Table 1.
Knowledge gaps that hamper prevention and control of antimicrobial resistance in Canada.
| Area | Knowledge gap |
|---|---|
| Treatment optimization | - Extent of antimicrobial misuse in Canada - BMPsa regarding antimicrobial prescribing in human/animal medicine - Economics of various efforts in lieu of AMUb - Socio-economic/behavioral drivers of AMU (prescriber and patient perspectives) - Efficacy of widespread adoption of alternative therapies to AMU - Understand and shift perspectives that identify AMU is a harmless “cure all” - Identifying barriers and enablers of optimal human/animal AMU - BMPs to reduce livestock-associated prophylactic AMU - Rapid diagnostic testing to assist AMU decision-making |
| Surveillance | - Up-to-date prevalence estimates of AMRc in the community, domestic animals, wildlife, production animals and the environment, not included in ongoing Canadian surveillance - Overall trends of AMR bacteria and their emergence in Canada - BMPs for integration of AMU/AMR data collection and reporting |
| Prevention of transmission of AMR | - Long-term efficacy of AMR mitigation efforts - BMPs for prevention of hospital-acquired AMR infectons - BMPs for reducing AMR in wastewater and subsequent impacts on human/animal health - How to reduce AMR prevalence in various resistance reservoirs - How to limit the risk of AMR in food systems - How to prevent cross-species AMR transmission - Quantitative risks associated with various incursion pathiways of AMR transmission Development of AMR - The direct relationship between AMU and AMR development - Role of the microbiome - Impact of heavy metals, cleaning agents and biocides, and other xenobiotic compounds on AMR development - How AMU in one health sector directly impacts AMR development in another sector (i.e., human AMU and animal AMR, and the reverse) - Relative importance of various routes of antimicrobial administration in AMR development - How to employ policy to effective limit AMR development Role of the Environment - Impact of human AMU/AMR on the environment - Impact of AMU/AMR in livestock industries on the environment - Relative importance of various environmental transmission routes (including transmission through ground water and livestock derived manure spreading, etc.) - Impact of antimicrobial residues in soil, water, and pastures - Economic impacts of reducing environmental AMR reservoirs and antimicrobial residues Role of Wildlife - Impact of AMR on wildlife health - Role of wildlife in transmission of AMR - Economic benefits of reducing AMR transmission from wildlife to livestock or humans |
a
BMPs, Best management practices.
b
AMU, Antimicrobial use.
c
AMR, Antimicrobial resistance.