Antibiotic resistance (ABR) constitutes a worldwide emerging threat and risk for society. Without measures to restrain this threat, the costs and burden of disease will gradually rise to a huge extent in the coming decades. One of the most obvious threats now is carbapenem resistance (CPE), since carbapenems are last resort antibiotics and the ability to cure infections with this antibiotic becomes very limited. Combatting the threat of ABR requires measures in different domains, e.g. reducing the use of antibiotics in human care and animal husbandry, adequate surveillance in humans, animals and environment, and improved cooperation between cure, care and public health institutions. Moreover, there is a need for new antibiotics and alternative methods and means to treat infection diseases.
The risks related to ABR can be classified as ambiguous. The transmission of ABR can easily be underestimated. For long time, resistant bacteria can go unnoticed, while they spread among healthy people and in animals and the environment. Consequently, the threat is not easily and broadly recognized and awareness amongst the public is low. Moreover, professionals, scientists, policy makers and directors of health care institutions considerably differ in their judgment of the impact and the necessity of enhanced national and international control. The current measures against ABR in human health care follow the perspective of human medicine: screening, treatment and isolation of infected hospital patients. Future measures may be stricter give rise to ethical questions. Elevation of CPE may ask for long-term isolation and measures that go beyond the medical profession and intervene in personal life.
Understanding the mechanisms and spread of ABR amongst people, animals and the environment requires adequate, risk based surveillance in the human and veterinary domain. For this purpose, enhanced cooperation between health care and research institutions at national and local level is a prerequisite. In addition, an integrated governance model is desired aiming at a balance between timely detection, outbreak control, and proportionality of measures.
In recent years, the Netherlands developed an integrated one-health strategy to combat ABR and control the threat. In this presentation, we elucidate this strategy and the difficulties of its implementation, and we discuss the different benefits, risks, pitfalls and future expectations.