10.2 A One-Health Perspective on Antimicrobial Resistance

No country is immune to the consequences of antimicrobial resistance (obviously) - antibiotic-resistant bacteria can spread from country to country because of travel, medical tourism, and the global trade of animals and food.

In 2008, a Swedish person became sick with a newly-identified multidrug-resistant infection that contains the NDM-1 enzyme in India. The NDM-1 enzyme (New Delhi metallo-beta-lactamase-1) enables resistance to last-resort antibiotics.

Figure 10.8: Statistics on Death from Antimicrobial Resistance

In 2019, an estimated 4.95 million deaths was associated with antimicrobial-resistant microbes (1.27 million deaths from antibiotic-resistant bacteria).

10.2.1 Drivers of antimicrobial resistance

Figure 10.9: Sources and Transmission Routes of Antimicrobial Resistance in the Food Chain

1. One in five resistant infections are caused by germs from food and animals.
2. Intensive farming practices are a result of increasing demand for animal protein (e.g., meat).
3. Some biological causes include: mutation, selection pressures, horizontal gene transfer

10.2.1.1 Global estimates of antimicrobial resistant infection from consumption of animals

There is a projected 67% rise in antimicrobial resistant bacteria in food animals by 2030. This rise is likely because of the growth in consumer demand for livestock products in middle-income countries and a shift to large-scale farms.

Hence, there are also calls for initiatives to preserve antibiotic effectiveness while also ensuring food security in low and middle income countries.

10.2.2 What about in Singapore?

Figure 10.10: Determinants Influencing Antibiotic Use in Singapore’s Aquaculture Sectors

10.2.3 Key data models

Figure 10.11: High Concentrations of ARG and MDR E. coli in Surface Waters of Farms and Transect

The above figure suggests that high concentrations of bacterial antimicrobial genes in surface water suggests that wastewater or animal feces could be possible polluting sources.

Figure 10.12: Antimicrobial Agents in Wild Birds

Multi-drug resistant E. coli was found in wild bird and rodent droppings. These strains were found via various antimicrobial resistance genes and could be considered as part of the environmental resistome.

The findings underscores close monitoring on antimicrobial-resistant bacteria in potential reservoirs and the necessity of environment management (including food and farm environments).

Figure 10.13: Bacterial Growth Varying According to Warmer Temperatures

An increase in 10 degrees Celsius is associated with antimicrobial resistances of 4.2%, 2.2% and 2.7% for the common pathogens E. coli, K. penumoniae, and S. aureus.