[Music]
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.
[Music]
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