Antimicrobial resistance: a One Health perspective

Area of Science:

• Microbiology
• Public Health
• Genomics

Background:

• Antimicrobial resistance (AMR) poses a critical threat to human and veterinary medicine.
• The prevalence of resistant microbes is exacerbated by the widespread use and misuse of antibiotics in both human and agricultural sectors.
• The rise of vancomycin-resistant Enterococcus faecium (VRE) in the European Union (EU) following the ban of avoparcin did not lead to a significant reduction in VRE rates.

Purpose of the Study:

• To investigate the origins and spread of antimicrobial resistance, specifically focusing on vancomycin-resistant Enterococcus faecium (VRE).
• To highlight the potential role of companion animals in the evolution and dissemination of AMR.
• To advocate for a comprehensive One Health approach in combating AMR.

Main Methods:

• Analysis of antimicrobial resistance surveillance data from hospitals in the EU and USA.
• Utilizing whole-genome sequencing data to trace the evolutionary pathways of VRE.
• Examining the correlation between antibiotic usage in agriculture and the rise of resistant microbes.

Main Results:

• Despite the ban on avoparcin in the EU, VRE rates did not significantly decrease.
• The USA, which never approved avoparcin, faces substantial VRE challenges in its hospitals, with no VRE detected in US livestock.
• Whole-genome sequencing suggests VRE may have evolved from ampicillin-resistant Enterococcus faecium originating in dogs, indicating companion animals as a potential overlooked reservoir.
• Poor sanitation, particularly in India, contributes to the prevalence of highly resistant microbes.

Conclusions:

• The emergence and spread of VRE are complex and not solely attributable to agricultural antibiotic use.
• Companion animals represent a neglected factor in the AMR crisis.
• An integrated One Health strategy, incorporating human, animal, and environmental surveillance through whole-genome sequencing, is crucial for understanding and controlling AMR.