Antibiotics, the therapeutic gem of the 20th century, are in danger. Their overuse and misuse have amplified antibiotic resistance. According to the O’Neill report (2016), this phenomenon, which consists of bacteria becoming resistant to antibiotics, might be responsible for more than 10 million deaths per year and thus become the leading cause of death in 2050.
To sustainably influence uses in human medicine, veterinary medicine and agriculture, CIRAD and its partners are mobilizing different disciplines, with a common “one health” approach. Today, the center coordinates two large-scale international projects, financed by France, within the framework of the Antimicrobial resistance priority research program supported by the alliance for life and health sciences (Aviesan).
Hinder transmission
The CIRCUS project (Circulation of multi-drug resistant Enterobacteriaceae in humans, animals and in the environment in rural, peri urban and urban areas in low-and middle-income countries: a One Health approach) uses epidemiology and microbiology in different contexts (urban, peri-urban and rural) and countries (Burkina Faso, Cambodia, Ivory Coast, Madagascar), in order to analyze the potential circulation of multi-resistant bacteria . “ Starting from cases of humans carrying or infected with this type of bacteria, we identify cross-contamination in members of their family, their animals, pets (dogs and cats) or livestock (poultry, pigs, ruminants), their environment (drinking water, rodent excrement near the home), says Éric Cardinale, veterinarian at CIRAD, and deputy director of UMR ASTRE. “ The bacterial strains are then analyzed to determine how each reservoir participates in the transmission of resistance in humans. Identifying traffic helps to limit it »adds the researcher.
At the same sites, the project RAMSES (Resistance to Antimicrobials: Socio-Economic factors and regulations influencing emergence and dissemination in developing countries) apprehends the circulation of antibiotics in the drug markets, their regulation by human and animal health professionals, and their use by consumers. It also assesses countries’ institutional capacities in terms of microbiology laboratories and surveillance networks.
“These two projects will give us a solid factual basis to help the authorities, in particular the national antimicrobial resistance committees, to rationalize the use of antibiotics”aspires Éric Cardinale.
Antibiotics: less and better
Using fewer antibiotics and wisely helps preserve their effectiveness. A particularly critical objective for those in the last line of defense such as carbapenems, 3rd and 4th generation cephalosporins and fluoroquinolones. The alternatives ? CIRAD is actively involved in promoting them, in particular through vaccination and strengthening the level of biosecurity on farms and in the surrounding area.
Quick and disseminating results
In the grip of less pressure, the bacteria gradually find a so-called “wild” phenotype, sensitive to antibiotics. “In Reunion, where CIRAD has carried out various projects in the field, the number of farms contaminated by multi-resistant bacteria has fallen by 50% in five years”, illustrates Éric Cardinale. And to conclude: “The countries with which we collaborate being part of regional organizations, if new antibiotic management policies are shared, we can increase the scope of our work”.
Other projects concern Togo (project to strengthen the control of antibiotic resistance in hospitals in Togo), Canada, the Netherlands, Hungary, Senegal and the Philippines (design project).
The work AMR Antibiotics and Bacteria – A History of Resistance dissects the complex phenomenon of bacterial resistance to antibiotics and its consequences, in order to change practices. This popular work will soon be the subject of a MOOC, particularly aimed at CIRAD’s partners in the South. Antibiotic resistance analyzed holistically, under the “one health” prism, should also become a training module.
