Ross D Booton1, Aronrag Meeyai2,3, Nour Alhusein4, Henry Buller5, Edward Feil6, Helen Lambert4, Skorn Mongkolsuk7, Emma Pitchforth8, Kristen K Reyher1, Walasinee Sakcamduang9, Jutamaad Satayavivad10, Andrew C Singer11, Luechai Sringernyuang12, Visanu Thamlikitkul13, Lucy Vass1, Matthew B Avison14, Katherine M E Turner1. 1. Bristol Veterinary School, University of Bristol, Bristol, UK. 2. Department of Epidemiology, Mahidol University, Bangkok, Thailand. 3. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK. 4. Bristol Medical School, University of Bristol, Bristol, UK. 5. College of Life and Environmental Sciences, University of Exeter, Exeter, UK. 6. Department of Biology & Biochemistry, University of Bath, Bath, UK. 7. Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok, Thailand. 8. College of Medicine and Health, University of Exeter, Exeter, UK. 9. Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand. 10. Laboratory of Pharmacology, Chulabhorn Research Institute, Bangkok, Thailand. 11. UK Centre for Ecology & Hydrology, Wallingford, UK. 12. Faculty of Social Sciences and Humanities, Mahidol University, Bangkok, Thailand. 13. Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 14. School of Cellular & Molecular Medicine, University of Bristol, Bristol, UK.
Abstract
OBJECTIVES: Antibacterial resistance (ABR) is a major global health security threat, with a disproportionate burden on lower-and middle-income countries (LMICs). It is not understood how 'One Health', where human health is co-dependent on animal health and the environment, might impact the burden of ABR in LMICs. Thailand's 2017 "National Strategic Plan on Antimicrobial Resistance" (NSP-AMR) aims to reduce AMR morbidity by 50% through 20% reductions in human and 30% in animal antibacterial use (ABU). There is a need to understand the implications of such a plan within a One Health perspective. METHODS: A model of ABU, gut colonisation with extended-spectrum beta-lactamase (ESBL)-producing bacteria and transmission was calibrated using estimates of the prevalence of ESBL-producing bacteria in Thailand. This model was used to project the reduction in human ABR over 20 years (2020-2040) for each One Health driver, including individual transmission rates between humans, animals and the environment, and to estimate the long-term impact of the NSP-AMR intervention. RESULTS: The model predicts that human ABU was the most important factor in reducing the colonisation of humans with resistant bacteria (maximum 65.7-99.7% reduction). The NSP-AMR is projected to reduce human colonisation by 6.0-18.8%, with more ambitious targets (30% reductions in human ABU) increasing this to 8.5-24.9%. CONCLUSIONS: Our model provides a simple framework to explain the mechanisms underpinning ABR, suggesting that future interventions targeting the simultaneous reduction of transmission and ABU would help to control ABR more effectively in Thailand.
OBJECTIVES: Antibacterial resistance (ABR) is a major global health security threat, with a disproportionate burden on lower-and middle-income countries (LMICs). It is not understood how 'One Health', where human health is co-dependent on animal health and the environment, might impact the burden of ABR in LMICs. Thailand's 2017 "National Strategic Plan on Antimicrobial Resistance" (NSP-AMR) aims to reduce AMR morbidity by 50% through 20% reductions in human and 30% in animal antibacterial use (ABU). There is a need to understand the implications of such a plan within a One Health perspective. METHODS: A model of ABU, gut colonisation with extended-spectrum beta-lactamase (ESBL)-producing bacteria and transmission was calibrated using estimates of the prevalence of ESBL-producing bacteria in Thailand. This model was used to project the reduction in human ABR over 20 years (2020-2040) for each One Health driver, including individual transmission rates between humans, animals and the environment, and to estimate the long-term impact of the NSP-AMR intervention. RESULTS: The model predicts that human ABU was the most important factor in reducing the colonisation of humans with resistant bacteria (maximum 65.7-99.7% reduction). The NSP-AMR is projected to reduce human colonisation by 6.0-18.8%, with more ambitious targets (30% reductions in human ABU) increasing this to 8.5-24.9%. CONCLUSIONS: Our model provides a simple framework to explain the mechanisms underpinning ABR, suggesting that future interventions targeting the simultaneous reduction of transmission and ABU would help to control ABR more effectively in Thailand.
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