The Antimicrobial Resistance and the Environment · samples • Resistant isolates were recovered...
19
The Antimicrobial Resistance and the Environment Shivaramu Keelara Veerappa, DVM, PhD and Paula J. Fedorka-Cray, PhD North Carolina State University, College of Veterinary Medicine Department of Population Health and Pathobiology, Raleigh, NC
Transcript of The Antimicrobial Resistance and the Environment · samples • Resistant isolates were recovered...
The Antimicrobial Resistance and the Environment
Shivaramu Keelara Veerappa, DVM, PhD and Paula J. Fedorka-Cray, PhD
North Carolina State University, College of Veterinary Medicine Department of Population Health and Pathobiology, Raleigh, NC
From: https://www.transitionnetwork.org/stories/jo-homan/2012-10/fossil-moments-june-2012; originally from http://sciencemax.pbworks.com/w/page/25910486/beylifestory
Genius.com
Fullhdspictures.com
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.00349534 million old bacteria with AMR
Therefore……..
• We MISSED and excluded talking about the most important piece of the AMR puzzle – the ENVIRONMENT
• We focused on the two vectors (animals and humans) that actuality SEED the environment with both bacteria and antimicrobials
• While neglecting, until recently, to discuss the origin of both resistance and bacterial populations!
• We should also recognize the role and contribution of plants in the equation
Carrying capacity
Unlimited resources Resources limited
First Use Timeline75 year span
1944:Aminoglycoside, Streptomycin
1935:Sulfonamides, Prontosil
1942:Penicillin, Benzylpenicillin
1967:Quinolone, Nalidixic acid1964:Cephalosporin, Cefalothin
1961:Dihydrofolate reductase inhibitor, trimethoprim
1955:Glycopeptide, Vancomycin
1952:Macrolide, Erythromycin
1949:Amphenicol, Chloramphenicol
1948:Tetracycline, Chlortetracycline
2000:Oxazolidone, Linezolid
1987:2nd gen Fluorquinolone, Ciprofloxacin and Ansamycin, Rifaximin
1985:Carbapenem, Imipenem
1968: 2nd Lincosamide, Clindamycin
1958:Polymyxin, Colistin
2001:Ketolide, Telithromycin
2009:Lincoglycopeptide, Telavancin
Mass Mkt Penicillin
1960:Nitroimidazole, Metronidazole
2010:Cephalosporin, Ceftaroline
Resistance has emerged to every antimicrobial and with all antimicrobial classes
Aragonhitchhikers.blogspot.com
5 Unique Opportunities for Study of AMR
• Hurricanes• Floods• Drought• Fire• Volcanic eruptions
• In each case• Environment has been reset
Kstp.comGreenville, NC
cnnphilippines.comPhilippines
usnews.comHurricane Katrina
netnewsledger.comOntario Forest Fires
Strangesounds.orgIndonesia
Hurricane Florence
• Hurricane Florence made landfall near Wrightsville Beach, NC on September 14, 2018
• Significant economic loss ($24 billion)
• Estimated that 3.4 million poultry, 5,500 hogs, and 37 people died due to Florence flooding
• Overflow of sewage, both animal and human wastes, across cities resulted in contamination of soil and water bodies
Recreational park
Source: http://thedailynewnation.com/library/1536941273_5.jpg
Neuse river
Source: https://www.ashp.org/-/media/assets/news-and-media/images/News-Storm-Surge.ash
Source: https://media2.s-nbcnews.com/j/newscms/2018_37/2567906/180915-new-bern-florence
Residential area
Hog farms
Source: http://img.purch.com/
Sampling sites: 1) Poultry production, 2) Neuse river, 3) Residential area, 4) Swine farm, 5) Human hospital and 6) Recreational park.
Poultry production area
Neuse river
Residential area
Swine farm
Human hospital
Recreational Park
Sample collection: 10gm of soil (n=10) per site and 10ml of water (n=2 creek S1,n=2 river S2, n=2 creek S3, n=4 river/sea inlet S6) each month over a period of 11 months (November 2018- September 2019)
BacteriaTotal
+Total +
S/WS1
S/WS2
S/WS3
S/WS4
S/WS5
S/WS6
S/W
Salmonella 59 44/15 0/2 27/4 4/6 8/NS 1/NS 4 /3
Enterococcus 718 608/110 94/22 103/22 107/22 106/NS 90/NS 108/44
Generic E.coli 470 365/105 38/22 85/20 35/21 53/NS 54/NS 100/42
ESBL E. coli 61 39/22 1/0 3/4 4/0 1/NS 1/NS 29/18
Total Number of Samples Collected: Soil=660; Water=110
NS=not sampled
46.7
73.3
80.0
68.3
63.360.0
45.0
55.0
43.3
26.7
45.0
0.0
5.0 5.0 3.3
11.7
6.73.3
11.7
3.36.7 5.0
96.7100.0
93.3
81.778.3
83.3 85.0
96.7 98.3 100.0 100.0
6.73.3 3.3 1.7 0.0
3.3 3.3 3.3
8.3
13.3
28.3
0
10
20
30
40
50
60
70
80
90
100
November December January February March April May June July August SeptemberE.coli ESBL E.coli Enterococcus Salmonella
% P
reva
lenc
ePrevalence by Month: Soil samples (n=60/month)
100.0 100.0 100.0
90.0
100.0 100.0 100.0 100.0
70.0
90.0
100.0
20.0
10.0
40.0
20.0
40.0
0.0 0.0
10.0
40.0
20.0 20.0
100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
20.0
10.0
0.0 0.0 0.0 0.0
10.0
20.0
30.0
40.0
0.00
10
20
30
40
50
60
70
80
90
100
November December January February March April May June July August September
E.coli ESBL E.coli Enterococcus Salmonella
% P
reva
lenc
ePrevalence by Month: Water samples (n=10/month)
50.00
20.83 20.83
50.00
91.67
50.00
29.1733.33
37.50
95.83
62.50
33.33
100.00
37.50
0
10
20
30
40
50
60
70
80
90
100
FOX AZI CHL TET AXO AUG CIP GEN NAL XNL FIS SXT AMP STR
% R
esis
tanc
e
Panel of antimicrobials tested
Legends: Cefoxitin (FOX), Azithromycin (AZI),Chloramphenicol (CHL) ,Tetracycline (TET) ,Ceftriaxone (AXO), Amoxicillin-clavulanic acid (AUG2), Ciprofloxacin (CIP), Gentamicin (GEN), Nalidixic Acid (NAL), Ceftiofur(XNL), Sulfisoxazole (FIS), Trimethoprim/Sulfamethoxazole (SXT), Ampicillin (AMP), Streptomycin (STR)
ESBL Isolates – n=24
ESBL E. coliPatterns exhibiting extended resistance
AMP-AUG-AXO-AZI-CIP-FIS-GEN-NAL-STR-SXT-TET-XNL (n=1) AMP-AXO-AZI-CHL-CIP-FIS-GEN-NAL-STR-SXT-TET-XNL (n=1) AMP-AXO-AZI-CHL-FIS-STR-SXT-TET-XNL (n=1) AMP-AXO-AZI-FIS-FOX-NAL-STR-SXT-TET-XNL (n=1) AMP-AXO-CHL-CIP-FIS-GEN-NAL-STR-SXT-TET-XNL (n=1)
Month Location Sample type PatternDecember 2018 Human hospital Soil AMP-AUG-AXO-FOX-XNLDecember 2018 Recreational park Soil AMP-AUG-AXO-FOX-XNLJanuary 2019 Recreational park Water AMP-AUG-AXO-FOX-XNLFebruary 2019 Recreational park Soil AMP-AUG-AXO-FOX-XNLFebruary 2019 Recreational park Soil AMP-AUG-AXO-FOX-XNL
Legends: Cefoxitin (FOX), Azithromycin (AZI),Chloramphenicol (CHL) ,Tetracycline (TET) ,Ceftriaxone (AXO), Amoxicillin-clavulanic acid (AUG2), Ciprofloxacin (CIP), Gentamicin (GEN), Nalidixic Acid (NAL), Ceftiofur (XNL), Sulfisoxazole (FIS), Trimethoprim/Sulfamethoxazole (SXT), Ampicillin (AMP), Streptomycin (STR)
In Contrast
• Only 4/12 Salmonella isolates exhibited any resistance and ONLY to Streptomycin
• All the resistant isolates were isolated from soil samples
• Resistant isolates were recovered from sites S2 (Neuse river), S4 (Residential area) and S6 (Recreational park)
SUMMARY
• Final collection and complete analysis of the Florence study should provide a unique perspective of an ‘environmental reset’
• The environment has been neglected within the AMR discussion
• Neglected area of research compared to humans/animals
• Complex eco systems, climate including extreme weather events, and the continued use (ANY use) of antimicrobials will exert selective pressure and evolutionary potential on bacterial populations
Acknowledgements
• Paula Fedorka-Cray• Charlene Jackson• Marcia Headrick• Benny Barrett• Leena Jain• Sonya Herbert• Stephanie Carter
• Roxanne Reeves• Jovita Haro• Takiyah Ball • Cheryl Gresham• Carolina Hall• Jennifer Murphy• The NARMS Working
Group
I wonder
if it’s cooked right?
I hope they washed
their hands!
I thought we were having beef!! Did anyone
consider the environment
