Agricultural Applications for Antimicrobials. A Danger to Human Health: An Official Position Statement of the Society of Infectious Diseases Pharmacists

From Herd Health to Public Health: Digital Tools for Combating Antibiotic Resistance in Dairy Farms

The emergence of antimicrobial resistance (AMR) is a significant threat to global food security, human health, and the future of livestock production. Higher rates of antimicrobial use in dairy farming and the sheer lack of new antimicrobials available for use focused attention on the question of how the dairy production sector contributed to the development of AMR and paved the path toward taking action to curtail it on the targeted type of farms. This paper aims to provide an introduction to a phenomenon that has gained considerable attention in the recent past due to its ever-increasing impact, the use of antimicrobial drugs, the emergence of antimicrobial resistance (AMR) on dairy farms, and seeks to discuss the possibilities of approaches such as digital health monitoring and precision livestock farming. Using sensors, data, knowledge, automation, etc., digital health monitoring, as well as Precision Livestock Farming (PLF), is expected to enhance health control and minimize disease and antimicrobial usage. The work presents a literature review on the current status and trends of AMR in dairy farms, an understanding of the concept of digital health monitoring and PLF, and the presentation and usefulness of digital health monitoring and PLF in preventing AMR. The study also analyses the strengths and weaknesses of adopting and incorporating digital technologies and artificial intelligence for dairy farming and presents areas for further study and level of use.

Antimicrobial use in 22 U.S. beef feedyards: 2016-2017

This study describes antimicrobial use in 22 U.S. beef feedyards by use of two metrics: milligrams of antimicrobial per kilogram of liveweight sold (mg/kg-LW) and antimicrobial regimens per animal year (Reg/AY). The primary objectives were to determine the feasibility of collecting antimicrobial use data at the level of the production system and to identify factors unique to feedyard systems which may confound interpretation of summarized antimicrobial use measures. Records were accessed directly from feedyards or through a data intermediary and then subjected to a process of standardization and quality assurance. Use is reported at the study level with all individual cattle lots from all feedyards combined, as well as at the feedyard level where values were first calculated for each feedyard and then expressed as means, standard deviations and median values. Use at the study level is first reported by antimicrobial class and then by antimicrobial class within the use categories of in-feed, control of bovine respiratory disease (BRD) and individual animal treatment. Due to wide variations of antimicrobial class within use category, feedyard level antimicrobial use is reported only by antimicrobial class. Use values for medically important and not medically important antimicrobial classes are reported separately. Regimens are described for each antimicrobial class within use category by milligrams per regimen and by timeframe from first to last administration. The authors' selection of measures reported here was driven by a desire to minimize necessary assumptions, resulting in transparent reporting of values which can be directly related back to the factors within feedyard systems which may have influenced calculations. Reporting the number of regimens stratified by antimicrobial class within use category and then describing the characteristics of the reported regimens (milligrams per regimen and timeframe) optimize these objectives for reporting.

Precarious Essential Work, Immigrant Dairy Farmworkers, and Occupational Health Experiences in Vermont

Migrant dairy workers in Vermont face a wide range of occupational and health hazards at work. This research examines the environmental risks, occupational health hazards, and health outcomes experienced by migrant dairy farm workers in Vermont. This research draws on a triangulation of sources including analysis of data—surveys and interviews with migrant dairy farmworkers gathered by the organization Migrant Justice since 2015 as well as relevant key informant interviews with community organizations across the state to characterize the occupational health experiences of migrant dairy workers in Vermont. Our results show that Vermont migrant dairy farmworkers received poor health and safety training and lacked sufficient protective gear. Over three quarters of the respondents reported experiencing harm from chemical and biological risks. Close to half the survey respondents reported headaches, itchy eyes and cough; a quarter reported breathing difficulties; three fourths reported being hurt by animal-related risks. These exposures and existing health concerns are avoidable. Migrant workers require better social representation and advocates to negotiate better work-related protection and training, access to health services, and social welfare to ensure their health and safety.

Evaluation of evidence-based urinalysis reflex to culture criteria: Impact on reducing antimicrobial usage

OBJECTIVES

To implement evidence-based urinalysis (UA) reflex criteria and to evaluate the impact of the intervention on reducing unnecessary antibiotic usage.

METHODS

A prospective intervention study was conducted on 4130 urine samples that were subjected to UA during March to May 2020. Results were analyzed in order to evaluate the effectiveness of newly implemented evidence-based criteria in predicting positive urine cultures. The intervention involved implementing evidence-based UA reflex criteria to ensure a high predictive value of the UA reflex parameters. Multivariable logistic regression was utilized to evaluate the effectiveness of these UA parameters in predicting positive urine cultures and to assess the impact of the new UA criteria on antibiotic usage.

RESULTS

A total of 4130 patient samples were included in the study; 60.1% (n = 2484) were from female patients and 39.9% (n = 1646) were from male patients. The total number of negative urine reflex samples was 3116, which accounted for 75.4% of the total UA reflex samples. In contrast, 24.6% of the urine reflex samples (n = 1014) returned positive UA results and were reflexed to urine culture. Among the urine samples that were cultured, 9% (n = 91) were negative urine cultures, while 91.0% (n = 923) were positive urine cultures. Chi-square analysis indicated highly statistically significant associations between the combination parameters of (≥5 white blood cells (WBCs) and positive nitrite) and positive urine cultures (Chi-square = 516.428, p < 0.001) and (≥5 WBCs and moderate or large esterase) and positive urine cultures (Chi-square = 503.387, p < 0.001). Additionally, Chi-square analysis indicated a highly statistically significant association between the combination parameters of (≥5 WBCs and ≥1 bacteria) and positive urine cultures (Chi-square = 434.806, p < 0.001). The statistical analysis showed that the implementation of evidence-based UA reflex criteria significantly decreased the number of urine cultures performed and potentially decreased the number of patients inappropriately treated with antibiotics from 45.1% to 9%.

CONCLUSIONS

In conclusion, ≥5 WBCs and positive nitrite yielded the highest positive predictive value of 98.00% and showed a highly significant association with positive urine cultures. It was observed that the new UA reflex criteria are highly effective in predicting positive urine cultures, thus potentially resulting in the reduction of unnecessary antibiotic usage.

From environment to clinic: the role of pesticides in antimicrobial resistance

Antimicrobial resistance (AMR) in pathogens has been associated mainly with excessive use of antibiotics. Most studies of resistance have focused on clinical pathogens; however, microorganisms are exposed to numerous anthropogenic substances. Few studies have sought to determine the effects of chemical substances on microorganisms. Exposure to these substances may contribute to increased rates of AMR. Understanding microorganism communities in natural environments and AMR mechanisms under the effects of anthropogenic substances, such as pesticides, is important to addressing the current crisis of antimicrobial resistance. This report draws attention to molecules, rather than antibiotics, that are commonly used in agrochemicals and may be involved in developing AMR in non-clinical environments, such as soil. This report examines pesticides as mediators for the appearance of AMR, and as a route for antibiotic resistance genes and antimicrobial resistant bacteria to the anthropic environment. Available evidence suggests that the natural environment may be a key dissemination route for antibiotic-resistant genes. Understanding the interrelationship of soil, water, and pesticides is fundamental to raising awareness of the need for environmental monitoring programs and overcoming the current crisis of AMR.

Mediation of oxidative stress toxicity induced by pyrethroid pesticides in fish

Organophosphate and organochlorine pesticides are banned in most countries because they cause high toxicity and bioaccumulation in non-target organisms. Pyrethroid pesticides have been applied to agriculture and aquaculture since the 1970s to replace traditional pesticides. However, pyrethroids are approximately 1000 times more toxic to fish than to mammals and birds. Fish-specific organs such as the gills and their late metabolic action against this type of pesticide make fish highly susceptible to the toxicity of pyrethroid pesticides. Oxidative stress plays an important role in the neurological, reproductive, and developmental toxicity caused by pyrethroids. Deltamethrin, cypermethrin, and lambda-cyhalothrin are representative pyrethroid pesticides that induce oxidative stress in tissues such as the gills, liver, and muscles of fish and cause histopathological changes. Although they are observed in low concentrations in aquatic environments such as rivers, lakes, and surface water they induce DNA damage and apoptosis in fish. Pyrethroid pesticides cause ROS-mediated oxidative stress in fish species including carp, tilapia, and trout. They also cause lipid peroxidation and alter the state of DNA, proteins, and lipids in the cells of fish. Moreover, changes in antioxidant enzyme activity following pyrethroid pesticide exposure make fish more susceptible to oxidative stress caused by environmental pollutants. In this review, we examine the occurrence of pyrethroid pesticides in the aquatic environment and oxidative stress-induced toxicity in fish exposed to pyrethroids.

A Review of Potential Public Health Impacts Associated With the Global Dairy Sector

Strong demand for dairy products has led to a global increase in dairy production. In many parts of the world, dairy systems are undergoing rapid intensification. While increased production may contribute to food security, higher dairy stocking rates in some regions have resulted in increased pressure on natural resources with the potential to affect public health and wellbeing. The aim of this review was to identify and describe the potential health harms and benefits associated with dairy production and consumption. Electronic databases Medline, Embase, Scopus, Web of Science, PubMed, and Google Scholar were searched for published literature that investigated human health impacts of dairy production and consumption. Occupational hazards, environmental health impacts, ecosystem health impacts, foodborne hazards, and diet-related chronic diseases were identified as potential public health hazards. Some impacts, notably climate change, extend beyond directly exposed populations. Dairy production and consumption are also associated with important health benefits through the provision of nutrients and economic opportunities. As the global dairy sector increases production, exposure to a range of hazards must be weighed with these benefits. The review of impacts presented here can provide an input into decision making about optimal levels of dairy production and consumption, local land use, and identification and management of specific hazards from this sector. Future research should consider multiple exposure routes, socioeconomic implications, and environmental factors, particularly in regions heavily dependent on dairy farming.

Differentiating Epidemic from Endemic or Sporadic Infectious Disease Occurrence

One important scope of work of epidemiology is the investigation of infectious diseases that cluster in time and place. Clusters of infectious disease may represent outbreaks or epidemics in which the cases share in common a point source exposure or an infectious agent in a chain of transmission pathways. Investigations of outbreaks of an illness can facilitate identification of a source, risk, or cause of the illness. However, most infectious disease episodes occur not as part of any apparent outbreaks but as sporadic infections. Multiple sporadic infections that occur steadily in time and place are referred to as endemic disease. How does one investigate sources and risk factors for sporadic or endemic infections? As part of the Microbiology Spectrum Curated Collection: Advances in Molecular Epidemiology of Infectious Diseases, this review discusses limitations of traditional approaches and advantages of molecular epidemiology approaches to investigate sporadic and endemic infections. Using specific examples, the discussions show that most sporadic infections are actually part of unrecognized outbreaks and that what appears to be endemic disease occurrence is actually comprised of multiple small outbreaks. These molecular epidemiologic investigations have unmasked modes of transmission of infectious agents not known to cause outbreaks. They have also raised questions about the traditional ways to measure incidence and assess sources of drug-resistant infections in community settings. The discoveries made by the application of molecular microbiology methods in epidemiologic investigations have led to creation of new public health intervention strategies that have not been previously considered. *This article is part of a curated collection.

W. Vieira C, Parveen S. Genotypic and phenotypic characterization of Escherichia coli isolated from mollusks in Brazil and the United States

The aim of this study was to determine the serogroups, antimicrobial resistance and genetic diversity of Escherichia coli isolates from samples of bivalve mollusks collected along Santa Catarina coast, Brazil, and from the Chesapeake Bay, Maryland, USA. One hundred forty-one E. coli isolates were characterized for serogroups with 181 specific O antisera and antimicrobial susceptibility using the disk diffusion method. The genetic diversity was assessed using pulsed-field gel electrophoresis (PFGE). The results showed that among the isolates, 19.9% were classified as multi-drug resistant (MDR) and resistance was most frequently observed to cephalothin, nitrofurantoin, and ampicillin. The predominant serogroups were O6, O8, and O38. Some serogroups were recognized as pathogenic E. coli. PFGE dendrograms indicated extensive genetic diversity among the isolates. Although characteristics of the E. coli isolates were highly variable, it is important to note that E. coli belonging to pathogenic serogroups and MDR isolates are present in mollusks of both study areas. This is the first report on the phenotypic and genotypic characterization of E. coli from mollusks from Santa Catarina and the Chesapeake Bay that should encourage studies focusing on comparison of isolates across countries.

A Review of Methods for Assessing the Environmental Health Impacts of an Agricultural System

(1) Background: Global agricultural production is projected to increase substantially in the coming decades. Agricultural production provides food and materials crucial to human survival and well-being and is a critical source of livelihood, providing employment opportunities and economic benefits. However, industrialized or intensified agricultural systems, in particular, can have adverse effects on public health, place pressure on natural resources, and reduce environmental sustainability. This review attempts to identify and characterize key environmental health assessment methods for examining a broad array of potential impacts; (2) Methods: Electronic databases Medline, Scopus, Web of Science, and GreenLINE were searched for published literature that presented methods for conducting an environmental health assessment of an agricultural system; (3) Results: Fifty-three sources were included in the review. Eight methods were selected to illustrate the wide range of approaches currently available: health risk assessment methods, health impact assessment, environmental impact assessment methods, environmental burden of disease, lifecycle methods, integrated assessment modeling, trade-off analysis, and economic assessment; (4) Conclusions: This review can provide guidance for selecting an existing method or for designing a new method for assessing the environmental health impacts of an agricultural system.

Accurate Quantitation and Analysis of Nitrofuran Metabolites, Chloramphenicol, and Florfenicol in Seafood by Ultrahigh-Performance Liquid Chromatography-Tandem Mass Spectrometry: Method Validation and Regulatory Samples

We developed and validated a method for the extraction, identification, and quantitation of four nitrofuran metabolites, 3-amino-2-oxazolidinone (AOZ), 3-amino-5-morpholinomethyl-2-oxazolidinone (AMOZ), semicarbazide (SC), and 1-aminohydantoin (AHD), as well as chloramphenicol and florfenicol in a variety of seafood commodities. Samples were extracted by liquid-liquid extraction techniques, analyzed by ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS), and quantitated using commercially sourced, derivatized nitrofuran metabolites, with their isotopically labeled internal standards in-solvent. We obtained recoveries of 90-100% at various fortification levels. The limit of detection (LOD) was set at 0.25 ng/g for AMOZ and AOZ, 1 ng/g for AHD and SC, and 0.1 ng/g for the phenicols. Various extraction methods, standard stability, derivatization efficiency, and improvements to conventional quantitation techniques were also investigated. We successfully applied this method to the identification and quantitation of nitrofuran metabolites and phenicols in 102 imported seafood products. Our results revealed that four of the samples contained residues from banned veterinary drugs.

A call to action for outpatient antibiotic stewardship

OBJECTIVES

To address the public health threat of antibiotic resistance, there has been an enhanced call for antibiotic stewardship programs throughout the health care continuum.

SUMMARY

While antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient programs is scarce. Establishing stewardship practices in the outpatient setting is necessary because more than 60% of human antibiotic use occurs in this setting.

CONCLUSION

In this article, we highlight the importance and need for stewardship in the outpatient setting, discuss strategies for the development of stewardship teams, and discuss potential metrics that can be used to assess effectiveness of antibiotic stewardship interventions.