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Draft:The Link Between Zoonotic Diseases and Antimicrobial Resistance

Introduction

The relationship between antimicrobial resistance (AMR) and zoonoses represents a critical area of concern in public health, as it emphasizes the interconnectedness of human, animal, and environmental health: One Health.[1]. Antimicrobial resistance represents one of the most significant global public health challenges. AMR is the phenomenon where microorganisms, like bacteria, viruses and fungi, evolve to resist the effects of medications that were previously effective in the treatment of infections caused by them [2]. Zoonoses are diseases with the potential to be transmitted between animals and humans [3]. Around 75% of emerging infectious diseases have zoonotic origin with 60% of all known infectious diseases in humans having zoonotic origin as well [4].

Background Information

Image Showing How Antibiotic Resistance is Transmitted

Antimicrobial Resistance (AMR)

Living things, including microorganisms, function with the purpose of reproducing. Microorganisms have different methods of adapting to their environment that ensure their growth, survival and subsequent reproduction [5]. Antimicrobial resistance is a natural evolutionary mechanism in microbes [6]. AMR contributes to replication of microorganisms, like bacteria, with traits or characteristics that encourage successful survival until the next replication cycle. AMR can occur because of genetic mutations or through horizontal gene transfer. Horizontal gene transfer (HGT) is characterized as genetic material being shared between microorganisms that are not part of a parent–offspring relationship [7].

Causes of antimicrobial resistance

Inappropriate use or misuse of antimicrobials is one of them. Antibiotics, antiviral and antifungal medications are used to treat bacterial, viral and fungal infections, respectively. Inappropriately prescribing antibiotics for a viral infections, for example, can increase the chances of developing antimicrobial resistance [8]. When patients do not follow the instructions given when taking antimicrobials, not finishing the course or missing doses, this can also contribute to resistance. There is also overuse of antimicrobials both in human medicine and agriculture like livestock farming. Approximately 80% of all antibiotics used annually in the USA are used in the agricultural sector [9]. Antimicrobial resistant pathogens can be passed on through human-animal contact or by ingesting contaminated animal food products. Environmental contamination (e.g. soil and water) with pharmaceutical wastes and inadequate sanitation and hygiene also play a part in disseminating the genes for resistance and resistant pathogens [10].

Zoonoses (also known as Zoonotic Diseases)[11]

Image Showing Examples of Zoonotic Diseases

Zoonotic diseases are any disease that can be “transmitted to humans by nonhuman vertebrate animals, such as mammals, birds, reptiles, amphibians, and fish” [12]. Zoonoses are especially important because of the close relationship that exists between human beings and animals as companionship animals (pets) or during livestock raring or processing as food. There is increasing human-animal interaction due to urbanization, habitat destruction (e.g. deforestation), wildlife exploitation and trade, climate change, and zoos. This has heightened the risk of zoonotic disease emergence [13]. Most zoonoses can be transferred to humans through direct contact, consumption of contaminated food or water, or via vectors such as mosquitoes, ticks, and fleas. Some significant examples of zoonotic diseases include swine influenza, bird influenza, rabies, salmonella, ringworm, leptospirosis, Yellow Fever, Zika virus and West Nile virus, Lyme disease and Ebola [14].

Link between Zoonotic diseases and antimicrobial resistance

Among the zoonotic diseases, many are linked to the overuse and misuse of antimicrobials. Some examples of zoonoses linked to antimicrobial resistance are E. Coli, salmonella, Methicillin-resistant Staphylococcus aureus (MRSA) and Brucellosis [1].

In agriculture, the use of antimicrobials for non-medical and/or non-therapeutic purposes at subtherapeutic levels over extended periods of time is seen [15]. This is primarily for growth promotion and disease prevention in healthy animals. To protect their investments, farmers will administer antimicrobials to animals to prevent infections and ensure they reach the stage in their lifecycle where they are market-ready, that is, useful for the production of meat, eggs, milk and pelts [16]. This is a common route for the genesis of antibiotic resistance and antibiotic-resistant bacteria and their subsequent transmission to humans. Approximately 2.5 billion cases of human illness and 2.7 million human deaths worldwide each year are caused by zoonotic diseases [17].

One pertinent example of a zoonotic disease linked to antibiotic resistance is Methicillin-resistant Staphylococcus aureus (MRSA). Staphylococcus aureus is a bacterium that can be resistant to different antibiotics like methicillin and similarly classed drugs like oxacillin, nafcillin as well as cephalosporins [18]. It was found in a series of experimental studies that MRSA was found after swabbing pigs’ noses, the noses of farm workers, in animal feed and even in the air downwind from the farms [19][20][21]. In another study based in Brazil, MRSA was found to contaminate milk samples, a bold example of how consumption of animal products can facilitate transmission [22][23]. Once in the healthcare setting, like in hospitals, MRSA is common and persistent as patients have weakened immune systems, breaks in the skin (wounds, burns) and other foreign objects placed in their bodies (breathing tubes, catheters, IV lines, surgery, injections). This facilitates infection with MRSA. This makes treatment more complicated for patients, resulting in longer illness durations, higher healthcare expenses and increased burden on the health care system [24][25]

Prevention Strategies[26][27]

As antimicrobial resistance continues to escalate, addressing the zoonotic contribution is in line with global health priorities. Therefore, strategies to prevent antimicrobial resistant zoonoses can be categorized under each component of One Health.

Human Health

·      Education and Awareness – disseminating information and promoting public education on the responsible use of antibiotics.

·      Infection Prevention and Control: Encouraging hand hygiene and proper sanitation as well as enforcing infection control protocols in healthcare settings (e.g. isolation of the sick if required, consistent use of personal protective equipment, sanitation and hygiene)

Animal Health

·      Responsible Use of Antimicrobials: Encourage veterinarians and livestock producers to use antibiotics judiciously; prescribing them only when necessary.

·      Vaccination Programs: Promotion of livestock and pet vaccination to reduce the incidence of diseases that may require antibiotic treatment.

·      Infection Prevention and Control: Creating healthy living conditions for livestock (e.g. avoiding overcrowding, proper sheltering). Encouraging hand hygiene and proper sanitation of individuals interacting with livestock as well as enforcing infection control protocols (e.g. isolation/culling of the sick animals if required)

Environmental Health

·      Waste Management: Improve the management of agricultural wastes (e.g. manure) to reduce antimicrobials and antimicrobial resistant microbes being released into the environment to contaminate soil and water.

·      Water and Soil Quality Monitoring: Monitor water sources and soil for contamination with resistant microorganisms, particularly in agricultural settings.

Integrated Strategies

·      Multidisciplinary Collaboration: Establish and maintain collaboration among the interprofessional team; healthcare professionals, veterinarians, environmental scientists, and policymakers to develop cohesive strategies against AMR.

·      Research and Development: Support and fund research initiatives focused on understanding the mechanisms of AMR transmission between animals, humans, and the environment.

·      Policy Development: Advocate for policies: promoting sustainable agricultural practices, responsible antibiotic use, and surveillance systems for AMR.

References

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  1. ^ a b Dafale, Nishant A.; Srivastava, Shweta; Purohit, Hemant J. (2020-03-04). "Zoonosis: An Emerging Link to Antibiotic Resistance Under "One Health Approach"". Indian Journal of Microbiology. 60 (2): 139–152. doi:10.1007/s12088-020-00860-z. PMC 7105526. PMID 32255846.
  2. ^ "The Journal of Global Antimicrobial Resistance meets the World Health Organization (WHO)". Journal of Global Antimicrobial Resistance. 18: 305–308. September 2019. doi:10.1016/j.jgar.2019.07.022. ISSN 2213-7165. PMID 31521332.
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  13. ^ Esposito, Michelle Marie; Turku, Sara; Lehrfield, Leora; Shoman, Ayat (2023-05-15). "The Impact of Human Activities on Zoonotic Infection Transmissions". Animals. 13 (10): 1646. doi:10.3390/ani13101646. ISSN 2076-2615. PMC 10215220. PMID 37238075.
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  16. ^ Mole, Beth; Nature Magazine. "From Fields to Fevers: Are Farms Breeding Deadly MRSA Infections?". Scientific American. Retrieved 2024-10-25.
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  18. ^ Ali Alghamdi, Bandar; Al-Johani, Intisar; Al-Shamrani, Jawhra M.; Musamed Alshamrani, Hussein; Al-Otaibi, Bandar G.; Almazmomi, Kholod; Yusnoraini Yusof, Nik (April 2023). "Antimicrobial resistance in methicillin-resistant staphylococcus aureus". Saudi Journal of Biological Sciences. 30 (4): 103604. Bibcode:2023SJBS...3003604A. doi:10.1016/j.sjbs.2023.103604. ISSN 1319-562X. PMC 10018568. PMID 36936699.
  19. ^ Moyer, Melinda Wenner (2016-12-01). "How Drug-Resistant Bacteria Travel from the Farm to Your Table". Scientific American. Retrieved 2024-10-25.
  20. ^ Smith, Tara C.; Gebreyes, Wondwossen A.; Abley, Melanie J.; Harper, Abby L.; Forshey, Brett M.; Male, Michael J.; Martin, H. Wayne; Molla, Bayleyegn Z.; Sreevatsan, Srinand; Thakur, Siddhartha; Thiruvengadam, Madhumathi; Davies, Peter R. (2013-05-07). "Methicillin-Resistant Staphylococcus aureus in Pigs and Farm Workers on Conventional and Antibiotic-Free Swine Farms in the USA". PLOS ONE. 8 (5): e63704. Bibcode:2013PLoSO...863704S. doi:10.1371/journal.pone.0063704. ISSN 1932-6203. PMC 3646818. PMID 23667659.
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  26. ^ White, Allison; Hughes, James M. (September 2019). "Critical Importance of a One Health Approach to Antimicrobial Resistance". EcoHealth. 16 (3): 404–409. doi:10.1007/s10393-019-01415-5. ISSN 1612-9202. PMID 31250160.
  27. ^ National Academies of Sciences, Engineering, and Medicine; Health And Medicine, Division; Board On Global, Health; Forum On Microbial, Threats (2017-12-08). Mundaca-Shah, Ceci; Ogawa, V. Ayano; Nicholson, Anna (eds.). Combating Antimicrobial Resistance. Washington, D.C.: National Academies Press. doi:10.17226/24914. ISBN 978-0-309-46652-3. PMID 29227604.{{cite book}}: CS1 maint: multiple names: authors list (link)
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