Maryn McKenna

Journalist and Author

Well, this is bad news.

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Hi again, constant readers – yes, eye-deep again in a chapter, and sinking. About which: Is there anyone there who remembers staph 80/81 and would like to talk about it? Email me, address in the right-hand bar.

And now to the bad news. I am coming to this story late, but truthfully I am not even sure how late, as it seems to have trickled out without fanfare, and different media have covered it at different times over the past month. At any rate: The FDA has quietly reversed a decision it took last summer, and will allow cephalosporins, a human medicine, to be used without restriction in food animals.

What’s a cephalosporin? The best-known one is the very commonly used drug Keflex (cephalexin), which you might take for tonsillitis or bronchitis – not a drug that you want to stop working because bacteria have developed resistance to it. (Yes, MRSA already has.)

Supporting material, tracking backward: A notice from the National Academies of Science news office from two days ago is here. An NPR story from Dec. 29 is here. A lengthy essay hosted by food-safety expert/attorney Bill Marler is here. A statement from the Pew Charitable Trusts’ Campaign on Human Health and Industrial Farming, dated Dec. 12, is here. A short story from the Wall Street Journal, dated Dec. 9, is here.

Here’s where I think this all ends up: On Nov. 25, the FDA put a note in the Federal Register announcing that it was reversing its earlier, July 3 decision to put curbs on the “extra-label” — anything not specifically allowed by the label — use of cephalosporins in animals. (Here’s a July 16 Q and A explaining what it was prohibiting.)

The reason for the revocation of the ban/permission to use without restrictions, the FDA said in the Nov. 25 notice, was that it had gotten so many public comments on the ban — which was supposed to take effect Nov. 30 — that it decided the only appropriate action was to lift the ban until it could fully consider whether to reimpose it. And, because it was a revocation of a previous order and not a new order, it did not have to give advance notice.

As to what this means, consider this stinging op-ed from John Carling, former governor of the very agricultural state of Kansas, and chairman of the Pew Commission, which produced a mammoth report last year on industrial-scale agriculture:

The rest of the world has leapt ahead of us on this issue. In Europe, antibiotics have long been eliminated from food production. South Korea followed suit this summer. Our refusal to turn away from this practice could cost us markets for our food products overseas and, by extension, precious jobs here at home.
The Pew Commission was composed of farmers, doctors, veterinarians, economists and other talented professionals who took on the challenge of finding a model that would allow U.S. farmers and ranchers the freedom to pursue their livelihoods in a way that does not adversely impact public health, the environment and the economies of their communities.
We believe we found such a model, and it included phasing out the indiscriminate overuse of antibiotics.
Changing the way agriculture works in this country will likely prove challenging, and involve many difficult decisions.
It’s a tragedy that on this occasion the FDA took the easy — and more dangerous — way out.

“Pig MRSA” in New York City – via the Dominican Republic?

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Folks: Back in October, I broke the news for you of an intriguing poster presentation at the ICAAC meeting. It revealed the discovery of ST 398, the anomalous staph strain found in pigs, pig farmers and health care workers in Europe, in residents of a Dominican-immigrant neighborhood in northern Manhattan, and also in the Dominican Republic.

Because there is so much traffic back and forth between those neighborhoods, the authors theorized that people are providing an “air bridge” for the bacterium — though they were unable to say whether the bug is moving from the Dominican Republic to the United States, or vice versa.

I was unable to link to that presentation at the time, because it was a meeting poster – yes, literally a poster, the authors stand by it to discuss it with anyone who wanders by. However, now it has been published as a paper, in the CDC journal Emerging Infectious Diseases; and because it is a CDC journal, the full text is available free online here.

Just to underline, despite my headline above, the strain found in NYC was not MRSA: It actually is MSSA, drug-sensitive staph. The ST 398 found in Europe, Canada and the American Midwest is MRSA. The authors hypothesize that the NYC strain is at risk of becoming MRSA also.

To see the multiple posts in this blog about MRSA ST 398 and other strains in the food chain, food animals, and pets, go to the labels under the time stamp on this post, and click “animals” or “food.”

The cite for the paper is: Bhat M, Dumortier C, Taylor B, Miller M, Vasquez G, Yunen J, et al. Staphylococcus aureus ST398, New York City and Dominican Republic. Emerg Infect Dis. 2009 Feb; [Epub ahead of print]

MRSA in meat in Louisiana: pig meat, human strain

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On Nov. 3, I posted on an enterprising group of TV stations in the Pacific Northwest who had retail meat in four states tested for MRSA. I said at the time that it was the first finding of MRSA in meat in the US that I knew of.

Turns out that I was wrong by three days. On Oct. 31, the journal Applied and Environmental Microbiology published an electronic version of a study that they will be printing in the paper journal on some future date. Journals do this when a finding is so important or timely that it should see the light immediately, rather than wait through the additional weeks or months of print production.

And this finding is certainly timely. Shuaihua Pu, Feifei Han, and Beilei Ge of the Louisiana State University Agricultural Center have made what appears to be the first scientifically valid identification of MRSA in retail meat in the United States. But — and this is an important point — it is not the swine strain, ST 398, that has been found in meat in Canada and Europe, and in hospital patients in Scotland and the Netherlands, and in pigs in Iowa; and in humans in New York, though that strain was drug-sensitive.

Instead, what the researchers found (in 5 pork and 1 beef samples, out of 120 bought in 30 grocery stores in Baton Rouge, La. over 6 weeks in February-March 2008) was USA300, the dominant community MRSA strain, and USA100, the main hospital-infection strain. In other words, they found meat that had been contaminated during production by an infected or colonized human, not by a pig. As they say:

…the presence of MRSA in meats may pose a potential threat of infection to individuals who handle the food. … (G)reat attention needs to be taken to prevent the introduction of MRSA from human carriers onto the meats they handle and thereby spreading the pathogen.

As we’ve discussed before, the primary danger from MRSA in meat is not that people will take the bug in by mouth (though that is a danger, since S. aureus because of its toxin production can cause severe foodborne illness — and these researchers found, overall, an S. aureus contamination rate of 46% of their pork samples and 20% of their beef samples). Rather, the danger is that people handling the raw meat will be careless in preparing it, and will colonize themselves by touching the meat and then touching their own noses or mucous membranes, leading to a possible future infection. As reader Rhoda pointed out in a comment last week, people could also infect themselves directly, by getting MRSA-laden juice or blood into an abrasion or cut.

So: Be careful in the kitchen, keep meat separate from other foods, wash cutting boards and knives, and (say it with me, now) wash your hands, wash your hands, wash your hands.

The cite for the new paper: Pu, S. et al. Isolation and Characterization of Methicillin-Resistant Staphylococcus aureus from Louisiana Retail Meats. Appl. Environ. Microbiol. doi:10.1128/AEM.01110-08. Epub ahead of print 31 Oct 08.

Housekeeping note: This is the 16th post I’ve written on MRSA in food animals and/or meat. Providing all the links to the previous posts is starting to obstruct the new news. So if you are looking for all those past posts, go to the labels at the end of this post, below the time-stamp, and click on “food.” You should get something that looks like this.

Final report from ICAAC-IDSA 08 (news from ICAAC, 3)

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The ICAAC-IDSA (48th Interscience Conference on Antimicrobial Agents and Chemotherapy and 46th annual meeting of the Infectious Diseases Society of America) meeting ended a week ago, and I’m still thrashing my way through the thousands of abstracts.

Here’s my final, highly unscientific selection of papers that caught my eye:

* Evidence that the community-strain clone USA300 is a formidable pathogen: It first appeared in the San Francisco jail in 2001. By last year, it had become the sole MRSA strain found in the jail — it crowded out all others. (P. Tattevin, abstract C2-225)
* Another paper from the same UCSF research group finds that the emergence of USA300 has caused a dramatic increase in bloodstream infections, most of which are diagnosed in the ER, not after patients are admitted to the hospital. (B. Diep, abstract C2-226)
* And the CDC finds that USA300 is picking up additional resistance factors, to clindamycin, tetracycline and mupirocin, the active ingredient in the decolonization ointment Bactroban. (L. McDougal, abstract C1-166)
* An example of the complexity of “search and destroy,” the active surveillance and testing program that seeks to identify colonized patients before they transmit the bug to others in a health care institution: Patients spread the bug within hours, often before test results judging them positive have been returned from the lab. (S. Chang, abstract K-3379b)
* In addition to the report from Spain I posted on during the meeting, there is a report of emerging linezolid resistance in France. (F. Doucet-Populaire, abstract C1-188)
* And in addition to the abundant new news about MRSA in pork, and “pork-MRSA” or ST 398, in humans, over the past few days, there were reports of MRSA in milk in Brazil (W. Gebreyes, abstract C2-1829) and Turkey (S. Turkyilmaz, abstract C2-1832), and beef and chicken in Korea (YJ Kim, abstract C2-1831), as well as ST 398 itself acquiring resistance to additional drugs. (Kehrenberg, abstract C1-171)
* Echoing many earlier findings that MRSA seems most common among the poor, the poorly housed and the incarcerated, BR Makos of the University of Texas found that children are more likely to be diagnosed with the bug if they are indigent, or from the South (which I imagine is a proxy for lower socio-economic status, since the South is a more rural, more poor region). (abstract G2-1314)
* And finally, to the long list of objects (ER curtains, stethoscopes) that harbor MRSA, here are more: The ultrasound probes in emergency rooms (B. Wessman, abstract K-3377). Also: Dentures. (Ick.) (D. Ready, abstract K-3354)

TV stations find MRSA in retail pork in Pacific Northwest

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In the comments, Coilin Nunan of the UK’s Soil Association (which published the wonderful 2007 report MRSA in Farm Animals and Meat report) calls attention to a report that I also spotted over the weekend.

A network of TV stations in Washington, Idaho, Oregon and California did a joint report in which they bought 97 packages of ground pork or pork cutlets and sent them to a laboratory for testing. The lab found that three of the packages, all ground pork, contained MRSA.

I believe this is the first time anyone has found (or, perhaps, looked for) MRSA in retail pork in the US. You’ll remember that MRSA ST 398 has been found in meat in Canada and Europe, and in hospital patients in Scotland and the Netherlands, and in pigs in Iowa; and MSSA ST 398 in humans in New York City.

There are some important unanswered questions about this report:

  • We aren’t told the strain. If it’s ST 398, that would be information on the spread of ST 398 in the US. If it’s USA300, on the other hand, it could be contamination from an infected or colonized human, perhaps someone in the preparation chain.
  • We aren’t told the provenance of the pork. Was it bought from a variety of markets, or one chain of supermarkets that might have one regional supplier? Was it organic v. conventional? Small-farm versus feedlot?
  • We can’t draw any broad conclusions from this. I am a poor biostatistician, but to me, this is purely a convenience sample. (If anyone disagrees with me, please weigh in.) In other words, it’s one data point. It says: There is MRSA in these packages of pork — which is an important piece of information — but it doesn’t say: 3% of all US pork contains MRSA.

Also, while the written version of the report that I linked above isn’t bad, overall, it contains one significant error. It says:

This drug-resistant bacteria is already responsible for more deaths in the US than AIDS. What makes MRSA so potentially dangerous is the bacteria can cause sickness just by touching it.

Well, not exactly. The concern with MRSA in meat is that, if you handle it without strict cleanliness, you might become colonized with the bacteria. That is not at all the same as developing a MRSA infection, much less the invasive MRSA the first sentence of that quote refers to. And yes, colonization can lead to infection. But to say that touching MRSA-contaminated meat will inevitably cause an invasive MRSA infection is alarmist.

I’m assuming the stations undertook this because it is sweeps month. (For those who have so far been spared the internals of TV news, “sweeps” are months — usually February, May, July and November — when stations’ audiences are measured to determine market rank and advertising rates. Because it is in the stations’ interest to attract as much audience as possible during those months, sweeps is usually when news stations run big investigative projects.) Interesting that they chose this topic. I think we can take this as an indicator — again, just one data point, but an interesting one — of emerging US concern over MRSA in meat.

Microbes in US meat, but no MRSA

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The ICAAC-IDSA meeting has ended, but there are still many abstracts that I have not been through. While I pore over them, though, an interesting paper has just been published that somewhat contradicts earlier research on the presence of MRSA in meat. (Earlier posts are here, here, here, here, here, here, here and here.)

The researchers, from the Warren Alpert Medical School of Brown University and Rhode Island Hospital, bought ground beef, boneless chicken breasts and pork chops from 10 stores in and around Providence. Two stores offered both conventional and “natural” choices, so they bought both, giving them 36 (=[10+2]x3) samples all told. They cultured for MRSA, vancomycin-resistant Enterococcus, extended-spectrum beta-lactamase producing Gram-negative bacteria and E. coli 0157:H7.

And they found… almost nothing. Only one samples grew a resistant microbe, the ESBL Gram-negative Serratia fonticola. A secnd level of testing, however, uncovered four samples carrying S. aureus — but all methicillin-sensitive, not MRSA.

So are we in the clear? Not necessarily. It is, as they say themselves, as small study, in which only a third of the samples were pork, though pigs are the animals most associated with MRSA via the strain ST398. And the presence of S. fonticola is troubling, because it not only causes disease directly (in animals and in humans), but also harbors a plasmid that can transfer resistance to other bacterial strains.

Nevertheless, it is a comforting reminder that, though MRSA has been found in meat, it has not been found everywhere. (Or at least, not in Providence.) Still, we shouldn’t let our personal vigilance lapse. The hypothetical danger from MRSA in meat is not that we’ll swallow it, but rather that we’ll be colonized if we handle the raw meat without being careful enough about kitchen hygiene. So keep raw meat away from other food, wash your cutting boards and counters, and (say it with me, now), wash your hands, wash your hands, wash your hands.

The cite is: Philip A. Chan, Sarah E. Wakeman, Adele Angelone and Leonard A. Mermel, Investigation of multi-drug resistant microbes in retail meats. Journal of Food, Agriculture & Environment, Vol.6 (3&4), July-October 2008.

ST 398 in New York City – via the Dominican Republic?

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Here’s a piece of MRSA news from the ICAAC meeting (see the post just below) that is intriguing enough to deserve its own post.

US and Caribbean researchers have found preliminary evidence of the staph strain ST 398, the animal-origin strain that has caused human illness in the Netherlands and has recently been found in Ontario and Iowa, in Manhattan. How it may have arrived: Via the Dominican Republic.

Th researchers (from Columbia University and Montefiore Medical Center in New York, three institutions in the Dominican Republic and one in Martinique) examine the influence of an “air bridge” — very frequent household travel — that is bringing MRSA and methicillin-sensitive staph back and forth between the Dominican Republic and the immigrant Dominican community at the north end of Manhattan. They compared 81 staph isolates from Dominican Republic residents and 636 from Manhattan residents and, among other findings, say that 6 Dominican strains and 13 Manhattan strains were ST398.

It is the first time ST398 has been found in Manhattan or in the Dominican Republic. (Most likely also the first time anyone has looked.)

The authors observe with some understatement:

Given the history of ST398’s rapid dissemination in the Netherlands, its history of methicillin-resistance and its ability to cause infections in both hospital and community, it will be important to monitor its prevalence in these new regions.

It is important to note that these ST398s were not MRSA — they were MSSA, methicillin-sensitive. However: Earlier this year, the Dutch researchers who have delineated the emergence of ST398 in Holland commented on the diversity of ST398 they have found on different pig farms and hypothesized that the resistance element has been acquired several different times by methicillin-sensitive staph. (van Duijkeren, E. et al. Vet Microbiol 2008 Jan 25; 126(4): 383-9.)

So it is possible to hypothesize that this strain arrived in Manhattan from the more rural Dominican Republic, though with the growth of hobby urban farming in NYC, one could also make the case that transmission went the other way. And it is also possible — I emphasize possible — that this could be a precursor to ST398 MRSA emerging in Manhattan. An interesting thought.

(This research is not online, because it is a poster presented at a medical meeting. For reference, the cite is: C. DuMortier, B. Taylor, J. E. Sanchez et al. “Evidence of S. aureus Transmission Between the USA and the Dominican Republic.” Poster C2-224. 48th ICAAC-46th IDSA, Washington DC, 24-28 Oct 2008.)

Breaking MRSA news from the ICAAC meeting 1

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There are 15,000+ people at the 48th Interscience Conference on Antimicrobial Agents and Chemistry (known as ICAAC – yes, “Ick-ack”) and 46th Infectious Diseases Society of America Annual Meeting, and at least half of them seem interested in MRSA. At the keynote address last night, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at NIH, referred to MRSA as a “global pandemic.”

Here are some highlights — a few of very, very many — from the first two days:

  • MRSA is truly a global phenomenon: Researchers here are reporting on local epidemics in Argentina, Australia, Botswana, Canada, Colombia, Ecuador, Greece, Japan, Nigeria, Peru, South Korea, Sweden and Taiwan.
  • In the United States, USA300 — the virulent community strain that is crowding out all other community strains — continues its dominance. It first appeared in the San Francisco jail in 2001 and now is the only cause of community MRSA infections there. (Tattevin, P. et al. “What Happened After the Introduction of USA300 in Correctional Facilities?” Poster C2-225.)
  • And MRSA continues to demonstrate its protean ability to cause unexpected forms of illness: The number of cases of sinusitis caused by MRSA seen at Georgetown University tripled between 2001-03 and 2004-06. (I. Brook and J. Hausfeld. “Increase in the Frequency of Recovery of Methicillin-Resistant Staphylococcus aureus in Acute and Chronic Maxillary Sinusitis.” Poster C2-228.)
  • Meanwhile, treatment options are shrinking. Hospitalization for vancomycin-resistant pathogens (that is, resistant to vancomycin, the drug of last resort for MRSA) doubled between 2003 and 2005 according to national healthcare utilization databases. (A.M. Ramsey et al. “The Growing Burden of Vancomycin Resistance in US Hospitals, 2000-2005.” Poster K-560.)
  • But, new drugs are beginning to emerge from the pipeline. Early results from a privately held company called Paratek Pharmaceuticals (co-founded by resistance guru Dr. Stuart Levy) showed that their new tetracycline relative PTK 0796 scored as well or slightly better than linezolid (Zyvox) in safety, tolerability and adverse events, and is advancing to a full Phase 3 trial. (R.D. Arbeit et al. “Safety and Efficacy of PTK 0796.” Poster L-1515.)

More as the meeting goes on.

MRSA and pets – any experience?

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Constant readers, I’m working on a chapter on MRSA in animals and would be curious to hear from anyone who has had experience with MRSA in a pet, whether as an owner/companion or on the veterinary side.

If this is you, please get in touch! Your options are: via the email address in the right-hand column; or via comments here. (I moderate all comments, which means that I see them before they post; so I can read a comment and remove it without its going public, if you prefer.)

Antibiotic resistance in food animals all across Europe

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Via a journal that’s new to me — the Acta Veterinaria Scandinavica, the open-access journal of the Veterinary Associations of the Nordic Countries — comes an amazing review of the prevalence of antibiotic resistance in cattle in 13 European countries. Based on 25,241 isolates collected over three years, Denmark, Britain, the Netherlands, Norway, Sweden and Switzerland do well, but “many isolates from Belgium, France, Italy, Latvia and Spain were resistant to most antimicrobials tested.“

Most resistant pathogen: E. coli. MRSA is present as well:

Of major concern is the level of resistance to oxacillin and 3rd generation cephalosporins (i.e. ceftiofur) in S. aureus. The prevalence of oxacillin resistance in Spain (3.7%) and France (8.3%) and the resistance towards cephalosporins in Spain (0.9% in 2004) and France (4.2% in 2002; 1% in 2003) indicate the presence of methicillin resistant S. aureus (MRSA) in these two countries.

The authors ascribe the differences among countries to different patterns of antimicrobial use by veterinarians and stress that it is time for veterinarians to begin using measurements of local resistance patterns (in human medicine, an “antibiogram”) before prescribing. Cite coming when the Acta site is updated. UPDATE: The paper is here; cite is: Hendriksen, RS et al. Prevalence of antimicrobial resistance among bacterial pathogens isolated from cattle in different European countries: 2002-2004. Acta Veterinaria Scandinavica 2008, 50:28doi:10.1186/1751-0147-50-28.

I wasn’t aware that this same set of authors (Hendriksen, RS et al.) just a few weeks ago published a similar review of antimicrobial resistance in pigs in Europe. It looks at several bacterial species in pigs, but unfortunately for our purposes, no S. aureus.

Great post elsewhere on antibiotic use in animals

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There will be a bit of a blog break, as I’m traveling for a week. But here as a walk-off is an excellent post from the marvelous public-health blog Effect Measure about the complexities (to be kind) of food companies declaring antibiotic use in food animals.

Very short version of the story: Massive chicken producer Tyson advertised its chickens as being “raised without antibiotics”; the chicken eggs were actually being treated with gentamicin before hatch (therefore technically not being “raised”; the US Department of Agriculture objected, then backed down, then objected again after Tyson’s competitors acted on their own.

Tyson announced it is “voluntarily” withdrawing the label. Which is more than the USDA did, apparently, its hand having been forced by Tyson’s competitors organized into the Orwellian-named Truthful Labeling Coalition (including Perdue Farms Inc., Sanderson Farms Inc. and Livingston, California-based Foster Farms). Perdue and Sanderson had sued over a label they considered “clearly false and misleading,” and a federal judge agreed, ordering Tyson to stop them from running any advertisements with the claim last month. Now, belatedly, the USDA is acting.

The entire post is worth reading, as is Effect Measure (which is running on a “summer schedule” and therefore posting only once a day, thus making us all look bad. Hmm, perhaps a Public Health Blog Truthful Labeling Coalition is in order…)

Closing the loop: meat, meat-eaters, health-care workers

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A posting on the international disease-alert mailing list ProMED led me to a scientific abstract presented at a European meeting this spring on the ST 398 MRSA strain. It adds another, quite unnerving piece to the emerging interplay of MRSA in pigs, humans who have close contact with pigs, humans who have contact only with pig meat, and health-care workers who treat those humans.

Brief precis: About a year ago, Dutch health authorities discovered that a patient who had come in for surgical debridement of a diabetic foot ulcer had an unrecognized MRSA strain in that ulcer. Subsequently, they discovered that four other patients and five health-care workers in the same institution were carrying the same strain. None of the patients reported any contacts with pigs (or calves, which have also been found to carry the strain). One of the health-care workers lived on a farm that raised pigs, but said that she had no contact with the animals in her daily life; nor did her partner.

The authors conclude:

While the source is not fully established it could be the HCW living on a pig farm. This outbreak makes clear that transmission on a larger scale can occur, even with NT-MRSA.

(Hat-tip to Helen Branswell of the Canadian Press for telling me about the ProMED report. And a note to loyal readers: The “MRSA in meat” story is being picked up by some US newspapers. Doesn’t it feel good to know you’ve been reading about the issue here for months? And if you’re a reader of Helen’s work, months more? Of course it does.)

New blog on animal health including MRSA

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Dr. J. Scott Weese of the Ontario Veterinary College (author of many important papers, discussed in many posts here, on MRSA in food and companion animals) has started a blog on animal-health issues. Here is a recent post on tracking down the source of a MRSA infection when there is a pet in the house.

The blog is called Worms and Germs and I’ve added it to the blogroll at right.

One more on MRSA in meat

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It turns out that European governments — in contrast to the United States — are taking very seriously the emergence of MRSA in food animals and its potential for transfer to humans. (For background, posts here, here, here and here.)

How seriously? They’re doing a sampling survey of pigs on farms across the European Union, at a cost of about $3 million in EC funds, with matching funds expected from each government.

The MRSA survey piggybacks (sorry) on a year-long survey of Salmonella incidence that the EC called for in September 2007. But in December, following publication of several significant papers about the ST 398 MRSA strain in pigs and pig farmers, the EC Directorate-General for Health and Consumer Protection pushed for an addition to the Salmonella study: a same-time sampling for the presence of MRSA strains in pig operations across 29 countries.

The sampling is taking place from January to December of this year, with results mandated by mid-2009, though individual country authorities may release data earlier if they choose. (In the wake of the finding of three ST 398 cases apparently caused by retail meat in the UK, the Soil Association has called on the British government to release whatever data it has ASAP. Before the EC decision, the UK government had refused to test its pigs; cf. these House of Lords minutes.)

Of note: The Soil Association is pressing the argument that ST 398 has developed in the setting of widespread use of antibiotics in food animals, and contends the strain’s arising in the Netherlands is especially alarming because they have some of the lowest animal-antibiotic use rates in the EC it illustrates the difficulties that even a society conscientious about antibiotic overuse can have keeping track of veterinary applications. The Netherlands has been successful limiting overuse in humans, but has found controlling veterinary use much more of a struggle. (Thanks to the Soil Association for correcting my misunderstanding!)