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Friday, December 9, 2016

Pig Health – A Balancing Act

Pigs are among the most intelligent animals.  Pigs are (or can be) cute. But did you know that pigs can also be an integral part of our health?  They provide nourishment (if you’re like me, you think pigs are delicious) and have the potential to save our lives, but they also have the potential of harming us.  From the “saving our lives” perspective, researchers have been trying for decades to make animal-to-human transplants work, a process known as xenotransplantation.  There are thousands of people on organ transplant waiting lists as there are not nearly enough donors, and having such a breakthrough would save lives.  In an article I came across, a research team has used CRISPR (a new gene editing technology) to create pig embryos designed to keep human immune systems from rejecting them with the hopes to move forward with animal trials in the near future.  Such a breakthrough would be enormous.

Conversely, a second article I read this week on pigs that was published in the journal of Antimicrobial Agents and Chemotherapy uncovered the fact that Carbapenem resistance has been found on at least one swine production facility in the US.  The researchers collected 1500 fecal samples and tested the pig’s environment four times over a 5-month period.  The gene that allows for Carbapenem resistance was found in several of the samples taken.  According to the researchers, none of the pigs on the farm were sick, but there could be a potential for human handlers to be colonized which could lead to person to person transmission.

2017 will mark the beginning of more stringent use of antibiotics in the farmed animal market. We are all responsible for the judicious use of antibiotics so that these lifesaving tools remain effective for treating people and animals.  As part of this antimicrobial stewardship initiative, changes are coming to how antibiotics are allowed to be used in the farmed animal market.  From a human perspective, CRE (Carbapenem resistant Enterobacteriaceae) are considered nightmare bacteria.  Half of the patients infected with CRE in their bloodstream have died as a result of it. One reason why CRE bacteria are so scary is that they can transfer their resistance to other bacteria within the same family. While currently almost all CRE infections occur in people receiving significant medical care in hospitals, long-term acute care facilities, and nursing homes, the fact that we have found CRE on at least one farm poses a concern for possible transmission and/or colonization outside of our healthcare facilities. This could leave us in a dire situation if even the strongest antibiotics we have in our treatment arsenal do not work in treating infections which could leave patients with potentially untreatable infections.

Before we start to panic, consider the positive. We are aware.  We can now make positive changes.  We know that CRE is spread from person to person through contact with an infected or colonised person.  This generally occurs directly from the hands of another person or indirectly from environmental surfaces or medical equipment that have become contaminated.  We know CRE is not spread through the air or by coughing or sneezing.  CRE is a vegetative bacteria.  While it carries antibiotic resistance, this does not make it more resistant to disinfectants.  As the environment is a key area of concern with respect to transmission, being vigilant and increasing or improving our cleaning and disinfection practices be it at a farm, in animal transport trailers, slaughter houses, food packaging facilities, hospitals, long term care facilities or our homes will help control this “nightmare bacteria”.  
This is a perfect example of the One Health initiative - Animals, People and the Environment.  We are all connected.  Pointing fingers or laying blame will not help.  We need to all work together towards the common goal of a world where people, animals and the environment can be happy and healthy.
Bugging Off!

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