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Antimicrobial resistant E. coli before and after California Senate bill 27 (ARES): a natural experiment

加州参议院第 27 号法案 (ARES) 前后的抗菌药物耐药性大肠杆菌：一项自然实验

基本信息

批准号：
10166761
负责人：
Sara Tartof
金额：
$ 71.7万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-05-09 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10166761
关键词：
Address Affect Air American Animal Feed Antibiotics Antimicrobial Resistance Antimicrobial susceptibility California Cephalosporins Chickens Clinical Clinical Data DNA Polymerase I Data Decision Making Domestic Fowls Electronic Health Record Elements Epidemiologic Methods Escherichia coli Evaluation Exposure to Food Future Generations Genes Gentamicins Growth Health Health system Human Incidence Industrialization Infection Ingestion Intervention Laboratories Lead Link Livestock Location Measures Meat Meat Products Methods Milk Mobile Genetic Elements Molecular Multi-Drug Resistance Natural experiment Outpatients Pathway interactions Patients Pattern Phenotype Phylogenetic Analysis Policies Population Prevalence Prevention Production Quasi-experiment Resistance Resistance profile Resistance to infection Risk Risk Factors Role Sales Soil Source Specimen Statistical Data Interpretation Statutes and Laws System Tail Testing Tetracyclines Therapeutic Time TimeLine Urinary tract infection Veterinarians Water Work antimicrobial antimicrobial drug base biobank cost density design disorder prevention evidence base foodborne genome sequencing gut colonization infection risk innovation man operation pathogen pathogenic Escherichia coli population health resistance gene spatial relationship spatiotemporal transmission process trend whole genome

项目摘要

ABSTRACT Overuse of antibiotics contributes to antimicrobial resistance (AMR) and is a growing threat to human health worldwide. In the U.S., industrial food animal production (IFAP) is a powerful driver of antibiotic use. Seventy percent of antibiotics are sold for use in livestock, including tetracycline, gentamicin, and third-generation cephalosporins (3GC). In an attempt to reduce AMR and population health impacts, beginning January 1, 2018, California's Senate Bill 27 (SB27) will ban all non-therapeutic uses of antimicrobials in livestock (includ- ing growth promotion and routine disease prevention) and require a veterinarian's prescription for therapeutic indications. We will quantify the effect of this legislation on AMR E. coli E. coli is an ideal pathogen for evaluating changes in antimicrobial use and AMR related to livestock production because (1) AMR profiles of E. coli circulating in livestock and humans overlap; and (2) extraintestinal pathogenic E. coli are a leading cause of human UTI, which cost Americans $1-2 billion annually. We plan to use data ranging from the molecular to the population level in a natural exper- iment to address three specific aims. In Aim 1, we will use whole genome sequencing and antimicrobial sus- ceptibility testing to characterize resistance genes, phenotypes, and E. coli populations isolated from retail chicken meat and UTI. We hypothesize that contaminated retail meat products contribute to the burden of AMR E. coli UTI in humans. In Aim 2, we will leverage longitudinal (2015-2021) electronic health records on retail chicken meat and human E. coli urinary tract infections (UTIs). (EHRs) on more than 7 million outpatients with 100,000 E. coli UTIs per year from two major California health systems to estimate longitudinal changes in the proportion of tetracycline-, gentamicin-, and 3GC-resistant E. coli isolated from retail chicken meat and laboratory-confirmed E. coli UTI before and after the implementation of SB27. We will also employ synthetic control statistical analyses to estimate the causal effect of SB27 on AMR trends in retail chicken meat and E. coli UTI. We anticipate that the enactment of SB27 will be associated with reductions in AMR of E. coli isolated from retail chicken meat and human UTI cases. In Aim 3, we will conduct spatial analyses using patient addresses from EHRs and IFAP location data. We hypothesize that pri- or to SB27, residential proximity to IFAP will be a risk factor for tetracycline-, gentamicin-, and 3GC-resistant E. coli UTI; after SB27, this risk will be reduced. The approach is innovative because it uses a quasi-experimental design built around a first-in-the U.S. policy-mandated reduction in livestock antimicrobial use. Results of this work will make a significant contribution to the evidence base connecting food systems and UTI and will de- termine if this state-level legislative intervention affects AMR trends in retail meat and human UTIs, informing decision-making about implementation of similar policies across the U.S.

抽象的过度使用抗生素会导致抗菌素耐药性 (AMR)，对人类健康构成日益严重的威胁全世界。在美国，工业化食用动物生产（IFAP）是抗生素使用的强大推动力。七十销售的抗生素用于牲畜，包括四环素、庆大霉素和第三代抗生素头孢菌素类（3GC）。为了减少抗菌素耐药性和人口健康影响，从 1 月 1 日开始， 2018 年，加州参议院第 27 号法案 (SB27) 将禁止在家畜中使用抗菌素的所有非治疗用途（包括促进生长和常规疾病预防）并需要兽医处方进行治疗迹象。我们将量化这项立法对 AMR 大肠杆菌的影响大肠杆菌是评估抗菌药物使用变化的理想病原体抗菌素耐药性与畜牧业生产相关，因为 (1) 在家畜和人类中传播的大肠杆菌的抗菌素耐药性概况重叠; (2) 肠外致病性大肠杆菌是人类尿路感染的主要原因，这让美国人付出了代价每年1-20亿美元。我们计划在自然实验中使用从分子水平到群体水平的数据迫切需要解决三个具体目标。在目标 1 中，我们将使用全基因组测序和抗菌悬浮技术敏感性测试，用于表征从零售中分离出的抗性基因、表型和大肠杆菌群体鸡肉和尿路感染。我们假设受污染的零售肉类产品加重了人类中的 AMR 大肠杆菌尿路感染。在目标 2 中，我们将利用纵向（2015-2021 年）电子健康记录零售鸡肉和人类大肠杆菌。大肠杆菌尿路感染（UTI）。 (EHR) 每年有超过 700 万门诊患者患有 100,000 例大肠杆菌尿路感染，来自加州两大主要医疗机构系统估计四环素、庆大霉素和 3GC 耐药大肠杆菌比例的纵向变化。实施前后从零售鸡肉中分离出的大肠杆菌和实验室确诊的尿路感染大肠杆菌 SB27 的。我们还将采用综合控制统计分析来估计 SB27 对零售鸡肉和大肠杆菌尿路感染的抗菌素耐药性趋势。我们预计 SB27 的颁布将与从零售鸡肉和人类尿路感染病例中分离出的大肠杆菌的 AMR 降低。在目标 3 中，我们将使用 EHR 中的患者地址和 IFAP 位置数据进行空间分析。我们假设优先或根据 SB27，居住地靠近 IFAP 将是耐四环素、庆大霉素和 3GC 的大肠杆菌的一个风险因素。大肠杆菌尿路感染； SB27之后，这种风险将会降低。该方法具有创新性，因为它使用了准实验方法该设计围绕美国首个政策要求减少牲畜抗菌药物的使用而设计。结果工作将为连接粮食系统和泌尿道感染的证据基础做出重大贡献，并将如果这种州级立法干预影响零售肉类和人类尿路感染的抗菌素耐药性趋势，则终止，通知有关在美国实施类似政策的决策

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A Review of the Effectiveness of Current US Policies on Antimicrobial Use in Meat and Poultry Production.

对当前美国政策在肉类和家禽生产中使用抗菌使用的有效性的综述。

DOI：
10.1007/s40572-022-00351-x
发表时间：
2022-06
期刊：
CURRENT ENVIRONMENTAL HEALTH REPORTS
影响因子：
7.9
作者：
Wallinga, David;Smit, Lidwien A. M.;Davis, Meghan F.;Casey, Joan A.;Nachman, Keeve E.
通讯作者：
Nachman, Keeve E.

Using source-associated mobile genetic elements to identify zoonotic extraintestinal E. coli infections.

DOI：
10.1016/j.onehlt.2023.100518
发表时间：
2023-06
期刊：
ONE HEALTH
影响因子：
5
作者：
Liu, Cindy M;Aziz, Maliha;Park, Daniel E;Wu, Zhenke;Stegger, Marc;Li, Mengbing;Wang, Yashan;Schmidlin, Kara;Johnson, Timothy J;Koch, Benjamin J;Hungate, Bruce A;Nordstrom, Lora;Gauld, Lori;Weaver, Brett;Rolland, Diana;Statham, Sally;Hall, Brantley;Sariya, Sanjeev;Davis, Gregg S;Keim, Paul S;Johnson, James R;Price, Lance B
通讯作者：
Price, Lance B

Development and validation of a prediction algorithm to identify birth in countries with high tuberculosis incidence in two large California health systems.

预测算法的开发和验证，以识别两个大型加利福尼亚州卫生系统中结核病发病率高的国家的出生。