One Health AMR: past, present and future

This issue is dedicated to Emeritus Professor John Turnidge MB, BS, FRACPA, FASM, AO and Emeritus Professor Mary Barton BVSc, MBA, DipBac, FACVS, FAVA, AO whose tireless efforts have placed Australia in such an enviable global position in the fight against the development of One Health antimicrobial resistance.

Antimicrobial resistance (AMR) and One Health are intimately linked given that many of the same classes of antimicrobials are prescribed for both humans and animals. Additionally, wildlife may access potential environmental sources of AMR such as refuse facilities, waste water treatment plants and livestock production sites. Humans also share living spaces with companion animals with frequent opportunities for cross-species transmission of AMR. At the Australian One Health Antimicrobial Resistance Colloquium held in Canberra in July 2013, Prof. John Turnidge famously said, ‘we’re all swimming in the same gene pool’.

Since Howard Florey first demonstrated the powers of penicillin in 1940, antibiotics have saved countless lives (both human and animal). However, the rapid development of AMR following the introduction of each new chemical class has led to warnings that we are heading towards a post-antibiotic age where once again, bacterial infections may become untreatable. AMR is predicted to result in 10 million deaths globally per annum by 2050, with a cumulative economic impact of >US$100 trillion.¹ AMR abatement requires a multifaceted approach by all end-users to reduce rates of resistance to existing drug classes while new generations of efficacious treatments are discovered, rigorously tested and registered, a process that may take 10–15 years and cost in excess of US$1 billion in the human market.^2,3 For both the human and animal health sectors, this approach includes adoption of prudent use guidelines, infection prevention and control, and biosecurity, education and training, governance, antimicrobial stewardship, identifying credible alternatives and preventatives, and undertaking surveillance of both antimicrobial use and AMR.

A ‘One Health’^A approach to AMR was first documented in Australia in 1999 by the Joint Expert Technical Advisory Committee on Antimicrobial Resistance (JETACAR) in its report to government on the use of antimicrobials in animals and possible links to human health (chaired by Prof. John Turnidge with Prof. Mary Barton a significant member).⁴ The JETACAR report made 22 recommendations that largely set the stage for Australia’s current AMR interventions and policies. Since that time, a number of key One Health initiatives have been adopted by the federal government, including development of the Expert Advisory Group on AMR’s Antibiotic Importance Ratings (republished in 2018 as the Australian Strategic and Technical Advisory Group on AMR Importance Ratings),⁵ restricting the use of critically important antimicrobials such as fluoroquinolones in human and animal health and the publication of two National Antimicrobial Resistance Strategies (2015–2019 and 2020 and beyond).^4,5

So what is Australia currently doing in the global fight against AMR and how do we compare with the rest of the world? What research initiatives are being funded to develop novel diagnostics and treatments for antimicrobial-resistant infections in humans and animals while preserving the lifespan of existing drug classes? These concepts will be further explored in this issue of Microbiology Australia.

In the first paper, Prof. Rebecca Guy and colleagues discuss how the Australian Research Council (ARC) Industrial Transformation Research Hub to Combat AMR is succeeding through development of new molecular diagnostic technology, improving the processes for identifying potential antibiotic compounds and advising on antimicrobial stewardship with a vision to transform social and health outcomes globally.⁶ Papers by the Australian Group on Antimicrobial Resistance and the Australian Centre for AMR Ecology and its collaborators respectively focus on AMR surveillance in humans and animals in Australia.^7,8 Eary career scientist Dr Veronica Jarocki and colleagues then present an up to date review on the important role of genomics in AMR surveillance.⁹ Professor Erica Donner and colleagues then highlight the goals and objectives of a new Cooperative Research Centre formed to solve AMR in Agribusiness, Food and Environments (CRC SAAFE).¹⁰ The CRC is ‘committed to protecting Australia’s food and agribusiness industries, and the environments in which they operate, from the growing threat of antimicrobial resistance’ (see https://www.crcsaafe.com.au/). Next, Assoc. Prof. David Ogunniyi and colleagues present a paper on the current status of new antimicrobial development of relevance to human and animal health,¹¹ followed by a review of antimicrobial stewardship in the human and animal health sectors in Australia by Dr Laura Hardefeldt and Prof. Karin Thursky from the National Centre for Antimicrobial Stewardship.¹² Early career scientist Dr Bjoern Kolbe and colleagues introduce plasma activated water as an innovative cleaning solution to tackle the rising threat of antibiotic-resistant superbugs and ensure safer food.¹³ The next paper, by Dr Caroline O’Brien and Prof. Tim Stinnear, focuses on Mycobacterium ulcerans, the agent of Buruli ulcer. Although not technically an AMR issue with correct diagnosis and treatment, it is nevertheless a fascinating One Health story.¹⁴ In the penultimate paper, Dr Branwen Morgan and Dr Emma-Leigh Synnott explore the issue of sustainability in our healthcare sector, covering both the direct and indirect costs to our environment of increased morbidity associated with antimicrobial-resistant infections and their prevention and control.¹⁵ Finally, Prof. Mark Blaskovich from the Centre for Superbug Solutions and ARC Industrial Transformation Training Centre for Environmental and Agricultural Solutions to AMR and Prof. Trevor Lithgow from the Centre to Impact AMR bring the issue to a close with their perspective on what the future holds for this extremely important One Health issue with multiple solutions.¹⁶