October 19, 2015

(Dan) Hi there folks, Dr. Dan from DocTalk. Thanks for joining us today, we’re gonna have a great show. We’re gonna talk about antibiotic resistance, surveillance of antibiotic resistance and many things to do with judicious use of our antimicrobials. Our guest today is Dr. Brian Lubbers from the Veterinary Diagnostic Lab here at Kansas State University’s College of Veterinary Medicine. Stay tuned.

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(Dan) Brian, welcome to the show. (Brian) Hi Dan, how are you? (Dan) Folks this is Dr. Brain Lubbers and he is a Clinical Pharmacologist and he is an Assistant Professor here at the Veterinary Diagnostic Laboratory at Kansas State University where he is working with different things that have to do with bacteria and antibiotics. Bugs and drugs, right? (Brian) Bugs and drugs, that’s right. (Dan) Well, I think one of the first things we need to talk about and just share with us is you do a lot of work with antibiotic resistance. (Brian) Yep. (Dan) And I think that right now there probably couldn’t be a hotter topic… (Brian) No probably not. (Dan) …in animal agriculture than antibiotic use, antibiotic resistance, and things to that nature. So, let’s just jump off and kind of start talking a little bit about antibiotic resistance in general terms. (Brian) Sure. And when we talk about antibiotic resistance, whether we’re taking about animal health or human health, the concepts are all the same. When a bacteria becomes resistant to antibiotics, something about that bacteria has changed. And antibiotics work, they’re chemicals, and so they fit into specific places and they either slow the growth of a bacteria or they stop that bacteria from reproducing. And that’s how antibiotics work. When a bacteria becomes resistant to that antibiotic something has changed and that chemical fit doesn’t work anymore and so basically the bacteria doesn’t respond the same way that it used to. (Dan) Gotcha, so you know, I’m sure there’s different ways that acquiring antibiotic resistance and different populations of bacteria out there that are just naturally resistant to different drugs. But what are some of our more common issues, or would you say, some of our more common problems with food animal antibiotic resistance or food-borne pathogens? (Brian) Sure. And there are kind of two issues and I think we’ll probably get into programs later, surveillance programs later, but you know, we talk about food-borne pathogens and resistance. Really probably the two biggest bacteria of concern would be camphylobacter and salmonella. If those bacteria become resistant, we see them go through the food chain and it’s still rare, but they can cause problems in humans. And the drugs for those that we would be worried about would be the third generation cephalosporins and our sister drug in animal health would Excenel or EXCEDE. (Dan) Right. (Brian) And then the fluoroquinolones and our sister drugs there would be Baytril or Danofloxacin, Avelox. Yep. (Dan) Yep. So I think it’s important for people to understand that we have these drugs labeled for specific cattle, specific animals, it’s not just cattle. And the impact that we have not only on the target pathogens that we’re treating for, we can also have some impact on food-borne pathogens. And that’s why it’s really important for them to work with their veterinarian. (Brian) Yea, and you’d asked on the animal health side, what we’re seeing here at Kansas State are some concerning trends with bacteria that cause Bovine Respiratory Disease. So Mannheimia haemolytica, pasteurella multocida, histophilus somni. We’re starting to see some increases in resistance with Mannheim specifically, not just to one drug but many drugs at the same time. So, one bacteria one Mannheim haemolytica from one animal case, can be resistant to six different classes of antibiotics. (Dan) Well, folks, we’re gonna take a break. It’s gonna be a great show. We’re glad Dr. Brian Lubbers is here. More after these messages.

(Dan) Hey folks, welcome back to DocTalk. Dr. Dan Thomson and Dr. Brian Lubbers, we’re from the College of Veterinary Medicine at Kansas State University, where Dr. Lubbers is a Clinical Pharmacologist. You’re over our Bacteriology Section. (Brian) That’s correct. (Dan) That’s the Veterinary Diagnostic Lab. So, Dr. Lubbers is seeing a lot of cases from all across the country when it comes to antibiotic resistance and bacteria and antibiotics susceptibility in bacteria to help veterinarians and producers get the right drug from the right bug, or the wrong bug, as we’re moving forward with our case load. And as we left we were talking about multi-drug resistance. And let’s talk a little bit about some of that and what you’re doing. (Brian) Sure. Really in the diagnostic lab our primary function is to help veterinarians and their clients, like you said, choose the right…for bacteriology, choose the right drug for that specific bacteria that they have going on in their herd or that situation. And we do that through a series of lab tests. We can test that bacteria against the panel of antibiotics and then help veterinarians choose the right one. And you had mentioned judicious use, and that’s a big part of judicious use of antimicrobials is, if we have an antibiotic that isn’t working, it’s not going to help, can promote resistance in those other pathogens, the other ones we’re not trying to get like the E. coli’s, the salmonellas, the campylobacter. But help them pick the ones for that BRD pathogen that’s really gonna give them the best shot of working. So, that’s our primary job. But the other thing that we do really on a daily to yearly basis, is we take all the results from those individual tests, and then we pool them together and we summarize them so that people have an idea even though I may not have a case right now, I want to know over the past year, what are the drugs that have generally been working against say the BRD pathogens? What are the things that aren’t working? And we take all those individual results and we pool them so that everybody gets the benefit. And that’s our version of surveillance, Dan. We take that and once we have…we’ve been doing that… we’ve actually just finished an 11-year summary of BRD pathogens. And what it does initially it gives us a baseline, so we know in year one our levels of resistance are 10 percent. And what we feel like that does is really, if we do it every year it gives us a real time feel for are we seeing big changes? And we are, like I said. We’re seeing those. So, it’s two steps to surveillance, establish a baseline and then after that use that baseline to help you detect kind of an early warning. (Dan) And I think that’s one of the reasons why it’s important that producers and veterinarians submit cases to the Diagnostic Lab, so that we have a good library and a good snapshot of what’s really going on. My Dad used to tell me it was easier to sell a vaccine for a few thousand dollars, than it was to sell a diagnosis for a few dollars. (Brian) Right. (Dan) And so you know, to say oh I’m just going to start using this vaccine or switch to this drug, without due diligence and getting that diagnosis and using the expertise that you have, to help us be more zeroed in and more laser focused. (Brian) Yea, and you know, the more samples we get that represent a broad base, the more applicable those results are to everybody at the end of the day. (Dan) Absolutely. I think that when we take a look at diagnosis…how many cases do you see on these? (Brian) Cases? The last few years of our surveillance, we’re getting about 300 Mannheim haemolytica islets a year. So, that doesn’t represent all the cases, it’s a smaller percentage. But we see several hundred to a thousand BRD cases a year. (Dan) That’s absolutely amazing. Well folks, we’re gonna take a break. When we do, we’re going to come back more with Dr. Brian Lubbers. You’re watching DocTalk and we’re sure glad you joined us.

(Dan) Folks, welcome back to DocTalk. Dr. Dan Thomson here with Dr. Brian Lubbers, where we work at Kansas State University’s College of Veterinary Medicine. And Dr. Lubbers is one of our top Bacteriology Section at the Veterinary Diagnostic Lab and he also works a lot with antibiotic resistance because he is a Clinical Pharmacologist which, in academia there aren’t very many of ’em. (Brian) Fifty-three. (Dan) Fifty-three total in the United States. And we’re very glad you could take time to be on the show; very thankful for what you’re doing for our state and for our industry. Let’s jump into some food-borne pathogen surveillance. And the reason why we want to is because there’s some pretty good news that could be told. (Brian) Sure. And really when you talk about those programs, really the one that we’ve had in the United States for a long time is called NARMS, the National Antimicrobials Resistance Monitoring System. And that program’s job, it really is focused on public health. So, their primary interest is monitoring bacteria and resistance that’s of concern in humans. But part of that is monitoring resistance in food borne pathogens. You know we had mentioned E coli earlier, salmonella earlier, campylobacter earlier. All of those bacteria are part of that NARMS program. And so every year they collect samples that come from sick people, they collect samples from meat products, and then they collect samples at the animal level too, not usually from individuals but from pen fecal samples, for example. And they take that data and they look at what are the percentage of those islets collected at each of those points that are resistant to their antibiotic panel. And again, that antibiotic panel is generally focused on the antibiotics that they use in human medicine. But there is significant overlap. A lot of the drugs that the antibiotics we use in veterinary medicine, they may not be the exact same, but they’re certainly sister drugs to those drugs. The idea is is that if we’re using those drugs in animal health, how does that contribute to the overall resistance problem in humans? (Dan) And when we start to think about resistance from antibiotic use in animals going to humans, the food borne pathogen is probably the highest priority as far as that transmission. (Brian) Yea, it’s pretty complex and there’s a lot of research going right now about how does resistance transfer through the environmental route. So, manure is collected on the farm that’s been exposed to antibiotics. If that gets into the water, is spread onto a field, how does that get into the food chain? But certainly the most direct route would be through the meat products themselves. (Dan) And we’ve had some pretty good news from farms. (Brian) Yea, everybody can access the NARMS report actually and if you go on there, for the most part, a lot of our drug resistance and specifically in meat products and the antibiotics that we use in animals health, it’s stable or going down. Now there are some bacteria that we’ve got some concerning trends that we need to watch, but it’s a lot of part of the good news. (Dan) Great. Well, we’re gonna take a break. Folks if you’re watching the show thanks for joining us. Also, for you out there, the producers, beef producers and veterinarians, thanks for the job that you’re doing, for having us have a safe and wholesome beef supply everyday. We’re gonna take a break. More after these messages.

(Dan) Folks, welcome back to DocTalk. We have a great show today. Hope that you’re enjoying it. We’re talking about antibiotic resistance and the good news that we’ve seen from decreased antibiotic resistance in our food borne pathogens thanks to judicious drug use, veterinarians and producers working together on a day-to-day basis to continually kind of rein in drug use to what’s appropriate. But you have a program going on over in Olathe, at our Olathe campus, that’s pretty exciting as well. (Brian) Sure. And what we did, again, we’re seeing some concerning trends of increasing resistance in the Bovine Respiratory Disease pathogens here. Now those samples are all taken from animals that were affected with respiratory disease, probably have been treated with antibiotics. Maybe died of respiratory disease. So, one of our questions was-is that representative of what’s happening with the healthy animals, the healthy population? And so working with Merck Animal Health, we actually started a new lab section that is specifically designed to monitor bacterial antibiotic resistance in the healthy populations of U.S. cattle. (Dan) Wow. So, how far along, how long have you been doing this? How do we get samples to you? Things to that nature. (Brian) We’ve had this program going for about a year and a half now. It’s a little bit early to make any definitive conclusions, but as far as getting samples to us, all of this is going through Merck Animal Health Technical Services, so if you’re a veterinarian contact your Merck Animal Health Technical Service. They are running part of the logistics, so we don’t want too many samples from one place, but we are trying to represent cow/calf, feedlot and dairy from all across the United States. We want a nice representative sample. (Dan) So then you get the samples, the respiratory disease samples, different size of cattle, different production systems, different geographical locations, and then you can start to zero in on antibiotic resistance within those different populations and geographical locations. (Brian) Yep. That’s absolutely right. (Dan) That’s a tremendous tool. And then will that be coming out in the publication, will Merck be sharing that then, bringing it forward? (Brian) Yep. (Dan) How are people gonna get access to that? (Brian) That’s our eventual goal is to make that public, to make a publication out of it really is what we’re trying to do. The goal, again with two points of surveillance established baseline and then the continuous monitoring allows us to detect those early warning signals. Right now we’re certainly in the baseline level of this program, so we want to know what does resistance look like out there? After that we hope that the program will continue and then if we see disturbing trends, increases, we’ll be able to pick that up early and then go back and kind of trace back what are the risk factors or what are the events that contribute to those? (Dan) Well thanks for being on the show today. (Brian) You’re welcome. Thank you. (Dan) And thanks for what you’re doing. (Brian) Thank you. (Dan) It’s a big job. Dr. Brian Lubbers at the Veterinary Diagnostic Laboratory at Kansas State University that he’s doing for our industry, he’s doing for One Health and we commend him for his service. Thank you for watching DocTalk. Remember always work with your local veterinarian. And if you want to know what Dr. Lubbers and I do here at Kansas State, you can find us on the web at www.vet.ksu.edu. I’m Dr. Dan Thomson, you’ve been watching DocTalk. We appreciate it. And I’ll see you down the road.

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