Knowledge Gaps in the Understanding of Antimicrobial Resistance in Canada

Abstract

Current limitations in the understanding and control of antimicrobial resistance (AMR) in Canada are described through a comprehensive review focusing on: (1) treatment optimization; (2) surveillance of antimicrobial use and AMR; and (3) prevention of transmission of AMR. Without addressing gaps in identified areas, sustained progress in AMR mitigation is unlikely. Expert opinions and perspectives contributed to prioritizing identified gaps. Using Canada as an example, this review emphasizes the importance and necessity of a One Health approach for understanding and mitigating AMR. Specifically, antimicrobial use in human, animal, crop, and environmental sectors cannot be regarded as independent; therefore, a One Health approach is needed in AMR research and understanding, current surveillance efforts, and policy. Discussions regarding addressing described knowledge gaps are separated into four categories: (1) further research; (2) increased capacity/resources; (3) increased prescriber/end-user knowledge; and (4) policy development/enforcement. This review highlights the research and increased capacity and resources to generate new knowledge and implement recommendations needed to address all identified gaps, including economic, social, and environmental considerations. More prescriber/end-user knowledge and policy development/enforcement are needed, but must be informed by realistic recommendations, with input from all relevant stakeholders. For most knowledge gaps, important next steps are uncertain. In conclusion, identified knowledge gaps underlined the need for AMR policy decisions to be considered in a One Health framework, while highlighting critical needs to achieve realistic and meaningful progress.

Invited review: Selective use of antimicrobials in dairy cattle at drying-off

“…Although these results should be interpreted with care, broader farm impacts of DCT AMU reduction should be investigated. Specifically, the One Health approach of AMU and AMR incorporates human, animal, and environmental considerations because antimicrobial and bacterial interactions are complex and are not limited to one health sector or species (McCubbin et al, 2021). The importance of One Health considerations in AMR is supported by AMU reductions in livestock production leading to a reduction in human occupation-associated AMR infections in the associated production system (Tang et al, 2017).…”

Antibiotic resistomes and microbial communities in biosolid fertilizers collected from two Canadian wastewater treatment plants in a 10-years interval-potential risks to food chains?

“…In recent years, effective actions, including a drastic reduction in antibiotics consumption, reduction in the uncontrolled use in humans and animals, and the ban of the sub-clinical dosage growth promoter) usage of antibiotics for animal and crop productions to promote growth have been in place to reduce the spread of ARGs globally (WHO, 2015;Merlin, 2020) and in Canada (McCubbin et al, 2021). It seems that the measures to reduce the use of AMRs in animals were effective in reducing ARGs in these animals (Dorado-Garcia et al, 2016;McDonnell et al, 2017;Bennani et al, 2020).…”

Bacteriophage Lytic Enzyme P9ly as an Alternative Antibacterial Agent Against Antibiotic-Resistant Shigella dysenteriae and Staphylococcus aureus

“…However, phage therapy was quickly abandoned in favor of antibiotics, which have broad antibacterial activity and are easy to prepare, store, and dispense. In recent years, the disadvantages of antibiotics have grown due to the emergence and spread of bacterial drug resistance ( McCubbin et al, 2021 ). At present, multidrug-resistant bacteria are an extremely serious global problem.…”