[MUSIC] So I'm now going to provide an introduction to some very specific systems and I'll talk about antimicrobial resistance surveillance systems. Now across the set of talks, there's a series of examples that we're providing, or specific surveillance systems. Including surveillance in control of vaccine preventable diseases, surveillance of nosocomial infections, surveillance for other infectious diseases, chronic disease surveillance, and syndromic surveillance. I will note that there's also a lot of surveillance systems that we won't talk about. Injury surveillance, surveillance for occupational illness and injury, epidemiological surveillance following disasters, surveillance for birth defects, hazard surveillance, pharmacosurveillance. Importantly, as you'll see, the systems within these surveillance systems are conserve and are consistent, even if the purpose of the surveillance systems vary. So then to talk a little bit more detail about antimicrobial resistance surveillance systems. The definition is that we are doing surveillance for the emergence of resistant strains of bacteria, virus' and other microbial pathogen. The purpose of these are that resistance reduces or stops the effectiveness of antimicrobial agents and it really threatens our ability to fight infectious diseases which would be a source of significant economic and public health consequences. Here you're looking at a cartoon from Vietnam that noted that, Thanks to Penicillin He Will Come Home! But it's important to note that whether we're talking about battlefields, outpatient settings, inpatient setting, the effective access to antimicrobials underpin modern medicine. And the threat to the use of those antimicrobial similarly threatens modern medicine. Now, the origin of antimicrobial resistance has at least two major sources. The major sources of subtherapeutic doses are food producing animals which, as we'll talk about, are where antibiotics are added to the feed to promote growth, to increase feed efficiency and to prevent infections. There's also significant amount of resistance associated with both the veterinary and human prescriptions, where people stop the antibiotic early because they feel better. And in that setting, it provides an opportunity for resistance. A minor source but I think increasingly important of subtherapeutic doses are related to lipid-soluble antibiotics in the food and water. And this is when people take their antibiotics properly or when animals take their antibiotics properly, they can still end up in the urine and feces. End up in the water supply and we end up drinking or eating these in our food and in our water, and being constantly exposed to these subtherapeutic doses which may facilitate resistance. But the focus in a little bit more on food-producing animals, here you're looking at a high throughput chicken facility. And one can only imagine that this concentration of chickens would only be feasible with the use of preventive antibiotics to prevent any infections from happening. Similarly, one can see an example here from a pig or swine facility. This concentration of animals is only feasible with the use of prophylactic antibiotics to prevent infections from happening. But the consequences from the use of those antibiotics is very real. Here you’re looking at a graph with the y-axis being percent overall resistance of different types of bacteria to fluoroquinolones. Fluoroquinolones are antibiotics that include very commonly used antibiotics including cipro or ciprofloxacin and levofloxacin in gatifloxacin and moxyprofloxacin. On the x-axis, you're looking at the years from 1987 to 1996 with hundreds of isolates taken in each year. In 1990, Fluoroquinolones were licensed for the use of poultry and livestock and you can see a rapid increased in the amount of resistance all the way through to almost universal resistance to certain forms of fluoroquinolones in the late 90s. Importantly, this isn't just limited to bacteria found in livestock. Here, we're looking at pneumococcal isolates or a type of bacteria that often causes upper respiratory tract infections or lower respiratory tract infections, including pneumonia. Here we're looking at different types of antibiotics including penicillin, erythromycin and trimethoprim sulfamethoxazole also known as bactrim, as well as tetracycline. On the y-axis, you’re looking at percent resistance of different isolates and again, you're looking at different years. And you can see that Bactrim or trimethoprim sulfamethoxazole, which is a commonly used antibiotic is now associated with significant resistance. Again, highlighting that one day this might be an antibiotic that we can no longer use even though it's the mainstay of current treatment. Different antimicrobial surveillance systems include in the United States the National AntiMicrobial Resistance Monitoring System or NARMS. And in Canada Canadian Integrated Program for Antimicrobial Resistance Surveillance, or CIPARS. And I think it's interesting to look at both those because they use slightly different systems in order to get at outcomes of looking at resistance. NARMS has objectives that should seem familiar to you because they are consistent across different types of surveillance systems, including the ones we've already talked about. They focus on monitoring trends in antimicrobial resistance among foodborne bacteria from humans, retail meats and animals. Disseminating timely information on antimicrobial resistance to promote interventions that reduce resistance among foodborne bacteria. Conducting research to better understand the emergence, persistence, and spread of antimicrobial resistance. And then assisting the FDA or the Food Drug Administration, it's a public health entity, in making decisions related to the approval of safe and effective antimicrobial drugs for animals. The sources are Health Departments and FoodNet Sites. And they systematically test every 15th or 20th isolate of Shigella, E Coli 0157:H7, and Campylobacter. FoodNet is a collaboration of ten states across the United States. And you can go to the website and look at the systems that are used across these ten states to support a country wide evaluation of antimicrobial resistance through NARMS as well as foodborne outbreak. The Canadian Integrated Program for Antimicrobial Resistance Surveillance, works a little bit differently. It focuses on a two stage sampling design of animals that are randomly selected from federally inspected slaughterhouses, as well as systematically selecting animals on the slaughter line. There's a uniform collection period throughout the 12 months. In addition, it looks at over the counter anti microbial sales and veterinary diagnosis. [MUSIC]
