Investigation: Drug Resistance, Chicken And 8 Million UTIs

So, there’s this thing. A big project. An investigative project, actually. I’ve been working on it for months, and finally I can tell you about it, because it all just published, in various venues, today.

I’ve been working with a great new group, the Food and Environment Reporting Network — one of the grant-funded journalism organizations that have arisen in the wake of the collapse of mainstream journalism — on an important, under-reported topic. Which is: Over the past decade, a group of researchers in several countries have been uncovering links between the use of antibiotics in chicken production and the rising occurrence of resistance in one of the most common bacterial infections in the world.

The infection in question is UTI, which just about every woman I know will recognize: It stands for urinary tract infection, and on average one out of every 9 women in the United States suffers one at least once per year. There are 6 million to 8 million UTIs in the US each year, costing at least $1 billion in healthcare spending.

That’s bad enough — not just the collective dollar amount, but the individual cost of annoyance, pain, lost work time to go to the doctor, and lost quality of life because of the urge, burning and disinclination to do anything except swill cranberry juice and spend hours in the bathroom. But an increasing percentage of UTIs are turning out to be antibiotic-resistant. That’s potentially an even more serious problem, because when a UTI is not treated — or treated with drugs that do not work, which is effectively the same thing — the infection can climb up the urinary system to the kidneys, and from there cross to the bloodstream, and from there create a whole-body infection that can potentially be fatal. The organism that causes UTIs, which overwhelmingly is a particular form of E. coli known as ExPEC, already is believed to cause up to 40,000 deaths from bloodstream infections each year, and antibiotic resistance is expected to make that worse — or may be doing so already.

Antibiotic resistance in ExPEC E. coli has been climbing for years, and most people who treat such infections have had very little idea why. But this small group of researchers has persistently been proving connections between the resistance pattern in human UTIs, and the same resistance pattern in E. coli carried in chickens and turkeys before slaughter, and chicken and turkey meat sold in supermarkets in the U.S., Canada and Europe. They contend that the link among all of those is antibiotics given to chickens as they are raised, creating antibiotic-resistant organisms that move off the farm to imperil human health. And the more research they do, the stronger that link becomes.

This is such an important topic– so costly in dollars and quality of life, and so significant for what it says about the impact of antibiotic use in large-scale agriculture — that our investigation at FERN attracted several media partners.

We have a video package with ABC News on Good Morning America and ABC Nightly News (link coming for the evening news as the West Coast hasn’t seen it yet) and a print partnership with The Atlantic that involves a much longer story than TV production limits allow.

From our story:

…the origin of these newly resistant E. coli has been a mystery — except to a small group of researchers in several countries. They contend there is persuasive evidence that the bacteria are coming from poultry. More precisely, coming from poultry raised with the routine use of antibiotics, which takes in most of the 8.6 billion chickens raised for meat in the U.S. each year.

Their research in the United States, Canada, and Europe (published most recently this month, in June, and in March) has found close genetic matches between resistant E. coli collected from human patients and resistant strains found on chicken or turkey sold in supermarkets or collected from birds being slaughtered. The researchers contend that poultry — especially chicken, the low-cost, low-fat protein that Americans eat more than any other meat — is the bridge that allows resistant bacteria to move to humans, taking up residence in the body and sparking infections when conditions are right.

“The E. coli that is circulating at the same time, and in the same area — from food animal sources, retail meat, and the E. coli that’s causing women’s infections — is very closely related genetically,” said Amee Manges, Ph.D., an associate professor of epidemiology at McGill University in Montreal who has been researching resistant UTIs for a decade. “And the E. coli that you recover from poultry meat tends to have the highest levels of resistance. Of all retail meats, it’s the most problematic that way.”

Not everyone agrees with this interpretation of the science, of course, and if you go through to the Atlantic story, you’ll find comments in it from several researchers who represent the agricultural research side and who don’t agree.

When I do stories like this, involving deep dives into the medical literature, people always ask me what my sources are. Here (in addition to many interviews) are some of them:

There are others, but that seems like a good beginning for a bibliography.

This is an important, not well understood issue, and I hope you’ll take a look.

Here’s the Good Morning America segment, featuring George Stephanopoulos:


And here’s the ABC World News segment, featuring Diane Sawyer and ABC medical director Dr. Richard Besser, former acting director of the Centers for Disease Control and Prevention — and before that, chief of the CDC’s efforts to track and reduce antibiotic resistance.



The National Chicken Council disagrees with the investigation’s results.

ABC News story on the investigation.

Twitter follower @JBetz03 alerts me to this additional newly published paper, from this month’s Emerging Infectious Diseases, on strains of a different gut bacterium, E. faecalis, crossing between chickens and people in Vietnam.

NPR’s Q&A with me about the backstory to the investigation.




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