1. 1 It is not difficult to make microbes resistant to penicillin in the laboratory, and the same has occasionally happened in the body. The End of Modern Medicine? Alexander Fleming, 1945 Nobel Prize Acceptance Speech

2. 2 Antimicrobial resistance HUMANS Hospital Care facilities Urban areas Rural areas Vegetables, seed crops, fruits & vegetables Irrigation water Soil WILDLIFE Sewage AQUACULTURE Seas & lakes Swim Drinking water Rivers & streams Handling, preparation, consumption Meat & fish Commercial abattoirs & processing plants COMPANION ANIMALS Animal feeds Direct contact Drinking water Farm effluents & manure spreading Offal Rendering Dead stock FOOD ANIMALS Swine Cattle Sheep PoultryOthers Industrial & household antimicrobial chemicals Antibiotics Food processing antimicrobials Epidemiology of AMR Diagram based on Linton (1977), as adapted by Rebecca Irwin, Health Canada (Prescott 2000) and IFT

3. 3 Economic costs Antimicrobial resistance Map and statistics from World Economic Forum “Global Risks 2013” except UK statistics, which are based on work published by Richard Smith of LSHTM Europe – cost of AMR €1.5bn and 600m lost days of productivity per year UK – cost of AMR £10bn/yr societal costs plus £20k per patient episode USA – cost of AMR Healthcare costs alone $21-34bn/yr Japan and Antarctica Resistant bacteria found in water samples Russia 83% of families use unnecessary antibiotics at home

4. 4 THE GLOBAL PICTURE Antimicrobial resistance

5. 5 Can we make a difference? Antimicrobial resistance

6. 6 Public information and education Antimicrobial resistance http://bit.ly/CMOatTEDxhttp://bit.ly/CMObook