Antimicrobial Usage and -Resistance in Livestock: Where Should We Focus?

Antimicrobials represent one of humanity’s medical revolutions enabling us to treat both human and veterinary bacterial infections. It is, therefore, of utmost importance to preserve their effectiveness. However, during the last decades, the continuing rapid development of antimicrobial resistance (AMR) has emerged as a major global public health concern (1). Resistant bacteria may hamper the treatment of infections resulting in prolonged illness, disability, and death (2). In veterinary medicine, antimicrobials play a crucial role in the maintenance of animal health, animal welfare, and food-safety (3). However, a not yet quantifiable share of the burden of resistance for public health is attributable to the use of antimicrobials in livestock production (4–6). Farm animals are exposed to considerable quantities of antimicrobials (7) and can act as an important reservoir of AMR genes, which could be transmitted to humans through the food chain, direct animal contact and the environment. Use of antimicrobials in agriculture also includes those defined by the World Health Organization (WHO) as “critically important” for human medicine (8). Resistance against these substances can limit dramatically the treatment options against serious human bacterial diseases. Notorious examples include the vancomycin-resistant enterococci (VRE), the extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae and the recently detected plasmid-mediated colistin resistance (mcr-1 gene) in livestock, food, and humans in China (9–11). Resistant bacteria can be introduced into the environment through several ways, such as the land application of livestock manure as fertilizer (12). The globally rising aquaculture sector, which is characterized by extensive use of antimicrobials, represents another important source of resistant bacteria that can find their way into the environment (13). Our understanding on the epidemiology of AMR in livestock production is also hampered by the lack of comprehensive antimicrobial usage (AMU) data in the majority of countries. Furthermore, AMR development and spread is driven by human behavior, from the prescription of antimicrobials to infection prevention and control. Understanding these factors is a major step toward fighting against AMR. The complex epidemiology of AMR emphasizes the need for highly interdisciplinary research approaches, comprising humans, animals, and the wider environment. In line with the WHO global action plan on AMR (14), it is the authors’ opinion that research should be prioritized toward (a) understanding the social/behavioral drivers of AMU and AMR, (b) establishing or improving systems to monitor AMU, and (c) encouraging a holistic approach through the One-Health concept when addressing the phenomenon and risk of AMR.