Existing AMR surveillance programme in livestock in India and - PowerPoint PPT Presentation

Existing AMR surveillance programme in livestock in India and suggestions for future framework Samiran Bandyopadhyay ICAR-Indian Veterinary Research Institute ICAR Indian Veterinary Research Institute samiranvet@gmail.com

Existing AMR surveillance

Use of antibiotics in animals  Both in food and pet animals antibiotics are used.  Concern regarding use of antibiotics specially in poultry feed feed.  Reserve antibiotics are reportedly used in poultry rearing.  By 2030 there is an estimated increase of antibiotic  By 2030 there is an estimated increase of antibiotic consumption by 99% in BRICS countries.  In many cases owners and farmers can not afford antibiotics although India accounted for 3% (4th largest) antibiotics although, India accounted for 3% (4th largest) of global consumption of antibiotics in food animals behind China(23%), USA (13%) and Brazil (9%), in comparison to India comparison to India with largest population of diverse ith largest pop lation of di erse livestock species.

Global average annual consumption of antimicrobials per kilogram of animal produced p 172 148 mg .Kg ‐1 m 45 Boeckel et al., 2015, PNAS 112(18): 5649–5654, doi: 10.1073/

Global trends in antimicrobial use in food animals Presumed to increase by 67% y Boeckel et al., 2015, PNAS 112(18): 5649–5654, doi: 10.1073/pn

No quantifiable data is available for use of antimicrobials in animals Tetracyclines Fluoroquinolones Aminoglycosides Cephalosporins Others Lactating cattle Poultry Proportion of different classes of antibiotics used in animals, WB, Data based on personal communication in few areas of WB, India

AMR surveillance surveillance  (INSAR) (2009-2012) network of 20 labs  (INSAR) (2009-2012) network of 20 labs with WHO support  MoHFW/NCDC : AMR surveillance network  MoHFW/NCDC : AMR surveillance network (10 labs)  ICMR  ICMR : : AMR AMR Surveillance Surveillance Network Network (4 (4 institutions/6 labs)  Veterinary/Agriculture sector  Veterinary/Agriculture sector – no organized no organized AMR surveillance and at its infancy

Bad Bugs in animal Bad Bugs in animal  Extended spectrum  -lactamase producers  Extended spectrum  lactamase producers  AmpC type  -lactamase producers  Fluroquinolone resistant enterobacteriaceae q  Methicillin resistant S. aureus and CoNS  Mettalo-  -lactamase producing enterobacteriaceae (EC & KP) (EC & KP) t b t i  Vancomycin resistant and intermediate S. aureus  Colistin resistant enterobacteriaceae  Colistin resistant enterobacteriaceae

Their trends … MRSA, ESBL and quinolone resistant enterobacteriaceae in lactating cattle S , S a d qu o o e es sta t e te obacte aceae actat g catt e in eastern and NE India during 2012 to till date, ICAR-IVRI ng cattle 20 in lactatin MRSA ESBL 15 QRE ence (%) i 10 Occurre 5 0 TP WB MZ OD JH TP: Tripura, WB: West Bengal, MZ: Mizoram, OD: Odisha, JH: Jharkhan p g

The occurrence of MRSA in food animal in India is subs Sl States Species Occurrence SCC me SPA* MLST* No mean (%) c * (range with 95% CI)** 1 Tripura Lactating 2.17 (1.14-3.74) SCC mec t005, t202, ST-63, cattle type t267, t524, ST-71, IV V IVa,V t527 t740 t527, t740, ST 97 ST-97, 2 Mizoram Lactating 1.26 (0.46 – and NT t800, t852, ST-2219, cattle 2.78) t3626, t4463, ST-1297, 3 Haryana Lactating 5.64 (2.4-10.8) t4931, and , cattle t6297 4 West Lactating 1.66 (1.06 -2.9) Novel spa Bengal Bengal cattle and cattle and type t15798 type t15798 goats (caprine) t16344 Pigs 3.27 (1.5-6.13) ( (buffalo) ) B ff l Buffalo 0 84 (0 3 2 01) 0.84 (0.3-2.01) 5. Odisha Lactating 1.66 (0.28 – * The data reflects analysis from representative samples ** Fisher cattle 5.3) Exact test (Clopper-Pearson)

oquinolone resistant enterobacteriaceae ( E. coli and K. pneumoniae ) in food a Sl States Species Occurrence PMQR Efflux QRDR No mean (%) pumps (range with (range with 95% CI)* 1 Tripura Lactating 9.56 (6.03- qnrA, QepA Mutation in cattle cattle 14.8) 14.8) a qnrB, qnrB, AcrAB AcrAB gyrA and gyrA and qnrS, ParC 2 Mizoram Lactating 14.1 (8.06– aac(6′)-Ib- cattle 23.5) a cr 3 3 West West Lactating Lactating 11.3 (7.28 11 3 (7 28 - Bengal cattle 17.1) a Poultry 19.56 (15.2- 24.7) b ) Buffalo 2.3 (1.29- 4.09) a 4. 4. Jharkhan Jharkhan Lactating Lactating 12.8 (6.6- 12.8 (6.6 *Score(Wilson) with Fleiss Quadratic Score(Wilson) with Fleiss Quadratic a Among ESBL producers only; b on basis of Phe cattle 22.7) a d Correction b differs significantly (P =0.01) poultry 20.9 (12.9 – 32) b

CBL and MBL enterobacteriaceae ( E. coli and K. pneumoniae ) in food Sl States Species p Occurrence mean (%) (range with 95% CI)* ( ) ( g ) No ESBL ACBL MBL Resistanc e determina nts 1. Tripura Lactating 10.1 (6.6- 6.06 (3.5- NDM-5 bla CTXM- cattle ttl 15) 15) 10 3) 10.3) (2) (2) 15 15, bla NDM bla CTX-M- 2. Mizoram Lactating 5.8 (2.4- 4.8 (1.8- was 63, cattle 12.7) 11.5) reported p bla CTX-M- 3. 3 West W t L Lactating t ti 4 4 (1 9 4.4 (1.9- 4 4 (1 9 9 2) 4.4 (1.9-9.2) in diary 9, bla TEM- Bengal cattle 9.2) animals 1, bla SHV- Buffalo 2.3 (1.29- 1.47 (0.6- (Ghatak 12, 4.09) 4 09) 3.14) 3 14) et al et al., bla AmpC, bla AmpC 2013) bla MOX, Poultry 14.5 (9.5- 20.1 (14.6- and in int1 21.1) 27) pigs possessing pigs pigs 6 (3 2 10 5) 6 (3.2-10.5) (Pruthvis dfrA12/17 a hree et nd 4. Jharkhan Lactating 12.8 (6.6- 10.2 (4.8- al., 2017) d cattle 22.7) 19.7) aad2/aad5 *Score(Wilson) with Fleiss Quadratic sul-1 Correction ( (

Characteristics of ESBL producers in food animals from India  The isolates were detected among dairy animals, organized poultry and piggery sector  Most of the isolates carried multiple Genetic environment of bla CTX‐M‐15 gene of bovine isolate from eastern and north eastern States, India, KT824860, KT824861 ESBL genes.  The genes bla CTX-M-15, bla CTX-M-9,  The genes bla CTX M 15, bla CTX M 9, bla SHV-12 and non ESBL gene bla TEM-1 were more common.  Presence of multiple resistance gene  Presence of multiple resistance gene Organization of gene cassette in the class 1 integron of MDR ESBL cassettes ( dfrA and aadA ) leads to producing Klebsiella pneumoniae isolates from cattle milk of Eastern and MDR phenomenon. North‐eastern India

of resistance pattern of MRSA isolates from lactating cattle of eastern and N (2012- till date, ICAR-IVRI) 100 Relatively sensitive to aminoglycosides, fluoroquinolones and glycopeptides 75 50 S I R 25 25 0 0 Ax AMC PTZ CPD CTX CPM CTR + TZ C Ak TOB GEN Nx CIP VAN LZ Resistant to beta-lactam or potentiated beta-lactam and macrolides

of resistance pattern of ESBL producers from lactating cattle of eastern and (2012- till date, ICAR-IVRI) 100 Relatively sensitive to carbapenem, colistin and chloramphenicol 75 50 S I R 25 0 0 Ax AMC PTZ CPD CTX CPM CTR + TZ C TET COL Ak TOB GEN Nx CIP IMP MEM to beta-lactam or potentiated beta-lactam, tetracycline, aminoglycosides and fluoroq

o C -infection of and producers are frequent cause of therapeutic failure in animals MRSA ESBL

VRSA and VISA in animals; possible Zooanthroponosis or other mechanism lying ?

Adopted pathway map of antimicrobial resistance (AMR) dissemination within agriculture, the environment, and the food processing industry. Movement of antimicrobial agents and AMR is indicated by overlapping circles and arrows, respectively; different colors define different groups of reservoirs . Thanner et al., mBio 7(2):e02227-15

Suggestions for future fram

Surveillance framework in food a What is the target population ? 1 Dairy and poultry sector should be given major emphasis 1. Dairy and poultry sector should be given major emphasis for systematic surveillance 2. Others include pigs, sheep and goat In case of meat producing animals, both on-farm and I f t d i i l b th f d slaughter house sampling are required. What should be the target organisms ? 1. Indicator: E. coli, S. aureus , 2. Food borne pathogens: Salmonella, Campylobactor 3. Sentinel organism: E. coli, Enterococcus 4 Others: Claustridium 4. Others: Claustridium

Surveillance in food animals: roa Surveillance in food animals: roa Sampling 1.Many potential sampling points in the production and 1.Many potential sampling points in the production and processing 2. Production/holding/processing slaughter/retail continuum 3 Environmental sampling 3. Environmental sampling - manure, water, feed etc manure water feed etc 4. Slaughter house: caecal content, floor, slaugter house drainage, hand swab 5. Sample information: animal species, time and place of Cross-sectional / time-series / case-control/ cohort collection, age and clinical status of the animal, and AMU analysis what will be appropriate ? analysis- what will be appropriate ? – a very a very pertinent question to understand Prospective/passive/random/systematic p p y Sentinel surveillance