COMBATING ANTIMICROBIAL RESISTANCE
A One Health Approach to a Global Threat
PROCEEDINGS OF A WORKSHOP
Ceci Mundaca-Shah, V. Ayano Ogawa, and Anna Nicholson, Rapporteurs
Forum on Microbial Threats
Board on Global Health
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and the U.S. Agency for International Development; U.S. Army Medical Research and Materiel Command (#10001249); U.S. Centers for Disease Control and Prevention (#10002642); U.S. Department of Homeland Security (#10003591); U.S. Department of Justice: Federal Bureau of Investigation, National Institute of Allergy and Infectious Diseases/National Institutes of Health (#10003226), Uniformed Services University of the Health Sciences (#10003626), and U.S. Food and Drug Administration (#10002125); and U.S. Department of Veterans Affairs (#10003353); and by the American Society for Microbiology, Infectious Diseases Society of America, Johnson & Johnson (#10003710), Sanofi Pasteur, and Skoll Global Threats Fund (#1003664). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-46652-3
International Standard Book Number-10: 0-309-46652-0
Digital Object Identifier: https://doi.org/10.17226/24914
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Combating antimicrobial resistance: A One Health approach to a global threat: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24914.
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PLANNING COMMITTEE ON COMBATING ANTIMICROBIAL RESISTANCE: A ONE HEALTH APPROACH TO A GLOBAL THREAT1
LONNIE J. KING (Chair), Professor and Dean Emeritus, College of Veterinary Medicine, The Ohio State University
FRANCK BERTHE, Senior Livestock Specialist, Agriculture Global Practice, World Bank
LAURA A. BOCZEK, Microbiologist, Office of Research and Development, National Risk Management Research Laboratory, U.S. Environmental Protection Agency
LUCIANA L. BORIO, Acting Chief Scientist for Science and Public Health, U.S. Food and Drug Administration
TIMOTHY BURGESS, Director, Infectious Diseases Clinical Research Program, Uniformed Services University of the Health Sciences
DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development
JAMES M. HUGHES, Professor of Medicine and Public Health, Rollins School of Public Health, Emory University
KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
RIMA F. KHABBAZ, Deputy Director for Infectious Diseases; Director of Office of Infectious Diseases, U.S. Centers for Disease Control and Prevention
JOHN H. REX, Chief Strategy Officer, CARB-X
JEFFREY SILVERSTEIN, Deputy Administrator, Animal Production and Protection, Office of National Programs, Agricultural Research Service, U.S. Department of Agriculture
PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army; Director, Translational Medicine Branch, Walter Reed Army Institute of Research
ED WHITING, Director of Policy and Chief of Staff, Wellcome Trust
MARY E. WILSON, Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
Health and Medicine Division Staff
CECI MUNDACA-SHAH, Director, Forum on Microbial Threats
V. AYANO OGAWA, Program Officer
T. ANH TRAN, Senior Program Assistant
JULIE PAVLIN, Director, Board on Global Health
Consultant
ANNA NICHOLSON, Consulting Writer
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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FORUM ON MICROBIAL THREATS1
DAVID A. RELMAN (Chair), Thomas C. and Joan M. Merigan Professor, Departments of Medicine and of Microbiology and Immunology, Stanford University
JAMES M. HUGHES (Vice Chair), Professor of Medicine and Public Health, Rollins School of Public Health, Emory University
LONNIE J. KING (Vice Chair), Professor and Dean Emeritus, College of Veterinary Medicine, The Ohio State University
KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security
ENRIQUETA C. BOND, Burroughs Wellcome Fund (Emeritus); QE Philanthropic Advisors
LUCIANA L. BORIO, Acting Chief Scientist for Science and Public Health, U.S. Food and Drug Administration
TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development
ARTURO CASADEVALL, Professor and Chair, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health
PETER DASZAK, President, EcoHealth Alliance
JEFFREY S. DUCHIN, Health Officer and Chief, Communicable Disease Epidemiology and Immunization Section for Public Health, Seattle and King County, Washington
EMILY ERBELDING, Deputy Director, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health
MARCOS A. ESPINAL, Director, Communicable Diseases and Health Analysis, Pan American Health Organization
JENNIFER GARDY, Canada Research Chair in Public Health Genomics; Assistant Professor, University of British Columbia
JESSE L. GOODMAN, Professor of Medicine and Infectious Diseases; Director, Center on Medical Product Access, Safety, and Stewardship, Georgetown University
EDUARDO GOTUZZO, Director, Alexander von Humboldt Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Peru
EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology, University of California, Berkeley
CAROLINE S. HARWOOD, Gerald and Lyn Grinstein Professor of Microbiology, University of Washington
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
STEPHEN A. JOHNSTON, Director, Center for Innovations in Medicine, The Biodesign Institute, Arizona State University
KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
GERALD T. KEUSCH, Associate Director, National Emerging Infectious Diseases Laboratory, Boston University
RIMA F. KHABBAZ, Deputy Director for Infectious Diseases; Director of Office of Infectious Diseases, U.S. Centers for Disease Control and Prevention
STANLEY M. LEMON, Professor of Medicine and Microbiology and Immunology, University of North Carolina at Chapel Hill
JONNA MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis
SUERIE MOON, Director of Research, Global Health Centre, Graduate Institute of International and Development Studies, Geneva
JENNIFER OLSEN, Manager, Pandemics, Skoll Global Threats Fund
GEORGE POSTE, Chief Scientist, Complex Adaptive Systems Initiative, Arizona State University, SkySong
KUMANAN RASANATHAN, Chief, Implementation Research and Delivery Science Unit, United Nations Children’s Fund
DAVID RIZZO, Chair, Department of Plant Pathology, University of California, Davis
GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center; Director, National Infectious Disease Services, Veterans Health Administration
PETER A. SANDS, Senior Fellow, Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School
THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis
JANET SHOEMAKER, Director, Office of Public Affairs, American Society for Microbiology
JAY P. SIEGEL, Chief Biotechnology Officer, Head of Scientific Strategy and Policy, Johnson & Johnson
PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army; Director, Translational Medicine Branch, Walter Reed Army Institute of Research
MARY E. WILSON, Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
EDWARD H. YOU, Supervisory Special Agent, Weapons of Mass Destruction Directorate, Federal Bureau of Investigation
National Academies of Sciences, Engineering, and Medicine Staff
CECI MUNDACA-SHAH, Director, Forum on Microbial Threats
V. AYANO OGAWA, Program Officer
T. ANH TRAN, Senior Program Assistant
JULIE PAVLIN, Director, Board on Global Health
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Keiji Fukuda, University of Hong Kong
Lonnie King, The Ohio State University
Kevin Outterson, CARB-X
Jeffrey Silverstein, U.S. Department of Agriculture
Kavita Trivedi, Trivedi Consults, LLC
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by Robert Lawrence, Johns Hopkins University. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The Forum on Microbial Threats staff and planning committee deeply appreciate the many valuable contributions from individuals who assisted us with this project. We offer our profound thanks to all the presenters and discussants at the workshop who gave so generously of their time and expertise. A full list of speakers and moderators and their biographical information may be found in Appendix C.
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Contents
Organization of the Proceedings of a Workshop
2 THE GLOBAL MOMENTUM TO COUNTER ANTIMICROBIAL RESISTANCE
Moving from Knowledge to Action
Devising and Prioritizing a Strategy for Immediate Action and Implementation
3 MICROBIAL AND GENETIC MOVEMENTS ACROSS THE ONE HEALTH DOMAINS
Strengthening the Knowledge and Evidence Base
Antimicrobials in the Environment
4 APPLYING SOCIAL AND BEHAVIORAL SCIENCES TO COMBATING ANTIMICROBIAL RESISTANCE
Reducing Antimicrobial Use: Stewardship Programs, Incentives, and Policy
Achieving Desired Behavior Change Through Prevention Measures and Education
5 RESEARCH AND DEVELOPMENT ACTIONS FOR REDUCING THE NEED FOR ANTIMICROBIALS
Vaccination to Reduce the Burden of Antimicrobial Resistance
Research and Development Actions in Diagnostics
Economic Strategies for Accelerating Research and Development for New Antimicrobials
6 STRENGTHENING PARTNERSHIPS AND INTERNATIONAL COOPERATION
Immediate Strategies to Develop or Refine Partnerships
The Role of Partnerships in Addressing Antimicrobial Resistance
7 MOVING FROM KNOWLEDGE TO ACTION—PARTICIPANTS’ PERSPECTIVES
Suggested Actions to Improve Surveillance
Suggested Actions to Improve Stewardship, Infection Prevention, and Behavior Modification
Suggested Actions to Improve Basic and Applied Research and Development
Suggested Actions to Improve Global Policy and Coordination
Boxes, Figures, and Table
BOXES
3-2 A Critical Threat of Horizontal Gene Transfer
3-3 Promising Manure Management Strategies
4-1 Results from a Nationwide Survey of Antimicrobial Stewardship Programs
6-1 Lessons from Bedaquiline for Addressing Antimicrobial Resistance
FIGURES
3-2 The Collective Antimicrobial Resistance Ecosystem (CARE) model
3-3 Surveillance of antibiotic use in China
3-4 The spread of antibiotic resistance through various vehicles
3-5 Manufacturing as one of many potential sources of antimicrobials in the environment
4-1 Antibiotic prescriptions over the course of a day
5-1 Conceptualizing microbiome disruption indices
5-2 Common alternative approaches to antibiotic use
5-3 Effect of pneumococcal conjugate vaccine on drug-resistant pneumonia
5-5 Phased-in approach to the Priority Antimicrobial Value and Entry (PAVE) Award
6-1 Projected effect of new tools on the global incidence rate of tuberculosis (TB)
6-2 Global alignment of priority pathogen lists to discern which drugs are most needed
TABLE
Acronyms and Abbreviations
AAVMC |
Association of American Veterinary Medical Colleges |
APHIS |
Animal and Plant Health Inspection Service |
APLU |
Association of Public and Land-grant Universities |
BEARI |
Behavioral Economics to improve treatment of Acute Respiratory Infection |
BMGF |
Bill & Melinda Gates Foundation |
BQA |
Beef Quality Assurance |
CARE |
Collective Antimicrobial Resistance Ecosystem |
CDC |
U.S. Centers for Disease Control and Prevention |
CMS |
Centers for Medicare & Medicaid Services |
COP |
colonizing opportunistic pathogen |
CRE |
carbapenem-resistant Enterobacteriaceae |
DRI |
drug-resistant infection |
EHR |
electronic health record |
ESBL |
extended spectrum beta-lactamase |
ESKAPE |
Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter |
FAO |
Food and Agriculture Organization of the United Nations |
FDA |
U.S. Food and Drug Administration |
GARDP |
Global Antibiotic Research & Development Partnership |
GDF |
Global Drug Facility |
GFSI |
Global Food Safety Initiative |
GHSA |
Global Health Security Agenda |
GLASS |
Global Antimicrobial Resistance Surveillance System |
GP |
general practitioner |
HAI |
health care–associated infection |
IACG |
Interagency Coordinating Group on Antimicrobial Resistance |
ICU |
intensive care unit |
IDSA |
Infectious Diseases Society of America |
IHR |
International Health Regulations |
IMI |
Innovative Medicines Initiative |
IV |
intravenous |
MDR |
multidrug resistant |
MDR-TB |
multidrug-resistant tuberculosis |
MI |
microbiome index |
MRSA |
methicillin-resistant Staphylococcus aureus |
MSSA |
methicillin-susceptible Staphylococcus aureus |
MTB |
Mycobacterium tuberculosis |
NAE |
no-antibiotics-ever |
NARMS |
National Antimicrobial Resistance Monitoring System |
NIFA |
National Institute of Food and Agriculture |
OIE |
World Organisation for Animal Health |
PAVE |
Priority Antimicrobial Value and Entry |
PCV |
pneumococcal conjugate vaccine |
RIF |
rifampin |
SHEA |
Society for Health Care Epidemiology of America |
SSAFE |
Safe Supply of Affordable Food Everywhere |
TB |
tuberculosis |
UN |
United Nations |
USDA |
U.S. Department of Agriculture |
VFD |
Veterinary Feed Directive |
WHO |
World Health Organization |
XDR-TB |
extensively drug-resistant tuberculosis |
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