Antimicrobial drug use in food-producing animals and associated human health risks: what, and how strong, is the evidence?

• Published in: BMC veterinary research Vol. 13; no. 1; p. 211
• Main Authors: Hoelzer, Karin, Wong, Nora, Thomas, Joe, Talkington, Kathy, Jungman, Elizabeth, Coukell, Allan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.07.2017; BioMed Central; BMC
• Subjects: Agriculture; Analysis; Animal Feed; Animal Husbandry - methods; Animals; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - adverse effects; Antibiotic resistance; Antibiotics; Antimicrobial agents; Antimicrobial drug use; Antimicrobial resistance; Bacteria; Bacteria - drug effects; Bacteria - genetics; Bans; Drug resistance; Drug resistance in microorganisms; Drug Resistance, Microbial; drugs; E coli; Farm animals; Farms; feedlots; Food; food animals; Food consumption; Foodborne Diseases - microbiology; Genes; human health; Humans; Infections; issues and policy; Livestock; Livestock industry; Mutation; Pathogens; Poultry; Public Health; Public health risk; Quality management; Review; risk; Risk Assessment; Salmonella; Testing; Veterinary medicine; Well being; United States > US; Farm animals; Antimicrobial resistance; Public health risk; Antimicrobial drug use
• ISSN: 1746-6148; 1746-6148
• DOI: 10.1186/s12917-017-1131-3

Antimicrobial resistance is a public health threat. Because antimicrobial consumption in food-producing animals contributes to the problem, policies restricting the inappropriate or unnecessary agricultural use of antimicrobial drugs are important. However, this link between agricultural antibiotic use and antibiotic resistance has remained contested by some, with potentially disruptive effects on efforts to move towards the judicious or prudent use of these drugs. The goal of this review is to systematically evaluate the types of evidence available for each step in the causal pathway from antimicrobial use on farms to human public health risk, and to evaluate the strength of evidence within a 'Grades of Recommendations Assessment, Development and Evaluation'(GRADE) framework. The review clearly demonstrates that there is compelling scientific evidence available to support each step in the causal pathway, from antimicrobial use on farms to a public health burden caused by infections with resistant pathogens. Importantly, the pathogen, antimicrobial drug and treatment regimen, and general setting (e.g., feed type) can have significant impacts on how quickly resistance emerges or spreads, for how long resistance may persist after antimicrobial exposures cease, and what public health impacts may be associated with antimicrobial use on farms. Therefore an exact quantification of the public health burden attributable to antimicrobial drug use in animal agriculture compared to other sources remains challenging. Even though more research is needed to close existing data gaps, obtain a better understanding of how antimicrobial drugs are actually used on farms or feedlots, and quantify the risk associated with antimicrobial use in animal agriculture, these findings reinforce the need to act now and restrict antibiotic use in animal agriculture to those instances necessary to ensure the health and well-being of the animals.