November 2, 2017

The Resistance is Coming

By Matt Kuhn

Some of the best experiences afforded to us as Externs on the Hill are completely spontaneous. As I looked at my twitter feed two weeks ago, I noticed a posting by the USDA advertising a live-stream for an upcoming conference on the National Antimicrobial Resistance Monitoring System (NARMS). As I looked into the event, I noticed the conference itself was being held at none other than USDA Headquarters, a ten-minute metro ride from our AVMA GRD office.

NARMS is a system formed jointly by the FDA, CDC, and USDA in 1996 to monitor isolates of bacteria from sick humans (CDC), retail meats (FDA), and farm animals (USDA) to detect and track the spread of antibiotic resistance. It has been one of the most successful inter-agency collaborations in the US government and has maintained its high regard from the scientific community through the years by continuing to be innovative and transparent, providing much of their raw data directly to the public to spur further research. Having such a unique event so close by was very fortunate, so I took advantage of the two days of presentations and discussions revolving around various topics effected by NARMS.

Over the course of the conference, a couple of trends emerged from those speaking, representing not only the three sponsor organizations, but others from academia, animal and plant trade organizations, and other governmental entities. The first trend was an emphasis on whole-genome sequencing. Previous to the mass use of whole genome sequencing, studying antibiotic resistant organisms relied heavily on phenotypic responses, meaning how an isolate of bacteria responded to treatment with various antibiotics. With whole genome sequencing, we can begin to match those phenotypic responses with specific genetic changes. This allows NARMS to track the spread of specific genes, cluster outbreaks based on similar genetics, and better predict how, when, and where future outbreaks may occur. Much of the first day delved deep into this topic as its full potential is only beginning to come to light.

Another obvious motif of the conference was the need to better measure and track antibiotic use to understand its impact on resistance. Currently, one of the tasks of the FDA is to collect antibiotic sales data from industry, which is many times used in a negative light against animal agriculture. The current means of measuring antibiotic use is based upon a total mass of product sold, which does not consider potency of the drug nor how it was used, both of which make it difficult to tie these data to any substantial conclusions about their impact on resistance. Further, antibiotics sold for human medicine are not reported in the same manner making comparisons between the two industries indirect and problematic.

Everyone at the conference agreed that we can do better when it comes to preventing antibiotic resistance, but almost all emphasized that this does not mean straightforward decreases in antibiotic use or further use restrictions as many law-makers not well-versed in science have proposed. Reducing resistance means using antibiotics judiciously. Using them after culture and susceptibility rather than as a means of diagnosis. Following the correct dosage, route, and duration of therapy. And this is not all confined to food animals. Speakers voiced concerns over more strict employment of these methods in companion animal and human healthcare as well.

Agriculture Secretary Sonny Perdue was kind enough to stop by and leave us with some kind words. He emphasized the great advances made in antibiotics over the past eighty years as well as the recognition and fight against antibiotic resistance there since. While he held everyone in the room and within our field in very high regard, we all can still improve and must improve on our antibiotic use and resistance monitoring if we hope to continue our dependence upon these antimicrobials into the future.