Surveillance -- Focus Area II: Prevention and Control -- Focus Area III: Research -- Focus Area IV: Product Development -- Acronyms and abbreviations ; Interagency Task Force on Antimicrobial Resistance ; co-chairs: Centers for Disease Control and Prevention, Food and Drug Administration. ; Title from caption (viewed on October 1, 2012). ; The Interagency Task Force on Antimicrobial Resistance (hereafter referred to as the Task Force) was created in 1999 to coordinate the activities of federal agencies in addressing antimicrobiala resistance (AR) in recognition of the increasing importance of AR as a public health threat. The Task Force is co-chaired by the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH) and also includes the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare and Medicaid Services (CMS), the Department of Agriculture (USDA), the Department of Defense (DoD), the Department of Veterans Affairs (VA), the Environmental Protection Agency (EPA), the Health Resources and Services Administration (HRSA), and the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR). ; Mode of access: Internet; PDF reader (Acrobat .pdf file: 300 KB, 34 p.). ; Text (electronic publication)

Antimicrobial resistance poses a growing threat to public health and the provision of health care. Its surveillance should provide up-to-date and relevant information to monitor the appropriateness of therapy guidelines, antibiotic formulary, antibiotic stewardship programmes, public health interventions, infection control policies, and antimicrobial development. In Europe, although the European Antimicrobial Resistance Surveillance Network provides annual reports on monitored resistant bacteria, national surveillance efforts are still fragmented and heterogeneous, and have substantial structural problems and issues with laboratory data. Most incidence and prevalence data cannot be linked with relevant epidemiological, clinical, or outcome data. Genetic typing, to establish whether trends of antimicrobial resistance are caused by spread of resistant strains or by transfer of resistance determinants among different strains and species, is not routinely done. Furthermore, laboratory-based surveillance using only clinical samples is not likely to be useful as an early warning system for emerging pathogens and resistance mechanisms. Insufficient coordination of surveillance systems of human antimicrobial resistance with animal surveillance systems is even more concerning. Because results from food surveillance are considered commercially sensitive, they are rarely released publicly by regulators. Inaccurate or incomplete surveillance data delay a translational approach to the threat of antimicrobial resistance and inhibit the identification of relevant target microorganisms and populations for research and the revitalisation of dormant drug-discovery programmes. High-quality, comprehensive, and real-time surveillance data are essential to reduce the burden of antimicrobial resistance. Improvement of national antimicrobial resistance surveillance systems and better alignment between human and veterinary surveillance systems in Europe must become a scientific and political priority, coordinated with international ...

National institutions/organisations participating in EARS-Net: Portugal - National Institute of Health Dr. Ricardo Jorge: Manuela Caniça; Vera Manageiro ; Antimicrobial resistance data reported to EARS-Net by 28 countries in 2010 and trend analyses including EARSS data from previous years, show that the Europewide increase of antimicrobial resistance observed in Escherichia coli during recent years is continuing unimpeded. The highest resistance proportions in E. coli were reported for aminopenicillins ranging up to 83 %. Despite the already high level of resistance the increase continues even in countries presenting resistance well above 50 %. The percentage of third-generation cephalosporin resistance reported among E. coli isolates has increased significantly over the last four years in half of the reporting countries, while a decreasing trend was observed in only one country. This resistance is directly linked to the high proportions (65–100 %) of ESBL-positives among cephalosporin-resistant E. coli isolates reported in 2010. A high frequency of multi-drug resistant Klebsiella pneumoniae was observed in southern, central and eastern Europe. In half of the reporting countries, the proportion of multiresistant K. pneumoniae isolates (combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides) was above 10 % and five countries show an increasing trend of carbapenem resistant K. pneumoniae. Carbapenems have been widely used in many countries due to the increasing rate of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae with a consequent impact on the emergence of carbapenemase production (VIM, KPC and NDM-1). Other trends in the occurrence of resistance reported to EARS-Net bring hope that national efforts on infection control and efforts targeted at containment of resistance may in some cases bring the development of resistance to a halt, or even reverse undesirable resistance trends, as exemplified by the development for meticillin-resistant Staphylococcus aureus (MRSA). Even though the proportion of MRSA among S. aureus is still above 25 % in eight out of 28 countries, the occurrence of MRSA is stabilising or decreasing in some countries and a sustained decrease has been observed in Austria, France, Ireland, Latvia, the UK and Cyprus. Furthermore, the United Kingdom has shown a consistent reduction of resistant proportions in K. pneumoniae for all antimicrobial classes under surveillance, and in a few countries (Germany, Greece, Italy and the UK) the efforts to control glycopeptide resistance in Enterococcus faecium seem to be successful and resulting in a continuous decrease of proportions of resistant isolates. Meanwhile, high-level aminoglycoside resistance in Enterococcus faecalis is stabilising in Europe at a level of 25–50%. For Streptococcus pneumoniae, non-susceptibility to penicillin remains generally stable in Europe and non-susceptibility to macrolides has declined in five countries while an increasing trend was observed in only one country. For Pseudomonas aeruginosa, high proportions of resistance to fluoroquinolones, carbapenems and combined resistance have been reported by many countries, especially in southern and eastern Europe. For several antimicrobial and pathogen combinations, e.g. fluoroquinolone resistance in E. coli, K. pneumoniae, P. aeruginosa and for MRSA, a north to south gradient is evident in Europe. In general, lower resistance proportions are reported in the north and higher proportions in the south of Europe. This is likely to be a reflection of differences in infection control practices, presence or absence of legislation regarding prescription of antimicrobial drugs. However, for K. pneumoniae, increasing trends of resistance to specific antimicrobial classes and of multiresistance have also been observed in northern European countries, like Denmark and Norway, which traditionally have a prudent approach to antimicrobial use. In addition to the regular trend analysis and situation overview, this 2010 EARS-Net report contains a focus chapter providing in-depth analysis for carbapenem resistant K. pneumoniae and P. aeruginosa. Results from susceptibility testing to carbapenems for these two pathogens reported since 2005, reveal a significant decrease of susceptibility to carbapenems in invasive K. pneumoniae over the period 2005–2010. Carbapenems are some of the few effective antimicrobials for the treatment of infections caused by bacteria that produce extended-spectrum beta-lactamases and thus resistance to carbapenems leaves very few therapeutic options available. Based on EARS-Net data, the antimicrobial resistance situation in Europe displays large variation depending on pathogen type, antimicrobial substance and geographical region. Besides evidence of stabilisation of the situation for some pathogens (e.g. MRSA) in a number of countries, the data show the unimpeded decline of antimicrobial susceptibility in other major pathogens (e.g. E. coli) and the alarming emergence of carbapenem resistance in K. pneumonia, leading to an unfortunate loss of antimicrobial treatment options.