Antimicrobial resistance: a One Health perspective.

Introduction: Worsening antimicrobial resistance (AMR) threatens the practice of modern human and veterinary medicine. For decades, medicine and agriculture have blamed each other for the rise of resistant microbes. Widespread use and misuse of antibiotics in both medicine and agriculture have increased the prevalence and expression of resistance genes.

VRE: The rise of vancomycin-resistant Enterococcus faecium (VRE) in the European Union (EU) led to the ban of avoparcin, an antibiotic that is chemically related to vancomycin. In the years post-ban, VRE surveillance data of EU hospitals showed no obvious reduction in VRE rates. The USA never approved avoparcin, yet VRE has been an enormous problem in its hospitals. AMR surveillance data showed zero rates of VRE in US livestock. Whole-genome sequencing data suggest that VRE might have evolved from ampicillin-resistant E. faecium from dogs. Companion animals have been completely ignored in the AMR debate.

Sanitation: In addition, 1 billion people openly defecate around the world. Of these, 60% live in India, a country with highly resistant microbes.

Conclusion: A One Health approach integrating human, animal and environmental whole-genome sequencing surveillance data is essential to getting to the root of AMR and developing effective prevention and control strategies.