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Well good morning everyone. Amanda and I are gonna give you a quick overview of the

footprint project that we have hopefully funding from the state legislature for.

It always has to get through the legislative process still. So, in short, we

know antibiotics are getting into the environment and classes such as

fluoroquinolones and macrolides and sulfa drugs... and we know in general the

pathways. They're used in agriculture, they're used for our companion animals, they're

coming out of wastewater treatment plants. And we've done some preliminary

work actually already looking for some of these compounds in the environment. So

this is just a set of samples we took along the Minnesota and Mississippi

rivers and I haven't put a little map here. I'm assuming you know where the

Minnesota River is...the Mississippi River is. So we start at the South Dakota

border and go to Jordan, Minnesota and the Minnesota River and then start in-

where did we start- we started in Grand Rapids, and went all the way down at Lake

Pepin and the Mississippi River. And so these are three compounds that are used

predominantly in agriculture and not surprisingly, we get the detections in

the sediment in the Minnesota River. And when we started this, we thought well,

there's more people in the Mississippi River Basin. We're gonna see the human

antibiotics in the Mississippi River Basin, and it turns out we do, but we

actually see a lot of them in the Minnesota River Basin as well. And so we

can't start with assumption about where we're gonna find things, to where to find

things where we don't expect. And we're hoping that the footprint process, in

gathering a whole bunch of data, will give us better targeting on where to go. So

some of the big questions we have are: what are the impacts of these

antibiotics in the environment on overall health and resistance, what

impacts might they have on ecological health, and where should we target any

interventions to lower the levels of antibiotics in the environment? So if we

have cost constraints, of course, we want to make sure we have the

most bang for the buck if we do an investment to reduce antibiotic loads.

And then the big question is: how do these antibiotics in the environment

affect resistance potentially in clinical or other health settings? And

the answer to that is the antibiotic resistome. The

antibiotic resistome is the collection of antibiotic resistance genes of all

microorganisms, basically you could argue in the world. But in any given setting we

have a specific antibiotic resistome. And what we know is that there are bacteria

everywhere. There are bacteria in the environment. And I'm gonna flip through a

few demonstrations here that show you how this resistome actually can impact

human health. There are susceptible bacteria in the

environment at any given point in time. There are also bacteria that have

resistance genes. And those resistance genes can be transferred from one

bacteria to another. In addition, there's also a natural drive towards the

development of antibiotic resistance through the formation of mutations in

individual bacteria. So we have the sharing of resistance genes, and we also

have the development of resistance as bacteria replicate. Now this is a natural

process; this happens all the time. You can find antibiotic resistance genes in

caves that have never been touched by humans. So we know that this is going to

happen and it's all part of this antibiotic resistome. What we also know,

however, is that we have antibiotic resistance that happens in our built

environments, in our environments where we have health care settings, where we

have communities, where we have parks, we have, of course, susceptible bacteria, but

we also have resistant bacteria that are sharing their genes and developing

mutations in our built environments as well. The built environment, the natural

environment- all of this together equals the antibiotic resistome. When we end up

with antibiotics in the environment, whether it's from our medical sector and

home use of antibiotics ending up in the septic, ending up in our landfills, or

whether it's from agricultural use where we have antibiotics used in crop

production, or we have antibiotics in manure that's spread on fields, we end up

with antibiotics in the environment. These antibiotics

drive the process of antibiotic resistance development in the entire

antibiotic resistome. And the challenge is that because these are antibiotics that

we're using in our treatment of animals, of people, that those are the antibiotics

that are driving resistance. So then we see our antibiotic resistome take on the

characteristics of resistance against the antibiotics that we most need.

And so that's why it's important for us to understand: what is the real

impact of antibiotics in our environment? Where do we expect that this problem is

going to be the greatest? The antibiotic resistome that we have in our built and

natural environments influences how we can treat patients. It influences the

susceptibility testing and the ability to use certain antibiotics for certain

certain infections. It also influences our overall picture of antibiotic

resistance when we're thinking about, how is resistance changing over time, over

years, over decades. So we really need to understand this better. We have a group,

from this collaborative, of scientists who have come together to think about

this problem. Particularly, what we want to do is figure out how we can be

smarter about sampling the environment for antibiotics and for resistance genes.

Our goal is to predict areas in the state of Minnesota that that are at

highest risk of contamination with antibiotics and resistance genes. So we

have this team from University of Minnesota, and from St. Thomas, and from

Minnesota Department of Health that is planning to do the following. What we

would like to do is develop an antibiotic footprint of Minnesota's

natural environment. The first step in this process is to create a map-based

model. We want to map out across the state of Minnesota where antibiotics are

used, both in human health and in animal health, where they're used in our homes

for our pets, where they're used in our health care facilities. We will make a map

of where people and animals live and where antibiotics are used. We will

then use modeling to determine where those antibiotics end up in the

environment. And what we'll have is a risk map, or a "hot spot" map, of where

antibiotics might be in our waters and in our soils. After we have a map, we will

rely on Bill and Tim LaPara at the University of Minnesota, and Kris

Wammer at St. Thomas University, to sample our environment, to look for

antibiotics, and to look for resistance genes... things that they have done many

times in the past, but what we have given them first is a map. It's a sort of a

treasure map of where to be looking for these antibiotics and these resistance

genes. They'll go out into the environment. They'll collect the samples.

And what we learn from that directed sampling will then improve our ability

to model and to map where we expect antibiotics and resistance genes to be

in the environment. So what do we need for this process? First, we need funding.

As mentioned, we think that we will be able to get some funding from the State

of Minnesota. This proposal has been recommended for funding through the

Legislative Citizens Commission on Minnesota's Resources, so that is

terrific. We also will need data. How do you make a map of where antibiotics are

used? How do you know how many antibiotics are used? A lot of this is

going to be based on our collaborative nature, getting data from health care,

getting data from public health, getting data from our animal health partners, and

we're going to have to put that all together. We're also going to need,

perhaps, to get expert opinion where there are not data available. We're gonna

need time. It takes time to develop such a model and it also will take time to

improve that. As I said, over time, the environmental sampling will improve our

model and make our mapping even better. Most importantly, we need your support. We

need the support of the Minnesota One Health Antibiotic Stewardship

Collaborative to take this idea that came from this group

and actually make it happen. We know that we want all of the entities in this room,

whether it's health care, animal health, animal agriculture, environmental health

to feel like this is a project that belongs to them

and it's going to give us valuable information that improves all of our

fields. Yeah, so our overall goals here is we want to be smarter about where

doing our sampling in the environment. It's expensive to do it. So if we want to

do the resistant genes and antibiotics in a single sample,

you count labor and everything else, it's about a thousand dollars. And so we can't

sample everywhere, and if we use the map to decide where to sample first, we can

do it much more targeted. We can also increase our knowledge greatly about

where antibiotics are used in terms of both human and animal health fields. And

the big thing here is, no state has done anything like this before and so we can

really be a leader in the country in developing a system like this. And also,

it's a big opportunity for environment, agriculture, human, One Health, all to come

together and do something that's much bigger than ...the whole will be

bigger than the sum of the parts. Thanks.

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