As part of activities for World Antibiotic Awareness Week 2017, Dr Andrew Singer of CEH joined a panel of experts to discuss antibiotics and antimicrobial resistance in the environment (AMR).
The Twitter chat was arranged by the Infectious Diseases Hub. Read through Andrew's answers below with further relevant links:
#TalkAMR Hi everyone, I'm Dr. Andrew Singer, an environmental microbiologist with a strong interest in pollution! Looking forward to getting through the many questions!— Andrew Singer (@OxonAndrew) November 14, 2017
Q: What do you see as your role in tackling AMR?
Andrew Singer (AS): As a research scientist, my role is to conduct the research that is needed to inform a holistic and effective strategy for tackling Antimicrobial Resistance, with a particular focus on the environmental drivers of AMR.
Q: The World Health Organization has stated that we could end up in a 'post-antibiotic era' - what are your views on this?
AS: I’m conflicted. On the one hand, I think it’s curious that drug-resistant infections aren’t more prevalent. Are there "natural barriers" to this AMR apocalypse? However, I also think if we did nothing, drug-resistant infections will be routine—so action is needed!
Q: What do you consider to be the best strategies to tackle growing antibiotic resistance?
AS: The best strategy is to have a holistic strategy in the first place—One Health (i.e., human, animal & environment). There is no shortcut to overcoming #AMR. The holistic One Health strategy must also be implemented globally.
Q: Do you think drug discovery for antimicrobials is sustainable?
AS: I’m conflicted (again). I don’t think we are lacking potentially transformative antimicrobial options—the literature is full of promising options. Test them! Explore them! Why do we feel the need to rely on Big Pharma for delivering this?
Q: What is your assessment on research into alternatives to traditional drugs?
AS: Alternatives to ‘traditional drugs’ is a necessity! All the resistance genes bacteria need to every ‘traditional drug’ we can think up is out there in bacteria found in our environment (soil/water). We need fundamentally new strategies to old problems.
Q: Much of the AMR focus is on bacterial resistance; could you also comment on resistance in fungi and parasites?
AS: Continued use of azole fungicides in rape and wheat crops, globally, has driven an increase in the prevalence of azole-resistant Aspergillus fumigatus (causes aspergillosis). Jenny Shelton will be studying this as part of her PhD (with the Centre for Ecology & Hydrology and Imperial College London).
Q: How important do you feel infection prevention and control is?
AS: Strict infection prevention and control saves lives. It’s been shown time and time again. This is true as much in the hospital as it is in the farmyard. Why not apply the concept to our environment, where sewage chronically enters our rivers and is spread on land?
Q: Why are communication and collaboration so important in helping contain AMR?
AS: The scope of AMR is inclusive of all of society. No one discipline can possibly have all the answers; hence, the way forward is to communicate and collaborate on developing a holistic AMR strategy.
Q: How important do you think a 'One Health' approach is in combating AMR?
AS: One Health should be seen as the only way forward. Even more important is to see this as a global problem.
Q: AMR is not just a problem for human health – What implications will it have on aquaculture, agriculture and animal husbandry?
AS: Controlling antibiotic use in animal husbandry is tractable in high income countries, but it is currently intractable in low- and middle-income countries that use unregulated drugs of questionable purity in mass.
Q: How does resistance arise in the environment, and is this a big issue?
AS: Firstly, antibiotic resistance BEGAN in the environment. Chemicals that inhibit/kill bacteria has driven the evolution of AMR for hundreds/thousands of millions of years.
Secondly, resistance to any novel drug will come from the IMMENSE pool of genes already in the environment, e.g., soil and water.
Thirdly, the co-location of resistance genes on mobile genetic elements means bacteria can retain resistance to antibiotics even in their absence.
Q: What do you think clinicians can do to reduce our use of antibiotics?
AS: They can follow the guidance provided to them regarding Antibiotic Stewardship.
Q: What research do you think needs to be done in the next 5–10 years in this field?
AS: Research need: 1) make the most of the existing prospective drugs in the literature/pipeline. 2) Find drugs with novel modes of action; 3) Behaviour change; 4) Relevance of Co-selection; 5) Mitigating environmental pollution.
Q: If you could implement one AMR-based policy immediately and universally, what would this be?
AS: Behavioural change is key. We know many of the big issues driving AMR, we have solutions, but we don’t have buy-in from those who need to implement these changes. e.g., patients need to stop asking for antibiotics.
Q: What knowledge/training do healthcare professionals/the public need to make a difference?
AS: AMR is relevant to everyone on earth, as we live in a world where there is chronic transmission of resistance from humans, animals, environment to humans. So long as this is the case, we all need to care about AMR!
For an update on current CEH research into antimicrobial resistance in the environment, see Andrew's blog post, AMR - investigating the knowledge gaps