CDC Issues Report on Antibiotic-Resistant Infections

CDC released their report on antibiotic resistant infections, and it "shows that there were nearly twice as many annual deaths from antibiotic-resistant infections as CDC originally reported in 2013. Since then, the new report shows, prevention efforts have reduced deaths from antibiotic-resistant infections by 18 percent overall and by nearly 30 percent in hospitals."

While there always seems to be a lot of attention on food, and not that improvements can be made there, the majority of the issues are in hospitals.  On the positive side, the number of deaths are decreasing, however, "resistance to essential antibiotics is increasing in seven of the 18 germs."

CDC News Release
https://www.cdc.gov/media/releases/2019/p1113-antibiotic-resistant.html?deliveryName=USCDC_1_3-DM13391
More People in the United States Dying from Antibiotic-Resistant Infections than Previously Estimated
Significant progress since 2013 could be lost without more action

Dairy Calves Linked to Outbreak of Antibiotic Resistant Strain of Salmonella

CDC has identified an ongoing Salmonella outbreak associated with dairy calves.  The calves originated in Wisconsin.  The ongoing outbreak has progressed for some time, dating back to January 2015, with now 54 people in 15 states.  It is a multidrug resistant strain of Salmonella Heidelberg.

Dairy Herd Management
https://www.dairyherd.com/index.php/article/cdc-links-salmonella-outbreak-contact-dairy-calves
CDC Links Salmonella Outbreak to Contact with Dairy Calves
John Maday
November 16, 2017 10:18 AM

FDA Report on Antibiotic Resistance of Bacterial Pathogens Indicates Improvement

The FDA released its 2014 National Antimicrobial Resistance Monitoring System (NARMS) report, which looks at antimicrobial resistance patterns in bacteria isolated from humans, retail meats, and animals at slaughter. Overall, the news is good, in that there have been decreases in bacterial pathogens with antibiotic resistance, or in other cases, the data has been steady, especially with regard to the medically important antibiotic types.

From the report:

• The prevalence of Salmonella in both retail chicken meat (9.1 percent) and retail ground turkey (5.5 percent) was at its lowest level since retail meat testing began in 2002. The prevalence of Campylobacter in retail chicken meat samples has gradually declined over time to 33 percent, the lowest level since testing began.
• Approximately 80 percent of human Salmonella isolates are not resistant to any of the tested antibiotics. This has remained relatively stable over the past ten years. Resistance for three critically-important drugs (ceftriaxone, azithromycin, and ciprofloxacin) in human non-typhoidal Salmonella isolates remained below 3 percent.
• Ceftriaxone, a third generation antibiotic used to treat infections where there is resistance to other antibiotics, has seen a continued decline in  resistance in non-typhoidal Salmonella with the exception of retail turkey meat isolates, where it rose slightly. In cattle, Salmonella isolates from carcasses collected at processing plants, ceftriaxone resistance reached its lowest level (7.6 percent) since 1999. In 2014, ceftriaxone resistance in human Salmonella Heidelberg isolates was 8.5 percent, down from a peak of 24 percent in 2010.   (But there have been some decreases in susceptibility in cattle and increases in resistance by strains of Campylobacter jejuni.)

FDA News Release
http://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm529719.htm
FDA Releases 2014 NARMS Integrated Report; Finds Measurable Improvements in Antimicrobial Resistance Levels

November 18, 2016

Improving Knowledge of Antibiotic Resistance - What You Should Know

This month's Food Protection Trends has an article by a group of experts on the topic of antibiotic resistance and the impact on human and animal health.  The goal was to provide knowledge to professionals in an way to counter the many misstatements being made in the news media by uninformed 'professionals.'

First, there are four main themes that should highlight communications:

Antibiotic Resistant E. coli Superbug Found in US

A strain of E. coli with resistance to the antibiotic Colistin, considered the last-line defense against antibiotic-resistant bacteria, was found in a Pennsylvania woman.  This is the first case here in the US.  It was found when she was being treated for a urinary tract infection.

This superbug had been earlier found in China in a few people , in pigs, and pig meat, and then a little later in Europe.

Washington Post
https://www.washingtonpost.com/news/to-your-health/wp/2016/05/26/the-superbug-that-doctors-have-been-dreading-just-reached-the-u-s/
The superbug that doctors have been dreading just reached the U.S.

For the first time, researchers have found a person in the United States carrying bacteria resistant to antibiotics of last resort, an alarming development that the top U.S. public health official says could mean "the end of the road" for antibiotics.

Report on Antimicrobial Resistance in Salmonella and Campylobacter

The FDA released its 2012-2013 National Antimicrobial Resistance Monitoring System (NARMS) Integrated Report.  The results are mostly encouraging.  From the report:

1. About 80% of human Salmonella isolates are not resistant to any of the tested antibiotics.
2.  Salmonella multi-drug resistance (resistance to three or more classes of antibiotics) in human, cattle, and chicken isolates has not changed (~10%) in the last decade, and the numbers of multi-drug resistant Salmonella isolates in retail chicken have gone down (~3%).   
3. But two types of Salmonella do show some increases.  Multidrug resistance (MDR) in human isolates of a common Salmonella serotype (l 4,[5],12:i:-) continues to rise. Resistance has more than doubled from 18% in 2011 to 46% in 2013.  And anincrease in MDR and ceftriaxone resistance was also observed in Salmonella serotype Dublin isolated from cattle and human sources.
4. Campylobacter jejuni resistance to the fluoroquinolone ciprofloxacin, the most common antibiotic used to treat human C. jejuni illness, was at its lowest level in retail chicken to date (11%).

 FDA News Release

http://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm457825.htm

FDA Releases 2012 and 2013 NARMS Integrated Annual Report; Finds Some Improvement in Antibiotic Resistance Trends in Recent Years

August 11, 2015

The U.S. Food and Drug Administration has released its 2012-2013 National Antimicrobial Resistance Monitoring System (NARMS) Integrated Report. This report replaces FDA’s annual NARMS Executive Summary report and highlights antimicrobial resistance patterns in bacteria isolated from humans, retail meats, and animals at slaughter. Specifically, the report focuses on major foodborne pathogens that are resistant to antibiotics that are considered important to human medicine, and on multidrug resistant pathogens (described as resistant to three or more classes of antibiotics).

Superbugs, Antibiotic Resistance, and Foster Farms Chickens

The term “Superbug”, a label coined by the US media, refers to those bacteria that cause serious disease in humans. Infections from these pathogens are difficult to treat in that those organisms have resistance to a number of commonly used antibiotics (multi-antibiotic resistance). Every time the discussion of superbugs comes up, people immediately identify food as the/a major issue. Primarily they identify meat and poultry as a source in the development and dissemination of superbugs. While there are antibiotic resistant bacteria associated with meat and poultry, the following facts should help clarify some of the myths associated with multi-drug resistant pathogens.

  

• According to the CDC, the most important source of antibiotic resistant organisms is in hospitals. Along with this, is the over prescribing of antibiotics to people by doctors.
• The use of antibiotics in animals is regulated - the administration of those drugs if limited to prevention and control of illness in the herd or flock, and that administration provides sufficient time so that there are no residues in the meat at the time of slaughter. The use of antibiotics for growth is not permitted.
• The classes of antibiotics used in animals are generally different than those used in people.
• Having antibiotic resistance does not necessarily mean an organism is a superbug - many organisms can have resistance to antibiotics and not cause illness, or in other cases, pathogens can have resistance to antibiotics that are not normally used to treat human illness.
• Many bacteria have naturally occurring antibiotic resistance, so to have raw meat or poultry with no antibiotic resistance microorganisms is impossible.
• If people properly handle and prepare / cook meat, they will eliminate all potential pathogens that may be present. Antibiotic resistance does not give organisms the ability to survive proper cooking or cleaning.

Now this is not to say that people can’t get ill from multi-antibiotic resistant pathogens. There has been the ongoing case of Foster Farms chicken in California that had been a source of severe illness. Some product was recalled – that was product that was cooked at a Costco store and then most likely mishandled leading to cross contamination. Foster Farms, the producer of the chicken, has what appears to be an on-going issue with consumers getting ill from the raw chicken parts that are purchased by consumers through retail stores. While USDA has worked with the facility to put in an action plan, it did not force the company to issue a recall.   

  

Much of the debate is whether Salmonella should be considered an adulterant. To this point in time, it is not considered an adulterant provided the company has safe handling instructions labeled on the product, and the company is following standard accepted practices. But will consumers properly handle and cook poultry?

  

There is a push to make those multi-antibiotic resistant strains of Salmonella an adulterant, but this is a slippery slope. Not all multi-antibiotic strains are responsible for making people ill. In fact, the Salmonella strain in the Foster Farms case have antibiotic resistance to antibiotics that are rarely used to treat people for salmonellosis. So what can the science support? What is practical, considering that Salmonella has been associated with birds much longer than modern man has been around?