Understanding 2019's AMR reports
07 Jan 2020
The latest edition of the VARSS (UK Veterinary Antibiotic Resistance and Sales Surveillance) Report was published in October, it was the fourth major publication discussing AMR published by the UK government in 2019.
In January, the UK published its 5-year action plan for 2019 – 2024 alongside the 20-year vision for AMR, and a few days later the UK One Health Joint report on antibiotic use and antibiotic resistance. These reports are a statement of the UK’s commitment to tackling AMR throughout these politically challenging times.
If you are interested in understanding these reports in greater depth, they are all available online:
- VARSS 2019
- AMR 5 year national action plan
- UK 20 year vision for antimicrobial resistance
- UK One Health Report 2019
Considering my PhD is focused on how the use of antimicrobials affects the level of resistance in E. coli in dairy cows, this has all been a lot of exciting material for me, particularly the VARSS, I’m sure everyone else feels the same?
In case this isn’t your cup of tea, please allow me to present some of the stand-out figures and suggestions of these reports. I think it’s best to start with the big picture, before getting into some of the nitty-gritty details.
Sales of antimicrobials for veterinary use are down
Due to the nature of prescribing in veterinary it is considerably harder to attribute a given antimicrobial’s use to a species let alone to a specific infection. Several antimicrobials are used across companion animals and food producing animals. This makes it difficult; to monitor how antimicrobials are used, and therefore to identify potential areas for improvement.
Overall sales give a broad view, sales were down to 226 tonnes in 2018, a 9% reduction compared to 2017 (248 tonnes) and a 49% reduction compared with 2014 (448 tonnes).
To put it another, possibly more appropriate way; in 2016, the UK government set a target of reducing antimicrobial use in food-producing animals to 50 mg/kg (that’s milligram of active ingredient per kilogram of animal for those of us who aren’t clinicians). This target was met in 2016 (39.3 mg/kg) and in 2018 it was almost half of the original target, 29.5 mg/kg. Crucially, sales of HP-CIA’s (Highest priority critically important antibiotic) have seen a 68% reduction since 2014.
These are antibiotics with applications in animal therapy, but due to their importance in human medicine and the potential for resistance generation in clinically relevant bacteria, the World Health Organisation suggests that their use be limited as much as possible.
If you want to understand more about HP-CIAs the WHO website is a good place to find information.
Out with the old, in with the new?
For the last four years, the VARSS report has been produced, and served as a confirmation that increased stewardship is working - plenty of seemingly simple statistics displaying a real change in the way antimicrobials are used. These gains are starting to shrink; the low hanging fruit has been picked and now we have to decide, where do we go from here?
VARSS 2019 is potentially the final hurrah for the current format, many hours have been spent arguing that mg/kg is the most appropriate measure to monitor usage, and therefore resistance, but under the surface, most admit that it was just the best figure we could obtain. The Veterinary Medicines Directorate has been attempting to collect real usage data, but this data is not easily obtained. Currently, there is no representative usage data for cattle and no data at all for sheep. Cheap and rapid diagnostics are essential here, it is far more likely that the data will be collected if it requires a quick swab and measure at the bedside or pen-side than if it requires the technical skills of a molecular lab.
To understand the real-world situation and make informed decisions, this usage data and associated resistance prevalence is essential.
The grand plan
That heading is a bit of a misnomer, there is currently no singular grand plan to tackle AMR. And that’s a good thing. A one size fits all plan is sure to fail, the nuances are so precise that each nation (and even communities within those nations) must personalise their strategy. All four reports acknowledge this and stipulate throughout that all recommendations are subject to contextual factors.
To summarise the reports, AMR is to be handled in the same manner as a newly emerging pathogen, and control measures will be similar; limit the spread through improved healthcare, environmental and agricultural practices. While encouraging innovation to find new control measures and educating the public on the risks and what they can do to help (e.g. not asking doctors for antimicrobials to treat viral infections).
Before we can begin solving AMR, we need to decide how we are going to monitor it, this monitoring needs to be achievable in the UK, but also globally. Once we have collected appropriate data, we can actually measure how effective current stewardship is and work to optimise our approaches.
ECS Events Officer