It is not difficult to make
microbes resistant to
penicillin in the laboratory,
and the same has occasionally
happened in the body.
Alexander Fleming, 1945
Nobel Prize Acceptance Speech
1
The End of Modern Medicine?
Epidemiology
of AMR
AQUACULTURE
Drinking
water
Farm effluents &
manure spreading
Rendering
Seas &
lakes
Drinking
water
Rivers &
streams
Soil
Sewage
Vegetables, seed
crops, fruits &
vegetables
Offal
Animal
feeds
Irrigation
water
Antibiotics
WILDLIFE
Dead
stock
Swim
Industrial &
household
antimicrobial
chemicals
Swine
Hospital
FOOD Cattle
ANIMALS
Sheep
Antibiotics
Poultry
Commercial
abattoirs &
processing
plants
Meat &
fish
Handling,
preparation,
consumption
COMPANION
ANIMALS
HUMANS
Urban
areas
Others
Care
facilities
Rural
areas
Food processing
antimicrobials
Direct contact
2
Antimicrobial resistance
Diagram based on Linton (1977), as adapted by Rebecca Irwin, Health Canada (Prescott 2000) and IFT
Economic costs
Europe – cost of AMR
€1.5bn and 600m lost days of
productivity per year
Russia
UK – cost of AMR
83% of families use unnecessary
antibiotics at home
£10bn/yr societal costs plus
£20k per patient episode
USA – cost of AMR
Healthcare costs alone
$21-34bn/yr
Japan and Antarctica
Resistant bacteria found in
water samples
3
Antimicrobial resistance
Map and statistics from World Economic Forum “Global Risks 2013”
except UK statistics, which are based on work published by Richard Smith of LSHTM
THE GLOBAL PICTURE
4
Antimicrobial resistance
Can we make a difference?
5
Antimicrobial resistance
Public information and education
http://bit.ly/CMObook
6
Antimicrobial resistance
http://bit.ly/CMOatTEDx