Background
Antibiotic resistance is one of the most serious global threats to public health. Antibiotics, which are essential for the treatment of bacterial infections, have become progressively less effective due to the spread of resistant bacteria. This phenomenon not only compromises the ability to treat common infections, but also to perform surgical procedures and cancer treatments that require infection prevention. Antibiotic resistance is not limited to humans, but extends to animals and the environment, creating a continuous cycle of resistance that requires an integrated and global approach. In this context, the “One Health” strategy has emerged as a key multidisciplinary approach to addressing antibiotic resistance. This article reviews the origin and impact of antibiotic resistance, the principles of the One Health strategy, and the scientific evidence supporting the integration of this approach to combat antibiotic resistance.
Antibiotic Resistance: A Global Problem
- Origin of Antibiotic Resistance
Antibiotic resistance is a natural phenomenon that occurs when bacteria develop mechanisms to survive exposure to antibiotics. However, the excessive and inappropriate use of antibiotics in human, veterinary, and agricultural medicine has dramatically accelerated this process (Laxminarayan et al., 2013). The prophylactic use of antibiotics in animal agriculture, in particular, has contributed to the selection of resistant strains that can be transferred to humans through the consumption of contaminated meat or through the environment (Landers et al., 2012).
- Impact of Antibiotic Resistance
Antibiotic resistance has devastating consequences for public health. Infections caused by antibiotic-resistant bacteria lead to increased mortality, morbidity, and healthcare costs (O’Neill, 2016). According to the World Health Organization (WHO), approximately 700,000 people die each year from antibiotic-resistant infections, and it is estimated that, without adequate interventions, this number could rise to 10 million by 2050 (WHO, 2015). Furthermore, antibiotic resistance also threatens the advances of modern medicine, making routine surgeries, organ transplants and chemotherapy treatments risky.
The One Health Strategy: an integrated approach
The complexity of antibiotic resistance requires an integrated approach that considers the interconnections between human health, animal health and the environment. The One Health strategy recognizes that human, animal and environmental health are interdependent and that multidisciplinary collaboration at global, national and local levels is needed to address global problems such as antibiotic resistance (Zinsstag et al., 2011).
- Principles of the One Health Strategy
The One Health strategy is based on three fundamental principles:
- Intersectoral Collaboration: Involves professionals from human, veterinary and environmental health to address common challenges related to global health.
- Integrated Prevention: Promotes the rational use of antibiotics in all sectors and the prevention of infections through hygiene practices, vaccination and sustainable management of the environment.
- Surveillance and Coordinated Research: Supports the collection and analysis of data to monitor the spread of antibiotic resistance and evaluate the effectiveness of interventions (Destoumieux-Garzón et al., 2018).
- The Importance of One Health in the Fight against Antibiotic Resistance
The One Health strategy is crucial in the fight against antibiotic resistance because it addresses the roots of the problem at a global level. For example, antibiotic resistance can emerge in animals raised for food production, spread through the environment (e.g., through agricultural waste) and eventually reach humans. A fragmented approach, focusing only on one of these aspects, will not be sufficient to solve the problem (Robinson et al., 2016).
Scientific evidence supporting the One Health Strategy
- Rational Use of Antibiotics in Human and Veterinary Medicine
One of the key aspects of the One Health strategy is the rational use of antibiotics. In humans, this involves reducing inappropriate antibiotic prescription, for example for viral infections, and promoting adherence to clinical guidelines (Dyar et al., 2017). In veterinary medicine, this involves limiting the use of antibiotics for animal growth and promoting agricultural practices that reduce the need for antibiotics, such as improved hygiene conditions and the use of vaccines (Tang et al., 2017). A study conducted in the Netherlands showed that reducing the use of antibiotics in pig farms, combined with improved management practices, led to a significant decrease in antibiotic resistance among zoonotic bacteria (Dorado-García et al., 2016). Similarly, interventions to improve the use of antibiotics in human medicine have reduced the incidence of resistant infections in hospitals and communities (Schuts et al., 2016).
- Surveillance of Antibiotic Resistance
Another pillar of the On Health strategy is the coordinated surveillance of antibiotic resistance between humans, animals and the environment. The collection and analysis of epidemiological data are essential to identify resistance outbreaks, monitor trends over time and assess the impact of control policies (McEwen & Collignon, 2018). A successful example of integrated surveillance is the European project EARS-Net (European Antimicrobial Resistance Surveillance Network), which monitors antibiotic resistance in human, veterinary and environmental pathogens through a network of laboratories in different countries (Klein et al., 2018). These data are essential to develop effective intervention strategies and to evaluate the effectiveness of measures adopted at national and international level.
- Preventing Infections through Environmental Management
The environment plays a crucial role in the spread of antibiotic resistance. Wastewater, agricultural wastes and industrial effluents can contain antibiotics and resistant bacteria that contaminate the environment and contribute to the spread of resistance (Berendonk et al., 2015). The One Health strategy promotes sustainable environmental management to reduce this spread, for example through wastewater treatment and agricultural waste management. A study conducted in China showed that wastewater treatment with advanced technologies can significantly reduce the presence of antibiotics and resistance genes in surface water, thus helping to limit the spread of resistance (Zhang et al., 2017). Similarly, agricultural waste management, such as composting and reducing antibiotic use in livestock, can reduce the release of resistant bacteria into the environment (Wang et al., 2019).
Challenges and opportunities for the One Health Strategy
- Coordination and Collaboration
One of the main challenges of the One Health strategy is coordination between different sectors and levels of government. Collaboration between doctors, veterinarians, farmers, researchers and policy makers is essential for the effective implementation of control measures (Destoumieux-Garzón et al., 2018). However, this collaboration requires resources, training and building a culture of cooperation between sectors that have historically worked independently.
- Global and National Policies
Antibiotic resistance is a global problem that requires a coordinated response at the international level. The WHO, the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE) have developed global action plans to combat antibiotic resistance, but the implementation of these policies at the national level is often uneven (Robinson et al., 2016). Strengthening national policies and ensuring their alignment with global goals is critical to the success of the One Health strategy.
- Education and Awareness
Education and awareness of the public and health professionals are crucial components of the One Health strategy. Awareness about the responsible use of antibiotics and the importance of infection prevention can reduce the demand for antibiotics and improve adherence to clinical guidelines (Dyar et al., 2017). Public awareness campaigns, training programs for doctors and veterinarians, and consumer education are key tools to promote responsible behavior.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.
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