Stewardship / Resistance Scan for Sep 22, 2017

One Health stewardship
MRSA risk in the home
Resistant farm E coli in China

FAO calls for One Health stewardship approach, cites success in Cambodia

More funding, public health efforts, and surveillance are needed to ensure responsible use of antimicrobials in food animals and humans, Maria Helena Semedo, deputy director-general with the United Nations (UN) Food and Agriculture Organization (FAO), said yesterday. She was speaking to participants at a UN General Assembly event on Antimicrobial Resistance (AMR).

"Good health, good productivity and good economies depend on safe and nutritious food. Prudent use of antimicrobials in public health and agriculture is essential to achieve this," Semedo said, according to an FAO news story. "We need surveillance on antimicrobial use and the spread of AMR — not only through hospitals, but throughout the food chain, including horticulture and the environment for more comprehensive risk assessments."

The challenge posed by AMR is also "an opportunity to unite health, agriculture and environmental concerns in collaborative global action," Semedo said, citing the FAO's experience in Cambodia.

"By strengthening collaboration between health and agriculture ministries [in Cambodia]; helping draft rules to regulate the sale of veterinary medicines; and assisting animal health labs — we helped increase awareness and greater cooperation in dealing with AMR," she said. Semedo added that Cambodia is now sharing its experience with neighboring nations, and the FAO has experienced similar success in Ghana, Kenya, Thailand, Vietnam, Zimbabwe, Latin America, and Central Asia.
Sep 21 FAO news article


Antibiotics, biocidal cleaners may promote multidrug resistance in MRSA

People or pets taking antibiotics and the use of biocidal cleaning products like bleach may contribute to multidrug resistance (MDR) in methicillin-resistant Staphylococcus aureus (MRSA) in the home, according to a study today in Applied and Environmental Microbiology.

Contamination of the home environment may contribute to reinfection of both humans and animals with MRSA and to subsequent failure of treatment, researchers from Baltimore and Pennsylvania concluded.

In the study, the scientists collected samples from home environments and pets of households enrolled in a large randomized controlled trial, which took place over 14 months. They tested whether household-wide efforts to eradicate MRSA — which included daily use of nasal mupirocin ointment and chlorhexidine body wash — were successful in reducing recurrence of MRSA among adults and children who had been diagnosed with a MRSA skin or other soft-tissue infection. The team repeated sampling in 65 homes 3 months after the residents had been treated for MRSA, or, as a control, after they had been educated about MRSA.

"Based on the evidence, we strongly suspect that environmental contamination of the home with MRSA contributes to recurrence," said corresponding author Jonathan Shahbazian, MPH, in a news release from the American Society for Microbiology (ASM), which publishes the journal.  The investigators also suspect that household-wide selective pressures on MRSA promote the persistence of MDR strains. "We hypothesize that infected or colonized people and companion animals shed MRSA into the home environment," which then re-infect household members, he added.

Treatment with mupirocin, an antibiotic used to treat skin infections and to eradicate MRSA from patients' nasal passages, was weakly associated with mupirocin resistance in the home. That could complicate decolonization efforts that rely on the drug, said Shahbazian. He added that all MRSA isolates the investigators obtained from rural homes were MDR, suggesting that might be a risk. The study also showed that clindamycin, whether used in humans or pets, was not associated with a higher risk of MDR bacteria in the home.

"We also found the presence of domestic pets was associated with multidrug resistant MRSA in the home environment, while the presence of unwanted pests, such as mice or cockroaches, was associated with non-multidrug resistant MRSA strains," Shahbazian said.
Sep 22 Appl Environ Microbiol abstract
Sep 22 ASM news release


E coli on Chinese farm animals show high levels of antibiotic resistance

A study yesterday in PLoS One reports a 94% prevalence of resistance to at least one antimicrobial and an 83% rate of resistance to three or more classes of antimicrobials in pathogenic Escherichia coli collected from Chinese poultry and livestock.

To determine the prevalence of drug-resistant E coli, researchers working in Jiangsu, China, tested 862 clinical isolates collected from cows, pigs, ducks, and chicken from 2004 to 2012. Almost all (94%) of the samples showed resistance to one antimicrobial, and 84% showed resistance to three or more classes. All isolates collected from ducks (44) were multidrug-resistant, as were 88.2% trom chickens and 21.3% from cows.

According to the study, the highest rates of resistance (>75%) were found with tetracycline, nalidixic acid, sulfamethoxazole, ampicillin, enrofloxacin, and trimethoprim-sulfamethoxazole.

China is the biggest user of agricultural antimicrobials in the world, the study authors write. "There is growing evidence that E. coli infections of animals and people are becoming increasingly difficult to treat in China and that guidelines and regulations are urgently needed to limit and rationalize antimicrobial use."
Sep 21 PLoS One study

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