A new research center, based in America's proverbial heartland, is aiming to take on some of the big questions about antibiotic use in animal agriculture, the role that it plays in antimicrobial resistance (AMR), and how to improve health for people, animals, and the environment.
The Institute for Antimicrobial Resistance Research and Education, based at Iowa State University, stems from the recommendations of a 2015 report by a joint task force from the Association of Public Land Grant Universities (APLU) and the Association of American Veterinary Medical Colleges (AAVMC), which called for the creation of a national institute that could coordinate and implement AMR research and education initiatives. Iowa State was chosen from eight land-grant universities to lead the institute, and will partner with the US Department of Agriculture, the University of Nebraska-Lincoln, the University of Iowa, and the Mayo Clinic.
CIDRAP News spoke recently with the institute's executive director, Paul Plummer, DVM, about the work the institute will be doing. Plummer is an associate professor of veterinary and diagnostic and production animal medicine at Iowa State and is well-versed in AMR. His research has focused on drug-resistant Campylobacter, and for the past 3 years he's been collaborating with other scientists in the school's AMR Consortium.
The following excerpts from the interview have been lightly edited for clarity.
CIDRAP News: What is unique about the institute's approach to AMR research? Is there a gap that you see the institute filling?
Plummer: I think, certainly, there are a large number of very good groups working on antimicrobial resistance, so it's not for a lack of those. I think what the focus of our efforts is going to be is really trying to do an outstanding job of engaging with the livestock industry, animal agriculture, and veterinary medicine, and do that in a manner that focuses on the One Health perspective.
We have strong connections to the animal agriculture industry, as well as to the [Iowa State] veterinary school, and so building on those engagements, getting everybody to the table, and developing research projects that look at the problem from a systems-level approach—from farm to fork, if you will—are certainly going to be focuses of our efforts.
Our center certainly seeks to increase the engagement of veterinary medicine and animal agriculture in the AMR discussion in a manner that truly does look at the issue from a systems-level perspective.
CIDRAP News: How will the One Health perspective guide the work of the center?
Plummer: One Health, in its most simplistic form, is looking at the intersection of all of the health sciences—environmental health, human health, and veterinary/animal health. I don't anticipate that every project that comes out of teams formed by the center is going to include all three of those, but we certainly have the opportunity, and the mission of our efforts is going to be focused on identifying not only the impact that recommendations or treatment decisions or stewardship campaigns have on one particular aspect of that, but really how they influence each other.
So already our research teams have been spending a lot of time looking at, for instance, the role of antimicrobial resistance in runoff from agricultural livestock facilities, and whether that impacts human health, and if it does impact human health, how? And vice-versa, how do antibiotics or antibiotic metabolites that are present in wastewater effluent coming out of human hospitals work into our waterways and potentially impact livestock, agriculture, and the environment?
Our mission also crosses into antimicrobial stewardship, just in the sense of what are the gaps, for instance, in vaccine technology, and how could we improve vaccine technologies that decrease the need to use antibiotics? How can we improve housing in animal agriculture that decreases the use of antibiotics? Our mission is not purely just about molecular analysis or detection or mitigation of antimicrobial resistance; it will also include an educational and research focus on alternatives to antibiotics and gaps in stewardship knowledge related to how do we best use what we have, in terms of dosing, frequency, duration, all those questions.
CIDRAP: As you know, one of the big issues with AMR is the role of medically important antibiotic use in food-producing animals and its impact on resistance and on human health. Will research in that area be a priority for the center?
Plummer: Definitely so. I am a veterinarian, so speaking from a personal perspective, and from an institute perspective, we recognize that antimicrobial use, even when we practice good stewardship, selects for antibiotic resistance. And certainly, any antibiotics we use, whether it's in animal agriculture, pet medicine (treating our dogs and cats), and human medicine, all of those impact human health, and vice versa. And so I think certainly, because of our ties to the animal agriculture industry, there are a lot of questions related to how do we best use antibiotics, and how do we best identify new ways of decreasing antibiotic usage that don't have downstream affects that are important to also consider.
It goes beyond just stopping a particular use of a single antibiotic. How do we better manage those animals to make sure that they remain healthy and don't have a welfare issue, and what impact does that have on economic and food security issues further down the system path? Members of our research group are already doing significant research in that area, and I anticipate that research will continue to grow.
Because of our ability to work with the stakeholders and interact with them and recognize their need and their importance and their ability to produce high-quality food that all of us consume, we have to identify new ways to make sure we maintain the health of our animals, maintain our food security, and be good stewards of antibiotics.
CIDRAP: There is some tension between people in the veterinary and agricultural communities who believe the focus should be on antibiotic overprescribing in human medicine, and those in the medical community who say there isn't enough focus on antibiotic use in agricultural. Do you think the center can help bring those sides closer together?
Plummer: I think certainly that's our goal. And some of that will come through better research or new research and new ways and how they tie together. I think some of that comes from actually doing a better job of sitting down at the table and talking.
We live in a system where, as health professionals, for all of us, it's easy to point fingers at somebody else. And the fact of the matter is that all of us that are prescribing or using antibiotics impact antimicrobial resistance. Even good stewardship, and appropriate, prudent use of antibiotics, still selects for resistance. So I think this is an opportunity to get all those parties engaged to sit down and learn from each other and identify ways that each of them can do things in a slightly different way.
I think certainly we have lots of opportunities on the veterinary side to improve our education of veterinary students and graduate practitioners, and make sure that we're promoting good stewardship of antibiotics, and I think certainly efforts are under way in the human medicine side to do that as well.
And in terms of veterinary medicine, we've also got significant issues about using antibiotics in pets. We often forget that we also have a lot of households in this country, 60% plus or so, that have dogs or cats that are sometimes receiving medically important antibiotics, and then those dogs and cats are licking our kids in the face or sleeping on their pillow. And so, there you're almost closer to a potential zoonotic passage than through handling raw meat, for instance, or consuming something.
That human/animal bond is important to us from a social and cultural perspective, but I sometimes think we don't think about the impact that has on antimicrobial resistance. So I think our center also needs to be focused on what do we do on pet medicine.
Jul 27 CIDRAP News stewardship/resistance scan on Iowa State center