The Role of Plant Agricultural Practices on Development of Antimicrobial Resistant Fungi Affecting Human Health Proceedings of a Workshop Series (2023) / Chapter Skim
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8 One Health Approach to Antimicrobial Resistance and Pathogen Surveillance
8 One Health Approach to Antimicrobial Resistance and Pathogen Surveillance
Pages 109-130
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From page 109... ...
, described the limited efforts to detect resistant fungal infections in the United States, a lack of available antifungal susceptibility diagnostic products, and low capacity for laboratory processing of these tests. He discussed the value of expanded antifungal resistance surveillance and of greater communication and collaboration between various sectors.
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Bas Zwaan, professor at Wageningen University & Research in the Netherlands, provided an overview of the One Health Aspects of Circularity project, the benefits and risks of a circular system of farming, and research efforts to identify interventions to mitigate the threat of agricultural antifungal resistance to clinical populations. ONE HEALTH APPROACH TO ANTIMICROBIAL RESISTANCE SURVEILLANCE AND MITIGATION MEASURES Verweij explored the necessity and benefits of adopting a One Health approach in conducting AMR surveillance and implementing mitigation measures.
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The Netherlands first authorized use of these fungicides between 1990 and 1996 (Snelders et al., 2012) and the first resistant isolates detected via susceptibility testing were from clinical samples dating back to 1998.
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Fungal resistance has not been prioritized, and many AMR programs exclude it. When fungal resistance is included in AMR programs,
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Of the nearly 12,000 clinical isolates collected since 1994, approximately 1,800 were azole-resistant, with significant increases since 2008. Moreover, the number of variants is also increasing, with 91 different resistant genotypes identified across the TR34, TR46, and F46Y groups, in addition to isolates with single resistance mutations.
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From page 114... ...
Conducted in settings where azoles are used, these studies aimed to identify hotspots -- i.e., locations where resistance is likely to be developing or is already abundant -- in order to target mitigation strategies. Multi-fungicide-resistant isolates were identified in a variety of agricultural settings.
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Brewer sought to determine whether the resistant isolates found in patients featured a signature that could be found in isolates from agricultural sites. She posited that the presence of resistance to multiple fungicide classes would indicate that A
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The longer a class had been in use in the environment, the higher the proportion of resistant fungal isolates were detected. Thus, evidence supporting an agricultural origin of pan-azole resistance includes (1)
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use. Minimizing the use of agricultural azoles by more exclusively using other fungicide classes may not successfully preserve azole therapies, as other classes may still indirectly select for azole-resistant isolates.
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Brewer noted that one of the tulip fields sampled was organic, but all bulbs were imported from the Netherlands, indicating a potential method of global movement of resistant isolates. Azole Resistance in Food Supply and Plant-Based Retail Products Another research effort investigated the possibility of human exposure to azoles used on crops via food and garden products by testing food and plant-based retail products for ARAf, said Brewer.
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DIAGNOSTICS, RESISTANCE TESTING, AND SURVEILLANCE CAPABILITIES IN HEALTH CARE AND AGRICULTURAL SYSTEMS Lockhart described the limited efforts to detect antifungal resistant infections in the United States and associated the country's low rate of resistant Aspergillus infections with a lack of detection, rather than absence of ARAf in clinical settings. He outlined the lack of antifungal susceptibility diagnostic products and the low number of laboratory facilities that process these tests.
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Furthermore, the problem of resistant antifungal infections is expected to grow. Since azole drugs came into use in the 1990s, resistance has been periodically observed in patients on long-term antifungal therapy, with rare cases observed in patients with severe acute illness (CDC, 2021b)
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A fumigatus samples can be sent to two of these laboratories, located in Tennessee and Maryland, where they are prescreened for antifungal resistance using agar plates, and broth microdilution can be performed.
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Communication in the Mycology Research Community The similarities in antifungal resistance in plants and in humans warrant communication between mycologists who study plants and those who study human fungal infections, said Lockhart. Findings from each of these communities are often published in journals typically only read by that group.
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will collect antimicrobial use data in animals. Pinto Ferreira remarked that with WOAH providing AMU in animals data and WHO providing data on human AMU and AMR, a data gap remains for AMR in animals and food and AMU in plant production and protection.
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Pinto Ferreira stated that resistance reporting is highly sensitive, given that it can impact a nation's trade activity. To help mitigate reservations governments may have about sharing resistance data, InFARM will include three reporting levels.
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Agricultural Antifungal Resistance Multiple factors relevant to the development of AMR should be considered in research, including resistance mechanisms, ecological settings, biology of the species, and the nature of the selection pressure, Zwaan explained. The One Health Aspects of Circularity project is currently at its midway point.
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Linking the Environment to the Clinic Zwaan emphasized that learning how long it takes for an ARAf spore to travel from its origin to a potential human host could contribute to understanding how to disrupt the spore's route. He and colleagues have investigated samples collected from flower bulb waste heaps in three different locations from 2016–2019 that include both susceptible and resistant fungal isolates.
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DISCUSSION Potential Interventions and Policy Changes McKenna asked the participants to provide interventions or policy considerations they view as priorities in addressing antifungal resistance. Verweij replied that, like Zwaan, he too has come to the realization that preventing resistance from emerging is unlikely.
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Zwaan described how the Dutch government formerly ran a knowledge center that advised farmers on issues such as chemical use, providing them with an information source other than the companies selling the products and systems. Such consultation services, stewardship practices, and approaches to plant waste could be helpful in decreasing the spread of resistant fungi.
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From page 129... ...
Awareness efforts are needed to inform growers that minimal, effective triazole practices can avoid resistance in plant pathogenic fungi as well as helping to reduce human pathogen risk. Pinto Ferreira noted that in the past, discussion of ending the use of growth promotion in animal production featured disputes that growth promotion was required to generate adequate animal protein.
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Similar molecular structure of the targets will pose a high risk for resistance selection, thus the level of similarity needs to be determined. Additionally, the entrance of a new class into the fungicide arena increases the likelihood that other new compounds in this class will emerge, each of these may have a closer molecular structure to that of the human medication olorofim.
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