[Market Watch] Antimicrobial Resistance Issues Spur Industry Initiatives

Antimicrobial resistance in its many forms is, and has been, the subject of much controversy, discussion and research for a number of years. Whether revolving around direct drug resistance in humans or the impact on humans of those used on animals designated for food, many of the arguments on both sides of the issue are based on the same fundamental questions: At what point do the risks of antimicrobials outweigh the benefits? Who makes those decisions? Who enforces them? How?

Because it is a current hot issue, these and other questions are being asked by consumers and industry alike, with discussion, best practices and “answers” being sought and offered in ongoing research, association initiatives, programs and events. Some of the recent and upcoming include:

Joint CDC, FDA, NIH Public Meeting, June 27, 2007.

The purpose of the meeting is to present the annual report of progress by federal agencies in accomplishing activities outlined in “A Public Health Action Plan to Combat Antimicrobial Resistance (Part I: Domestic Issues)” and solicit comments from the public regarding the annual report. Discussion at the meeting will include brief reports in four focus areas: surveillance, prevention and control, research and product development. The action plan and annual report are posted at www.cdc.gov/drugresistance.

Animal Agriculture Alliance Stakeholders Summit, March 2007. Arlington, Va.

In a presentation at the March summit, Michael Doyle, Ph.D., a professor at the University of Georgia and leader of an Institute of Food Technologists team of experts studying antimicrobial resistance, noted the importance of antimicrobials to food production and manufacturing, “providing for good physical condition of crops, good health of food animals and maintaining sanitation during food processing. Antimicrobials are important to reduce and control foodborne pathogens in food animals and in their further processing.” In fact, he said, 95 percent of antibiotic use in agriculture is for therapeutic treatment of disease or control of pathogens. In addition, when the European Union eliminated in-feed antibiotics, he added, it likely resulted in increased intestinal disease in animals, causing therapeutic antibiotic use to rise which then triggered an increase in resistant microbes in EU nations. Some types of antimicrobial resistance in S. Typhimurium, C. jejuni, and E. coli have even increased in Europe since the ban was instituted. “This summer the IFT report indicated that eliminating antimicrobials from food animal production may have little positive impact on resistant bacteria of concern to human health,” added Alliance Executive Vice President, Kay Johnson. “Then, just a couple weeks ago, a team of scientists at the University of Georgia found that antibiotic resistance doesn’t necessarily stem from antibiotic use.” More information is available from www.animalagalliance.org.

Antimicrobial Resistance: Implications for the Food System. A report by the Institute of Food Technologists (IFT). June 2006.

Based on the conclusions of a panel of internationally renowned experts convened by IFT, the report addresses the concern that the use of antimicrobials in food production, manufacturing and elsewhere may lead to the emergence of foodborne pathogens that are resistant to antimicrobials, compromising the ability to control them. The resulting report summary explains the importance of antimicrobials to our food system, noting “antimicrobials provide for high quality or good physical condition of crops and good health of food animals entering the food chain. Non-antibiotic antimicrobial agents enable disinfection or sanitization of animal production premises, transport equipment, carcasses, slaughter facility equipment, and effective sanitation during food processing, and ensure food quality and safety,” then goes on to state that antimicrobial resistance may be intrinsic to a microorganism, or it may develop via mutation or adaptation to stressors. 

Because of the complexity, a single approach to solving the resistance issue is not possible, the report continued, rather qualitative and quantitative risk assessments are being applied, which are showing a small estimated risk to human health for many antibiotics. In fact, it adds, risk management strategies to minimize and contain antibiotic-resistant foodborne bacteria are in place all along the food chain, but can be improved. 

In the future, the report concludes, the public health benefit as well as risks of losing the efficacy of existing and future antimicrobials must be considered. Further, regulatory targeting of specific antibiotic-resistant foodborne pathogens may not be the most successful or cost-effective means to reduce overall foodborne illness. Applying interventions to control foodborne pathogens in general, rather than focusing on antibiotic-resistant strains specifically would have the greatest impact in reducing overall foodborne illnesses. More information and the full report are available at www.ift.org.

Collaboration in Animal Health and Food Safety Epidemiology (CAHFSE).

CAHFSE is a joint effort among three USDA agencies: the Animal and Plant Health Inspection Service (APHIS), the Agricultural Research Service (ARS), and the Food Safety and Inspection Service (FSIS). Its mission is to enhance understanding of bacteria that pose a food-safety risk by monitoring them on farm and in plant over time, and to provide a means to routinely monitor critical diseases in food-animal production. A particular emphasis of CAHFSE is to address issues related to bacteria that are resistant to antibiotics, with swine as the first commodity studied. Current and future plans include commencement of the third phase of that program this year; continued data collection; evaluation of methods to select future CAHFSE participants from among producers that participate in the NAHMS national studies; attempts to harmonize data- and sample-collection methods with a similar project being conducted in Canada; and expansion of CAHFSE into other commodity areas, including poultry. More information on this program is available at www.aphis.usda.gov/cahfse.

The National Antimicrobial Resistance Monitoring System — Enteric Bacteria (NARMS).

Established in 1996 as a collaborative effort between the FDA’s Center for Veterinary Medicine, USDA and CDC, NARMS monitors changes in antimicrobial drug susceptibilities of selected enteric bacterial organisms in humans, animals and retail meats to a panel of antimicrobial drugs important in human and animal medicine. The primary objectives of NARMS are to provide descriptive data on the extent and temporal trends of antimicrobial drug susceptibility in Salmonella and other enteric bacterial organisms from human and animal populations, as well as retail meats; to facilitate the identification of antimicrobial drug resistance in humans, animals and retail meats as it arises; and to provide timely information to veterinarians and physicians on antimicrobial drug-resistance patterns. Additionally, NARMS provides a national source of enteric bacterial isolates for research. The ultimate goal of these activities is to prolong the lifespan of approved drugs by promoting prudent and judicious use of antimicrobial drugs and to identify areas for more detailed investigation. More information on NARMS is available at www.fda.gov/cvm/narms_pg.html. Among the programs NARMS has initiated is the current collaborative effort with CDC:

CDC/NARMS. Get Smart on the Farm.  Begun in 2004, a program named Get Smart: Know When Antibiotics Work on the Farm emerged from a more general  program to focus on the agriculture industry and promote appropriate use. The program includes a number of state-specific initiatives including:

Colorado: Develop and establish partnerships with key organizations in the cattle industry with a goal to create a coalition between agriculture and public health to discuss antibiotic resistance issues.
Georgia: Expand the Georgia United against Antibiotic Resistant Diseases coalition to include veterinary medicine through the development of educational messages and outreach materials; pilot studies on appropriate antibiotic use interventions within the poultry and cattle industries using assessment tools, educational and training seminars.
Michigan: Continue to develop and house the Web-based veterinary curriculum project and species-specific modules; publicize the Web site among the colleges of veterinary medicine.
Minnesota: Continue development of educational modules for the veterinary curriculum through the University of Minnesota, including current swine and small animal modules.
Nebraska: Convert FDA, USDA and CDC educational materials into glossy booklets, PowerPoint presentations and Web pages to provide concise information on the judicious and prudent use of antibiotics.
Ohio: Assess food animal veterinarians to target the most common practices believed to contribute to antibiotic resistance in agriculture; develop intervention recommendations and plans, and a communication plan; conduct training seminars; develop educational materials.
Pennsylvania: Assess the knowledge, attitudes and practices of dairy veterinarian’s antibiotic use; develop educational materials with the State Veterinary Laboratory and Pennsylvania State University; host seminars on appropriate antibiotic prescribing for large and small animal veterinarians; survey consumers and farmers on the use of antibiotics in meat and milk and preferences for antibiotic-free products.
South Carolina: Develop and implement an assessment tool to evaluate the knowledge, attitude and practices about the use of antibiotics on dairy farms, develop educational materials; conduct a follow-up assessment to analyze attitude changes.
Tennessee: Create partnerships with beef cow/calf producers, groups and organizations; assess the knowledge, attitudes and practices of antibiotic use among beef producers; create educational materials and courses on biosecurity, antibiotic resistance and prudent antibiotic use.
Washington: Continue collaboration with the Washington Dairy Federation; continue assistance to eight leading dairies with individualized antibiotic stewardship and biosecurity plans and farm-specific recommendations; educate and train producers on electronic documenting and tracking of an antibiotic use and response. More information on this CDC program is available at www.cdc.gov/narms/get_smart.htm.
 
USDA/ARS Research Project May 2006-May 2011: Epidemiology, Ecology, and Molecular Genetics of Antimicrobial Resistance in Pathogenic and Commensal Bacteria from Food Animals.

The research uses antibiotic resistance data from the Collaboration on Animal Health and Food Safety Epidemiology (CAHFSE), National Antimicrobial Resistance Monitoring System (NARMS) and poultry studies to identify sources, reservoirs and amplifiers of resistant foodborne and commensal bacteria, and bacteria dissemination in food-producing animals. Results of the research will be applicable to risk assessment and development of mitigation strategies. In addition, the research will map the U.S. spread of antimicrobial resistance and analyze and differentiate antimicrobial resistance mechanisms. More information is available at www.ars.usda.gov/Research/.
 
Lisa Lupo is staff editor of QA magazine.