Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Antimicrobial Resistance Across Species
Join us as Dr. Neil Vezeau breaks down complex antimicrobial resistance (AMR) dynamics in both domestic animals and wildlife, explaining how pets, livestock, migratory waterfowl, and even urban animals like crows and rats contribute to the spread of resistant bacteria. The episode sheds light on the intricate interplay of these species in urban environments, urging the need for continuous research and strategic resource allocation to combat AMR effectively. Neil advises veterinarians to adhere to clinical guidelines while encouraging the public to appreciate the complexities of AMR. Don't miss this deep dive into the multifaceted world of AMR and its far-reaching implications.
JAVMA article: https://doi.org/10.2460/javma.24.02.0123
AJVR article: https://doi.org/10.2460/ajvr.24.02.0040
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Speaker 2:You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode, we chat about wildlife and antimicrobial resistance with our guest, Neil Vizzo.
Speaker 3:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today we have Neil joining us from Hawaii. Neil, thank you so much for taking time out of your very busy day to be here with us today.
Speaker 4:Thanks for having me.
Speaker 2:All right, let's dive right in, neil, your current Someone Health. Jadma and AJBR articles discuss wildlife and antimicrobial resistance. Please share with our listeners the background on these articles.
Speaker 4:Yeah. So antimicrobial resistance is, of course, a pretty hot topic that I'm sure most people listening here are familiar with. The basic thesis is that antimicrobial resistance is ancient and everywhere. As it's been described Basically, it's an evolutionary mechanism that's advantageous for a large variety of microbes to have. So you'll find it with or without the presence of human or anthropogenic use of antimicrobials, and that extends to us domestic animals as well as wildlife and the environment surrounding all of us as well, which is actually a really important transmission pathway of AMR. So because of that, basically anywhere we look we'll start to find it, and our kind of surveillance programs or going out and trying to find AMR different places has been expanding little by little, especially in the past two decades. So our understanding of where Xactate is and what quantity and what the character of it is like, what the resistance is, what the bacteria is, has been growing significantly, particularly in the past 10 to 20 years, and that includes, of course, in these different wildlife species that we can further get into as our hosts want.
Speaker 2:Your articles are super informative and we definitely appreciate you sharing them, too, with our journals. So now we're going to get more into the nuances of the articles. So what are some of the take-home messages from the JABMA article?
Speaker 4:the take-home messages from the JABMA article. Yeah, so for the JABMA article, basically we outline kind of different ways and that's we being Dr Conner and myself who is the co-author we outline domestic animal populations, divided into both companion animal or sort of more urban populations as well as livestock and more rural populations can both be conveyors as well as also recipients and sources of AMR, and that's both for use of antimicrobials as well as conveying bacteria as well as, in some cases, conveying naked genes. So that's something that you more find investigated in environmental contexts. That's sort of the basic synopsis of that article at least, and though there's no like really hard and fast clinical guidelines that we've developed from sort of this investigation that we can get maybe a bit more into that later on.
Speaker 2:Basically just the status quo of prudent use, of judicious use, kind of remains the same and what are some important take-home messages from the AJVR article?
Speaker 4:Yeah, so that kind of breaks down most of the main animal populations that are of highest relevance, I guess, to humans that are not companion animals or not domestic animal stock, that we do know that we have identified AMR to be in, and so one of the biggest ones among those actually are migratory waterfowl.
Speaker 4:So in humans, particularly in the context of like emerging viral pathogens, airplanes are typically held to be like this big intercontinental source of like conveyance and you get a variety of waterfowl that go from on a yearly basis like Europe to South America and that can be, that can connect very disparately isolated populations of people, animals, wildlife, domestic animals, that sort of stuff. Secondarily to that, or perhaps I guess, one thing I should also emphasize is that the bacteria and the resistances are being characterized. The amount of contact points, that's still a bit more of an emerging area. So the amount of the exact level of risk that's posed to different populations is still very much an emerging area of research. So anything I say here is based on not like the hugest body of evidence, at least at this point though it is.
Speaker 4:You know we do have for any given thing, maybe like five to 10 papers that at least tangentially address what it's talking about, at least tangentially address what it's talking about. Then you also have more urban populations like crows, rats, that can go around and carry sort of what you might call filth, which is probably one of the biggest ways of at least investigating where AMR is. You're just taking fecal samples and then you can also do that with wildlife populations as well. In wildlife populations, in those urban settings especially, there seems to be really complex interplay where the rises in antimicrobial resistance that we're seeing are not fully correlated with human use of antimicrobials, and that's in both human and veterinary medicine. So there's kind of this complex dynamic that's been investigated in those settings, but that again is a more emerging area of research.
Speaker 3:Yeah, I like what you said about there's not a huge amount of resources or investigation right now, but your articles are really thought-provoking and I think, are excellent examples of One Health. I think your articles did a fantastic job of showing not just how small the world is, but how the One Health concept of the intersection between human, animal health and the environment. So I just can't thank you and your author, co-author enough to bring this to Jabma and AJVR.
Speaker 4:Yeah, absolutely and specifically resources and allocating resources to investigation is such an important point. There was a kind of panel type session I was at or kind of a workshop I was at actually in the Netherlands last October and there was a very, very intelligent veterinary scientist from Germany who actually works on this very specifically and he was making the point that, you know, among all the other considerations, that we have AMR, we have COVID in deer, we have all these important things we need to find out, and the problem of cutting the cake typically is going to allocate very little to specifically wildlife AMR, allocate very little to specifically wildlife AMR.
Speaker 4:So indeed, much of the publication, much of the knowledge we have on this is purely academic at this point and it's probably going to stay that way for some time, though again, we do have those like with COVID and whitetail deer, that has spurred on quite a large amount of government programming to investigate emerging viral pathogens in wildlife populations, and this is far, far easier said than done. But one potential that exists is to kind of append AMR investigations onto those viral ones. But again, that would be an entirely other discussion.
Speaker 3:Do you think that the lack of investigations into wildlife, also our lack of understanding on how the environment, is involved in AMR? I ask that, neil, because you said earlier there's not a strong correlation between human AMR and filth carriers, rats and others. So is that this? Am I being naive in thinking those in the environment is more linked to wildlife than it would be the environment to domesticated animals?
Speaker 4:Yeah, so basically our knowledge on routes of conveyance and let me know if I'm not totally addressing what you're getting at with this Our knowledge on all those interface points and routes of conveyance, especially on like a really large population scale, is still a pretty emerging area of understanding, starting to have and this is when you use like very broad methods of correlation that, uh, that necessarily need to lose a lot of like granularity.
Speaker 4:Um, we are finding that um, amr and like livestock is most correlated not with human use but with livestock use, and human AMR is most correlated with human use. So you do see kind of these segregations that exist, that are becoming more and more evidenced, and so that potentially allays some of the previous fears about these large amounts of spillover. Of course we still do have those interconnections, those are still relevant, but just the magnitude of them is maybe not what we first thought it was. So again, that could very well be sort of overturned, I guess, with future investigations. But that's sort of just where we're at right now. And this is kind of the same deal where it's going to be very difficult to characterize at that broad level all those points of interface, all those routes of conveyance and those environmental components basically, and how those affect the spillover of AMR, or rather the spread of AMR between those different populations.
Speaker 3:What sparked your research interest in AMR?
Speaker 4:I think just what first brought me in was the large variety of kind of society that goes into determining sort of the goings-on of AMR.
Speaker 4:I mean, there's a lot of microbiology to it, there's a lot of politics to it and policy to it, and then, of course, there's a lot of clinical science to it as well, and you just have to consider all of these things not in isolation, which can be like really tough sometimes to juggle all of those different cognitive loads at once, which is basically you need like at least five people, um, to say, or at least five experts to say like anything like really broad and sweeping about amr, each with like their different distinct expertise, um, but just that multifaceted um, part of it is what got me into amr and that would have been, I mean, this amr was the topic of, like, my undergrad thesis back in like 2016, so, um, it's been something that's been of interest for quite some time at least in terms of in the, in the terms of my life thus far there, there will be many more decades, hopefully, to come hopefully many, many more articles to Jabman AJVR too.
Speaker 4:Hopefully, yeah. That's the plan at least.
Speaker 3:You spoke with Sarah earlier about one of the most salient findings of these articles, but always when we write these things, something is surprising. I mean, I know they're basically review articles, but you still things spark curious minds like yours. What things came to mind surprising things, from these writing these two articles?
Speaker 2:That's a good question.
Speaker 4:I think, just there there's a lot of different species of, there's just so many species out there, there, there there's just such a such a massive volume of biological diversity on the earth, and even non-living factors play such a hugely salient role in the health of um, seemingly disparate populations, seemingly disconnected populations and at this, like understanding at a deeper level, the, the magnitude to which that is the case, is what was the real kind of like mind blow from this whole thing?
Speaker 2:I really loved all the graphics too and your manuscripts. I think they're really helpful for the reader to just kind of visualize the impact, especially the diverse species too that are affected.
Speaker 4:So yeah, yeah, like I, I never would have thought that, um, and some of the categorizations are based on, like, what's like for some of this stuff there was. There just happened to be a lab out of, uh, I believe, the university of Guelph that did a lot of work on like mesocarnivores, um, so like mid-sized carnivores basically, um, and that's why that presents as like a like kind of a singular category and a lot of this is, like a lot of these investigations are done or sort of like assigned a speculative importance due to their perceived like amount of contact with human populations. So that's why there's so much focus on what you call like parodomestic animals, like rats, which have lived alongside humans as pets and you know otherwise for like thousands of years, and and crows and all these different populations that will readily feed on human thrash and refuse and all that sort of stuff. But, yeah, these categorizations of these different species is a bit along those lines, due to those factors previously described.
Speaker 2:Yeah, that's fascinating. Thank you for sharing described. Yeah, that's fascinating. Thank you for sharing. And for those of you just joining us, we're discussing wildlife and antimicrobial resistance with our guest, Neil Vazow. So, Neil, how did your training prepare you to write this manuscript?
Speaker 4:That's a great question.
Speaker 4:So in undergrad I was able to get a little bit more of the kind of political and microbiological dimensions of things because I was studying microbiology in undergrad so it helped a lot of like the actual cellular mechanisms that dictate how this all works.
Speaker 4:For veterinary training, that was, of course, the clinical perspective and a lot of how you know basically antimicrobials are assigned importance, which are most commonly used, what you use for different cases and how often those clinical presentations are that you would actually, you know, empirically use certain antimicrobials for and then all kind of, I guess, balled up to form this sort of thing. But honestly, anytime I go and do a review like this, that's like the main learning experience almost, just because you're going and finding a lot of different literature and seeing what the sort of state of the field is and some of the most, I think, relevant learning experiences. There's a lot of back and knowledge it takes to go into all that sort of, to go into this, but kind of the main show as far as actually learning what's happening as a person, as an author, is actually just going out and doing it, going out and writing it and then hoping that can be of some use to the you know boots on the ground.
Speaker 2:Definitely, it's always our goal with any of our manuscripts that we are considering is is going to have a big clinical impact.
Speaker 4:Absolutely, absolutely.
Speaker 2:So this next set of questions is going to be really important for our listeners. The first one is regarding the veterinarian's point of view. So what is one piece of information the veterinarian should know about wildlife and antimicrobial resistance?
Speaker 4:So the main take home is just follow the clinical guidelines as they're presented to you by the main experts right now. We are always trying to find out if there's more relevant factors to take into consideration. I've talked to a variety of colleagues to see if anyone is sort of developing guides on this sort of thing right now. It doesn't seem like that's the case at this point, or at least it won't be for some time until we get the political willpower, the money, the interest otherwise to put together some kind of blue ribbon panel of experts to develop guidance for veterinary medicine, for veterinarians regarding wildlife, animal. So, as it stands, follow the clinical guidelines as they're given to you by the experts on those topics.
Speaker 2:And then on the other side of the relationship, what's one thing the public should consider around wildlife and antimicrobial resistance public should consider around wildlife and antimicrobial resistance Just as one more way.
Speaker 4:Well, first of all, I think the public. It would be great if they sort of had an understanding of what antimicrobial resistance writ large is. I was actually at a public health conference some years back and someone who was maybe on the more kind of infrastructural side of public health was like, oh, that's when people become resistant to the drugs, right, and that's, you know, of course, not the case. It's a very complex topic that even to get kind of those basics down takes potentially years of study. So, just honestly, having an understanding of what AMR is and that it's very multifaceted would be great and hopefully we can spur some level of more public engagements with the upcoming United Nations General Assembly's high-level meeting or UNGA-HLM as it's characterized or shortened to on AMR. That's going to be this September in New York City and that's going to hopefully spur a lot of political action and, with that kind of trickle down to or maybe, you know, connect with grassroots efforts from other civil society organizations that aren't necessarily representative of clinical or technical populations.
Speaker 3:Yeah, when you said earlier about the emergence of COVID and other diseases, and now you know bird flu into cows and that sort of thing, I think it's very difficult for public policymakers, for the public in general, to grasp the importance of AMR.
Speaker 4:Yeah, how it works kind of at a political level and how you merge that political ability to kind of like be a mover and shaker with that technical expertise is something that I'm still trying to better understand. Probably one of the most salient examples of that is the global leaders, the, the I'm not sure exactly who has it, essentially the one health quadripartite, if you're familiar with them, uh, their global leaders group on amr, and that's a bunch of like heads of state, I think maybe some ministers of health, and then people like, uh scott weiss, who's like a extremely prominent uh amr researcher in in canada at the university of guelph. Uh, so just having a combination of people like that is is, I guess, one of the best ways to do it and it's kind of just one health in general and AMR as a very one health issue is no different.
Speaker 3:Yeah, that's a very, very fair assessment. As we wind down, neil, we'd like to ask just a little bit more of a personal question, and Sarah and I kind of try to guess, based on people's credentials, where they fall into, because I think we've identified three big buckets, but we'll see, maybe you'll establish a fourth. When you begin a puzzle, do you start with the inside or the exterior border pieces?
Speaker 4:Let me know if this is the answer that you weren't expecting, but I do start with the outside.
Speaker 3:No surprise.
Speaker 4:So every year at Christmas my sister and I, and potentially some other people, do a puzzle, and maybe it's me more just following her lead. But we start with the outside just to put that kind of framework in place and kind of build in.
Speaker 3:I had you for a I don't know why, but I had you for a color thematic person Like, oh, here's like a starburst over here and then building out from there.
Speaker 4:I think my mind is drawn to that the most. But I sort of just to sort of get things started, I realized that the most effective way to lay it all out is to get that outside border done first, and then I can sort of start working in that manner does your sister know you follow her lead I think I still have yet to tell her, but uh, I can actually text her right after this and let her know send her.
Speaker 3:Send her a link to the podcast when it yeah, it will do you're right, sis.
Speaker 4:Yeah, yeah, exactly, she's the right one.
Speaker 2:I had you pegged for an interior piece person, so I was also surprised by your answer.
Speaker 4:Absolutely absolutely.
Speaker 2:Awesome. So thank you so much, Neil. We really appreciate you being here with us today and for sharing your manuscripts, too, with our journals.
Speaker 4:Absolutely. Thank you guys for having me Appreciate it.
Speaker 2:And to our listeners. You can read Neil's articles and print Javma or online in AJVR using your favorite search engine. I'm Sarah Wright with Lisa48. We want to thank each of you for joining us on this episode of the Veterinary Vertex podcast. We love sharing cutting edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
