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EPA Office of Research & Development Initiatives to Monitor Environmental AMR and Model Risk
Citation:
Garland, J., A. Franklin, M. Bagley, S. Keely, N. Brinkman, M. Jahne, L. Boczek, C. Nietch, AND R. Mitchell. EPA Office of Research & Development Initiatives to Monitor Environmental AMR and Model Risk. Presidential Advisory Committee on Combating Antibiotic Resistant Bacteria (PACCARB), Washington, DC, DC, March 23 - 24, 2023.
Impact/Purpose:
Share information on relevant EPA ORD activitities with the PACCARB.
Description:
Antimicrobial resistance (AMR) has been identified as one of the top medical issues worldwide, leading many countries to place greater emphasis on combating resistant bacteria through a multipronged, coordinated approach. A consensus has emerged among the greater public health profession to adopt an interdisciplinary one health model of infectious disease monitoring and control. The One Health paradigm recognizes 1) that human and animal health are linked to environmental health, and 2) the need to better understand the role of the environment in the spread of disease. The urgency of resistance requires that all available expertise, infrastructure, and resources are garnered and that government agencies collaborate in new ways to help combat this global health threat Im 1996, FDA’s Center for Veterinary Medicine (CVM) initiated the National Antimicrobial Resistance Monitoring System (NARMS) for enteric pathogens in collaboration with the Center for Disease Control (CDC) and the United States Department of Agriculture (USDA). Following recommendations of the FDA Science Board in 2017, NARMS has been transitioning to an integrated, One Health model of surveillance to include animal pathogens and environmental testing. The NARMS surface water pilot goals align with several objectives in the NARMS strategic plan, including the establishment of a baseline understanding of AMR in aquatic ecosystems and research to understand sources, microbial processes, selective gradients, and health burdens to humans and animals. The NARMS Environmental Working Group (EWG), comprised of scientists from EPA, FDA, USDA, and CDC, , defined that the overall purpose to the pilot study was to is to develop a national-scale, quantitative assessment of AMR within surface water. The four main objectives as developed from initial meetings of the NARMS-EWG re (I) standardized measure (and library of samples) to monitor trends as part of NARMS, (II) provide input to models of AMR risks for various end uses of water (recreational, drinking, agricultural, water reuse), (III) help quantify drivers of occurrence and selective pressures for potential amplification, and (IV) identify critical control points and assess current and new mitigation strategies It is not possible to achieve each of these goals with a single study design, as they relate to questions at different temporal and spatial scales, ranging from national to in-stream. Therefore, it was decided to use a “hybrid design”, which allows us to look at trends and processes at different scales. The backbone of this approach is the national probabilistic survey (EPA’s Nastional Rivers and Streams Assessment), which will provide a snapshot of ARG and ARB prevalence using a statistically valid design for estimating their extent in rivers and streams. This survey will provide information on which types of aquatic systems tend to be associated with higher ARG and ARB prevalence, will identify what environmental and landscape factors tend to be associated with AMR, and will form a baseline for measuring long term trends. However, since most sites are visited once during the summer and are tens to hundreds of kilometers apart, the national survey will provide little detail about seasonal patterns, the importance of storm events, and the dynamics or AMR as it moves from sources to receptors. The watershed study is complementary to the national survey in that it addresses these questions of seasonal and interannual dynamics as well as local-scales processes that modify ARGs and ARBs in the environment. Importantly, One Health linkages between humans, animals, and the environment are more visible at the watershed scale. Thus, the watershed study will greatly increase our understanding of both risk and intervention control points.