Antimicrobial Resistance and Regulatory Changes - Feedlot School February 7, 2018 Dr. Betty Althouse Chief Veterinary Officer Saskatchewan ...
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Antimicrobial Resistance
and
Regulatory Changes
Feedlot School
February 7, 2018
Dr. Betty Althouse
Chief Veterinary Officer
Saskatchewan Ministry of Agriculture
What I hope to answer today • What is antimicrobial resistance? – Some definitions and acronyms – Is it real? • What role does livestock production play? – How much do we really use? – Stewardship • What is Canada doing about it? – Pan-Canadian Framework for Action – Federal regulatory changes • What does this mean to Saskatchewan livestock producers?
• AMR- antimicrobial resistance • AMU- antimicrobial use • API-active pharmaceutical ingredient • MIA- medically important antimicrobials • OTC- over the counter (no Prescription) • OUI- own use import • Pr- prescription-supplied by a veterinarian under a valid VCPR • VCPR- veterinary client-patient relationship • VDD- Veterinary Drug Directorate of Health Canada
A legitimate VCPR is considered to
exist only if medical records of the
practice contain sufficient evidence of
relevant and timely interaction
between the veterinarian, animal
owner and animal patients.
Antimicrobial resistance (AMR) is the ability of a microorganism (like bacteria) to stop an antimicrobial (such as antibiotics) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.
Antibiotic resistance can be shared
AMR vs residues Follow label directions On-farm food safety programs
AMU in Agriculture • Use in livestock – Growth promotion – Metaphylaxis (disease prevention) – Treatment • Bees • Fish • Horticulture
AMU in livestock
• US- estimated that about 70 percent of
antibiotics are used in agriculture
2015 FDA report-
• Canadian Antimicrobial Resistance Surveillance
62 % antibiotics given to
System (CARSS) Report (2016)
animals were medically
- 82% of MIA were intended for
important for human
production animals
health
-(up from 73% in 2014)
- 18% were for humans
- less than 1% for companion animals,
- less than 1% for crops
Adjusting for underlying populations and
weights there was roughly 1.7 times more
antimicrobials distributed for use in animals
than humansAMU Livestock
• Medically important antimicrobials (MIAs)
– Category 1- very high importance
• Critical for human medicine; few/no alternatives
• Fluoroquinalones (Baytril), ciprofloxacin, polymixin B
– Category 2- high importance
• Used to treat serious infections; alternatives exist
• Penicillin, tylosin, trimethoprim-sulfa, macrolides (Micotil, Draxxin, Zuprevo)
– Category 3- medium importance
• Infections where alternatives exist
• Tetracyclines (Liquamycin), flurfenicol (Nuflor)
• Category 4- low importance- not used in human medicine
• Ionophores (coccidiostats)Addressing AMR crisis: global community effort
Tackling Antimicrobial Resistance and Antimicrobial Use
What is “Meat Inspection”?
A Pan-Canadian Framework for Action
Surveillance Infection Research and
AMR Stewardship
Prevention and Innovation
AMU Control
One Health Approach-human, animal, environmentAMR Surveillance
• CIPARS, CARSS
– National on-going programs
– Annual reporting
• Laboratory surveillance
– Routine submissions
• Treatment failures vs pre-treatment
• Antibiogram
– Systematic surveillanceAMU Surveillance Distribution level: – by province – by species? – Feedmill use data Actual use: – all use – sample users
Infection Prevention and Control Hand-washing, sterilization, isolation Human Health Context – Health care settings- screening, isolation, information posting – Vaccinations, outbreak control – Disinfection protocols, accreditation programs, training Agriculture Context: – Disease control plans – Vaccination protocols – All-in; all-out production – Cleaning and disinfection – Biosecurity
Stewardship
Prudent UseResearch and Innovation • New antimicrobial detection, development • Alternatives- probiotics, prebiotics • New production practices • Resistance- genomics • What else?????
Federal Regulatory Changes
Veterinary Drug Directorate
• Removal of growth promotant claims for MIAs
• Increasing veterinary oversight on all MIAs- Pr
• Facilitating access to low risk veterinary health
products
• Increasing oversight on imported vet drugs (Own
Use Import-OUI)
• Increasing oversight of the import and quality of
active pharmaceutical ingredients (APIs)
• Mandatory reporting of sales volumes
(manufacturers and importers)Lay outlet antimicrobial access
Implicated MIAs for switch from OTC to Pr status • Apramycin • Sulphonamides • Bacitracin • Tetracycline/Chlortetracycline/Oxy • Erythromycin tetracycline • Lincomycin • Tilmicosin • Neomycin • Tiamulin • Penicillin G • Tylosin/Tylvalosin • Spectinomycin • Virginiamycin • Streptomycin/Dihydrostreptomycin • Or their salts or derivatives
Antimicrobials in feeds
• All will need a veterinary prescription by
December 2018
• No more MIA in feed available OTC
• Feedmills will be able to dispense MIA in feeds,
premixesAntimicrobials in feeds?
Stewardship- Feedlot AMR Study
% of Isolates Non-Susceptible to:
% of Isolates
Period Species # of Isolates
Pan-susceptible % Isolates of
One Two or more
Non-susceptible
antimicrobial antimicrobials
to antimicrobial
without CLSI
approved
breakpoints
H. somni 26 4% 42% 54% 0%
Arrival M. haemolytica 81 11% 4% 83%
2%
P. multocida 82 4% 1% 90% 5%
H. somni 44 23% 39% 30% 8%
Post-Arrival M. haemolytica 67 9% 24% 58%
9%
P. multocida 40 15% 5% 75% 5%Mannheimia haemolytica Proportional Antimicrobial Susceptibility
Arrival Post Arrival
Antimicrobial
Fisher's Exact (p-
Proportion CI 95% Proportion CI 95% value)
Ceftiofur 100% 0.955 - 1.00 100% 0.946 - 1.00 N/A
Enrofloxacin 99% 0.933 - 1.00 97% 0.896 - 0.996 0.6
Florfenicol 98% 0.914 - 0.997 99% 0.920 - 1.00 1.0
Spectinomycin 100% 0.955 - 1.00 100% 0.946 - 1.00 N/A
Gamithromycin 95% 0.878 - 0.986 96% 0.875 - 0.991 1.0
Tildipirosin 95% 0.878 - 0.986 87% 0.760 - 0.937 0.1
Tilmicosin 99% 0.933 - 1.00 72% 0.593 - 0.820What do all these changes mean to Saskatchewan livestock producers? Short-term: • need for valid VCPR • access may be more difficult-vet clinic, pharmacy • prudent use, stewardship • disease prevention plans • biosecurity Longer-term: • decreasing access, move to alternative products, research funding, reporting on use, possible production changes
Electronic export certification
Traceability • SK PID program links livestock and poultry to geographic locations for planning and responding to emergencies.
Animal ID PID Movement Reporting
How to enroll
• Individually:
– On line – premisesid.saskatchewan.ca
– By mail
– By email
Phone AKC: 1-866-457-2377QUESTIONS?
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