What do hospitals and pig farms have in common? More than you think, says Bill Pomputius, pediatric infection disease consultant at Children’s Hospitals and Clinics of Minnesota.
“We share a lot of bugs and resistance genes, but we also may share a lot of solutions,” Pomputius says.
Antibiotic exposure is an inescapable web, making antibiotic resistance a reality we can’t avoid. About 175,000 tons of antimicrobials are produced globally each year, he says.
“Our use of antibiotics accelerates the pace at which antibiotic resistance emerges and spreads in bacteria through both evolution and selective pressure,” Pomputius says.
In 2013, more than 2 million people encountered illnesses due to resistant bacteria, of which there were 23,000 deaths, according to the Centers for Disease Control and Prevention. Since 2013, the problem has only worsened.
“We need to utilize the growing ability of new technologies and platforms to make a quick and accurate diagnosis, and avoid the days of broad-spectrum, empirical antibiotics,” Pomputius says.
Antimicrobial stewardship, processes that measure and optimize the appropriate use of antimicrobials by selecting the appropriate agent, dose, duration of therapy and route of administration, are helping decrease AMR at Children’s Hospitals and Clinics of Minnesota.
“We are reducing excessive costs attributable to inappropriate or unnecessary therapy, suboptimal outcomes, toxicity and other adverse events, and antimicrobial resistance,” Pomputius says.
He commended producers on their use of alternatives to antibiotics from increased use of vaccines to the use of prebiotics, probiotics and synbiotics.
From an environmental standpoint, he suggested a few areas of focus for pork producers.
Research shows that anaerobic digestion and lime stabilization are more effective than UV-importing treatment in reducing bacterial content in human waste streams, Pomputius says.
“We need to refine or rethink wastewater management practices,” he says. “We know that both bacteria, their genes, and antimicrobial agents are essentially just being recirculated over and over again using current methods.”
There are also some simple solutions that can make a big difference, including placing ring covers over manure piles to reduce the risk of runoff from the piles into local water sources.
He also recommends identifying “hot spots” of increased antimicrobial resistance gene burden such as slaughterhouses or early finishing pig barns when the pigs have a higher load of bacterial colonization.
Above all, he encourages everyone to get back to the basics. He says the global equivalent of good handwashing is a focus on infrastructure as part of a WASH (water, sanitation, hygiene) initiative.
“Low-tech is king,” he adds. “If you don’t wash your hands, it doesn’t matter what fancy antibiotics you are using.”
Both hospitals and farms face core challenges when it comes to changing the culture of prescribing antibiotics.
“There’s no denying that you feel better when your patient is being treated,” he says. “It's also hard not to treat an animal or human when you have been told by people older, more experienced than you, that this is how one does it.”
Pomputius views his antimicrobial steward role as a coach or a mentor. When it comes to decreasing antimicrobial use, it takes a team.
“Every member of the team contributes something unique to the effort. There is no one person who has a monopoly on the truth,” he says. “And perhaps most importantly, every success needs to be shared with the team because those successes will feed the next.”
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