antibiotics Archives - Page 2 of 9 - Maryn McKenna

From Bird Flu to Big Farms: The Rise of China's Agriculture

February 21, 2014 By Maryn Leave a Comment

Image: Willem vdh/Flickr

Image: Willem vdh/Flickr

In my last post, I talked about the unnerving increase in avian flu H7N9 in China. The novel flu strain, now in its second year, appears to be spreading more rapidly than it did in its first appearance, and also more rapidly than H5N1, the avian flu strain that has caused the most worry internationally.

You can’t have avian flu — or at least, not this avian flu — without birds; most of the people who have been diagnosed with H7N9 had contact with live chickens or visited a market that sold live poultry for slaughter. H7N9 is continuing to spread in China; and so it’s a lucky coincidence that a nonprofit with deep knowledge of Chinese agriculture has just published a series of reports exploring the vast expansion of Chinese production of meat animals, including chickens.

Report: FDA Documents Show Decade of Unsuccessful Attempts to Control Farm Antibiotics

January 28, 2014 By Maryn Leave a Comment

Image: gina pina/Flickr

Image: gina pina/Flickr

A nonprofit group that has been using the courts to pressure the Food and Drug Administration into exerting more control over farm antibiotic overuse has done a deep review of FDA documents prised loose through Freedom of Information Act requests — and concludes that by allowing the drugs to remain on the market as formulated, the agency isn’t meeting its own internal safety standards.

Instead of only making that assertion, the Natural Resources Defense Council took the unusual step of showing its evidence in detail. NRDC published its analysis, Playing Chicken with Antibiotics, alongside a selection of the raw documents it received from the FDA. You’ll have to be a document-obsessive to take it on: The file (cached in a Dropbox and requiring download to view) is 306 mb and 971 pages. But even without considering its content, the file’s heft makes clear how much discussion there has been at the FDA over this issue, and suggests how much evidence has been accumulating over the problem of antibiotic resistance emerging from livestock production. Also telling: The FDA has been attempting to put some controls on livestock production since 1977; these documents cover only reviews of antibiotic feed additives that were conducted between 2001 and 2010.

NRDC’s conclusion, in its report:

FDA’s scientific reviewers’ findings show that none of these products would likely be approvable as new additives for nontherapeutic livestock use if submitted today, under current FDA guidelines. Eighteen of the 30 reviewed feed additives were deemed to pose a “high risk” of exposing humans to antibiotic-resistant bacteria through the food supply, based on the information available. The remainder lacked adequate data for the reviewers to make any determination and their safety remains unproven. In addition, FDA concluded in their review that at least 26 of the reviewed feed additives do not satisfy even the safety standards set by FDA in 1973.

Almost Three Times the Risk of Carrying MRSA from Living Near a Mega-Farm

January 22, 2014 By Maryn Leave a Comment

Pig farms from the air. Image: Maryn McKenna

Pig farms from the air. Image: Maryn McKenna

In the long fight over antibiotic use in agriculture, one of the most contentious points is whether the resistant bacteria that inevitably arise can move off the farm to affect humans. Most of the illnesses that have been associated with farm antibiotic use — resistant foodborne illness, for example — occur so far from farms that opponents of antibiotic control find them easy to dismiss. So whenever a research team can link resistant bacteria found in humans with farms that are close to those humans, it is an important contribution to the debate.

A team from the University of Iowa, Iowa City Veterans Affairs, and Kent State University have done just that. In next month’s Infection Control and Hospital Epidemiology, they survey 1,036 VA patients who lived in rural Iowa and were admitted to the Iowa City facility in 2010 and 2011. Overall, among those patients, 6.8 percent were carrying MRSA, drug-resistant staph, in their nostrils. But the patients’ likelihood of carrying MRSA was 2.76 times higher if they lived within one mile of a farm housing 2,500 or more pigs.
[Read more…]

Can Antibiotics User Fees Force Down Drug Mis-Use and Overuse?

January 7, 2014 By Maryn Leave a Comment

image: NeilT (CC), Flickr

Happy new year, constant readers. Here’s the most urgent thing I have to say today: Stop reading and go set your DVRs for 8pm ET tonight. The fantastic The Poisoner’s Handbook, written by Wired colleague and dear friend Deborah Blum, has been adapted by PBS and airs tonight on The American Experience. It’s going to be superb.

Back? OK, on to business. Just before the holidays, the Food and Drug Administration finalized its long-aborning plan to ask the meat-production industry to reduce its use of routinely administered antibiotics. (My posts on the move here and here.) The FDA’s guidance to industry, as it is called, is not a regulation but rather a request for voluntary action on the part of veterinary-drug companies. It has met with skepticism and concerns that manufacturers will redefine the uses of their drugs in such a way that nothing will change.

The FDA action is aimed at the routine use of antibiotics for what is called growth promotion — causing animals to gain muscle faster than they would without the drugs being used — and is modeled on a ban on growth promoters enacted by the European Union in 2005. The goal, as in the EU, is to reduce the drugs’ use, and therefore the antibiotic-resistant bacteria that use stimulates.

In a recent New England Journal of Medicine, University of Calgary economist Aidan Hollis suggests though that a ban may not be the most useful or practical approach to the problem of drug overuse. In its place, he suggests the pocketbook persuasion of having to pay a fee.

Re-Examining the FDA Antibiotics Decision: Banning Growth Promoters Won't Be Enough

December 27, 2013 By Maryn Leave a Comment

USDA Photos by Lance Cheung/Flickr

In my first take on the news of the FDA finalizing its request to agriculture to stop using growth-promoter antibiotics, I promised to come back for a more thoughtful reaction. And then this happened, and this happened, and the holidays happened, and, well, it’s been a busy few weeks.

So, finally getting back to it: When the news broke, a number of people, including me, said that this was a long-awaited first step on the part of the FDA, but of uncertain ultimate impact because it asks for voluntary action and does not address whether the drugs simply can be relabeled. I still agree with both those points, but think the possibly most important issue — which I raised briefly in the first post — is that merely removing antibiotics, without changing the system in which those antibiotics have been administered, may cause significant animal-welfare problems, without having any real effect on human health.

(If you’d like the short version of this, listen to my chat with NPR’s Weekend All Things Considered.)

Drug-Resistant Bacteria on Chicken: It's Everywhere and the Government Can't Help

December 19, 2013 By Maryn Leave a Comment

image: Thousand Robots (CC), Flickr

Two important, linked publications are out today, both carrying the same message: The way we raise poultry in this country is creating an under-appreciated health hazard, and the government structures we depend upon to detect that hazard and protect us from it are failing us.

The two pubs are:

A long piece that will be in the Feb. 2014 edition of Consumer Reports but has been placed online today.
A companion report by the Pew Charitable Trusts, addressing some of the systemic problems raised by the Consumer Reports story.

Short version: Independent tests show that multi-drug resistant disease-causing bacteria are widely present on chicken, and the US Department of Agriculture’s Food Safety and Inspection Service (FSIS) has insufficient personnel, or legal authority, to change that.

Both these assertions are important, because foodborne illness, and especially drug-resistant foodborne illness, are also under-appreciated — for how serious the disease can be, and how long-lasting the after-effects are. (For more on those: Here’s a piece I wrote for The Atlantic about how drug-resistant bacteria on chicken are causing an epidemic of urinary tract infections, and one for Scientific American about the lifelong cost of foodborne illness.)

It’s worth emphasizing also that we are right now in the middle of an outbreak of Salmonella on chicken that has been going on for about a year. The Centers for Disease Control and Prevention posted an update just this morning: 416 people since since last February, in 23 states and Puerto Rico, 39 percent of them hospitalized, linked to a single producer’s brand of chicken.

FDA Scrutinizes Antibacterial Products for Hormonal Disruption, Bacterial Resistance

December 16, 2013 By Maryn Leave a Comment

Image: Jim Belford (CC), Flickr

More news today out of the Food and Drug Administration — so while I’m still writing my follow-up to last week’s news on growth promoters, I want to toss this up first. The latest: The FDA has announced that it is formally reconsidering “antibacterial” soaps and other personal-care products, charging that the antibacterial ingredients confer no benefit over regular soap and water while carrying extra risks.

In a draft rule that will be published Tuesday in the Federal Register, the agency calls for manufacturers of consumer antibacterial products to begin providing data that shows the ingredients are both safe for daily use, and also more effective than plain soap and water. Deep in the 137-page rule, it also raises the issue that’s most interesting to me: whether the routine use of these products causes bacteria to develop resistance against the active ingredients, and against antibiotics as an unintended side effect.

Antibacterial products are a vast market; according to the FDA there are more than 2,000 currently for sale to consumers. (NB: This rule does not cover antibacterial hand-sanitizers; neither does it include the kind of washes and wipes used in healthcare.) The announcement today opens a 6-month comment period that ends next June. It will be interesting to see where this goes.

FDA Finally Imposes Some Controls on Agricultural Antibiotics. Sort Of.

December 11, 2013 By Maryn Leave a Comment

USDA Photos by Lance Cheung/Flickr

This morning, the US Food and Drug Administration dropped some long-awaited-but-still-big news regarding the use of antibiotics in meat production. Tl;dr: The FDA asked (but did not compel) the livestock industry to stop using the micro-dose “growth promoter” antibiotics that are widely believed to contribute to increase in antibiotic resistant bacteria in animals, food and humans.

With exquisite timing, they happen to have picked a day when I am traveling, in order to get to my end-of-semester evaluation tomorrow for my MIT fellowship. So I’m going to do what curation I can on this, and point to some important reactions and analyses. I’ll come back for a deeper look, probably on the weekend.

So here are the basics.

MRSA in UK Turkeys Raises Questions of Communication, Transparency and Risk

December 2, 2013 By Maryn Leave a Comment

Image: OZinOH (CC), Flickr

Two years ago, I celebrated Thanksgiving here on Superbug by announcing some new studies on resistant bacteria being found in turkey meat in the US. That did not go over well; so this year, I saved the bad-turkey news for the post-holiday week. And here you go:

Just in time for our Thanksgiving — and in the ramp-up to English Christmas, for which turkey is a traditional dish — the UK’s Animal Health and Veterinary Laboratories Agency announced that livestock-associated MRSA, drug-resistant staph, has been found in UK poultry for the first time. From their not-very-informative press release:

The Animal Health and Veterinary Laboratories Agency (AHVLA) has identified the presence of Livestock-Associated Meticillin Resistant Staphylococcus Aureus (LA-MRSA) in poultry on a farm in East Anglia… Once the poultry have been slaughtered and sold the owner will carry out cleansing and disinfection of their accommodation to ensure the next birds do not become colonised when they arrive on site. The AHVLA will revisit the farm after depopulation and thorough cleansing and disinfection to determine whether LA-MRSA is still present.

Antibiotic Overuse on Farms: Is the Opinion Tide Turning?

November 4, 2013 By Maryn Leave a Comment

USDA Photos by Lance Cheung/Flickr

It’s been a busy few weeks here at Casa Superbug — including some conference appearances, more on them later — so the first thing I’d like to do is point out some things that appeared while I was offline. Notably: In editorials, three newspapers recently challenged the way antibiotics are used on farms and asked why we can’t do better.

Shutdown Salmonella Outbreak Continues. CDC Food Safety Chief: 'We Have a Blind Spot.'

October 10, 2013 By Maryn Leave a Comment

Image: Ben Husmann, (CC), Flickr

We’re 11 days now into the federal shutdown and four days since the announcement of a major foodborne outbreak in chicken that is challenging the shutdown-limited abilities of the food-safety and disease-detective personnel at the Centers for Disease Control and Prevention, Food and Drug Administration and Department of Agriculture. Here’s an update.
[Read more…]

CDC Threat Report: Yes, Agricultural Antibiotics Play a Role in Drug Resistance

September 17, 2013 By Maryn Leave a Comment

Campylobacter bacteria. Image: CDC

The grave assessment on the advance of drug resistance, released Monday by the US Centers for Disease Control and Prevention, contained some important observations about the relationship between antibiotic use in agriculture and resistant infections in humans. Those observations, combined with remarks made yesterday by the director of the CDC and also with testimony given in the past by other CDC personnel, ought to put to rest what seems like a persistent meme: that the CDC has never said, or doesn’t believe, that agricultural antibiotic use plays a role in the advance of resistance.

This is important because it puts the CDC in line with a substantial body of research pointing to agricultural use playing a role in the emergence of resistance outside farm properties. With the CDC agreeing — plus, to some degree, the Food and Drug Administration — surely it’s time to move on to whether there are things that could be done to curb the risks posed by some ag practices, while respecting the role that livestock-raising in particular plays as a substantial economic sector, and as an engine in feeding the world.

CDC Threat Report: 'We Will Soon Be in a Post-Antibiotic Era'

September 16, 2013 By Maryn Leave a Comment

Image: CDC

The U.S. Centers for Disease Control and Prevention has just published a first-of-its-kind assessment of the threat the country faces from antibiotic-resistant organisms, ranking them by the number of illnesses and deaths they cause each year and outlining urgent steps that need to be taken to roll back the trend.

The agency’s overall — and, it stressed, conservative — assessment of the problem:

Each year, in the U.S., 2,049,442 illnesses caused by bacteria and fungi that are resistant to at least some classes of antibiotics;
Each year, out of those illnesses, 23,000 deaths;
Because of those illnesses and deaths, $20 billion each year in additional healthcare spending;
And beyond the direct healthcare costs, an additional $35 billion lost to society in foregone productivity.

“If we are not careful, we will soon be in a post-antibiotic era,” Dr. Tom Frieden, the CDC’s director, said in a media briefing. “And for some patients and for some microbes, we are already there.”

Two Former FDA Commissioners Agree: Ag Antibiotic Policies Must Change

August 27, 2013 By Maryn Leave a Comment

source: Anselm (CC), Flickr

This is an ICYMI (“in case you missed it”) post, twice over. Last week, former Food and Drug Administration Commissioner Donald Kennedy, Ph.D., wrote a piece for the Washington Post in which he urged that the FDA change how it regulates antibiotics that are used in agriculture as part of meat production.

His prescription is notable, not just in itself, but because it marks the second time in a few months that a former commissioner of the FDA used a major paper’s op-ed page to criticize his former agency’s conduct on farm antibiotic use. David A. Kessler, M.D., did the same thing, hitting many of the same points, in the New York Times in March.

Kennedy was FDA Commissioner from 1977 to 1979, just as scrutiny of antibiotic use in livestock-raising was beginning. (There’s a timeline in this post.) Kessler was Commissioner from 1990 to 1997, during the time in which the FDA began to look for, and find, antibiotic-resistant bacteria on retail meat. There were almost 20 years between their tenures — and 16 years from Kessler to now — and yet almost nothing has changed.

Antibiotic Use in Chickens: Responsible for Hundreds of Human Deaths?

August 9, 2013 By Maryn Leave a Comment

Flickr: Thousand Robots, CC

In the long back and forth between science and agriculture over the source of antibiotic resistance in humans — Due to antibiotic overuse on farms, or in human medicine? — one question has been stubbornly hard to answer. If antibiotic-resistant bacteria do arise on farms, do they leave the farm and circulate in the wider world? And if they do, how much damage do they do?

A multi-national team of researchers recently published their answers to both questions. Their answer: In Europe, 1,518 deaths and 67,236 days in the hospital, every year, which would not otherwise have occurred.

'Nightmare Bacteria' Attack an ICU and Close a Burn Unit

August 1, 2013 By Maryn Leave a Comment

Flickr: Denis Bocquet, CC

I thought I was done for the time being with “nightmare bacteria” (the US CDC’s characterization of disease organisms resistant to the last-ditch antibiotics called carbapenems), but there are two stories today that deserve to be called out as examples of how rapidly and dangerously these pathogens are spreading.

More on 'Nightmare Bacteria': Maybe Even Worse Than We Thought?

July 30, 2013 By Maryn Leave a Comment

Flickr: CelesteH, CC

In my last post I talked about the under-appreciated emergence of “nightmare bacteria” (those are the Centers for Disease Control and Prevention’s words, not mine) that are widely distributed in hospitals and nursing homes around the world and do not respond to a last-ditch small family of antibiotics called carbapenems. That seemed dire enough, but new research suggests the problem, bad as it looks, has been understated.

There’s an ahead-of-print article in Antimicrobial Agents and Chemotherapy whose authors include David Shlaes, a physician-researcher and former pharmaceutical executive, now consultant, and Brad Spellberg, an infectious disease physician on the UCLA medical faculty and author among other books of Rising Plague, about antibiotic resistance. In a commentary examining the Food and Drug Administration’s promised “reboot” of antibiotic development rules, they analyze privately gathered data on resistance in the United States and conclude the incidence of highly resistant bacteria is greater than the CDC has estimated.

Where 'Nightmare Bacteria' Came From, And How Our Inattention Helped Them Emerge

July 25, 2013 By Maryn Leave a Comment

Zebbie (CC), Flickr

Cast your minds back a few months ago, to when the director of the US Centers for Disease Control and Prevention announced, “We have a very serious problem” with “nightmare bacteria,” and the chief medical officer of the United Kingdom backed him up a few days later, describing a “ticking time bomb” that threatens national security as seriously as terrorism.
[Read more…]

More on MRSA on Farms and in Farm Workers, and the Arguments for and Against

July 12, 2013 By Maryn Leave a Comment

Photo: ROIrving/ Flickr

In my last post I promised to catch up on some of the other research that has been published on the flow of MRSA (and other resistant organisms) between farm animals and farm workers as a result of farm antibiotic use.

Before I do that, though, I want to nod toward two other great pieces published on this. First, Mark Bittman examined this issue closely at the New York Times. And Clare Leschin-Hoar also covered the new research at Take Part. (Bonus: Don’t miss her dissection of the news that a National Geographic photographer was arrested in Kansas after taking pictures of a feedlot — from the air.)

"Pig MRSA" Carried by Workers from North Carolina Intensive Hog Farms

July 5, 2013 By Maryn Leave a Comment

Pig farms from the air. Maryn McKenna,

I saved this post until today to allow everyone to get their holiday hot dogs guilt-free. Now that’s over: An important study has just been published which makes a close connection between the emergence of antibiotic-resistant bacteria, and the use of antibiotics on large-scale conventional hog farms. Bonus: It involves the resistant bacterium MRSA ST398 (known in shorthand as “pig MRSA”), which is widespread in Europe but up to this point has been found mainly in only one state in the US, Iowa. With this paper, the count rises to two(see Update): The study subjects in this paper are hog-farm workers in eastern North Carolina.

A quick explanation of why this is important: “Pig MRSA” is a particular strain of drug-resistant staph that is slightly different from the hospital and community (sports, gym) varieties. It was first spotted in the Netherlands in 2004, in the toddler daughter of pig farmers and in the family’s pigs. Since then, it has spread widely across Europe, not just in agriculture, but in healthcare and in everyday life, and has also been found widely in retail meat.

The question of whether livestock production’s use of antibiotics causes antibiotic-resistant bacteria to move into the wider world is much argued-over, and pig MRSA, or ST398 to be polite, is crucial to that dispute. That’s because, unlike most resistant bacteria, it has a genetic signature that makes an inarguable link back to farm drug use. More on that below. (If you want more, here’s an archive of my posts on ST398; the story of its emergence in 2004 and what happened afterward is told in my 2010 book SUPERBUG.)

Now, the study. Quick summary, with more unpacking to follow: Researchers checked livestock-farm workers in North Carolina to see whether they were carrying staph, and also drug-resistant staph. The workers formed two groups: one group worked at conventional hog operations, which routinely use antibiotics, and the other group at antibiotic-free farms. Both groups carried staph and also drug-resistant staph, which would be expected; about 30 percent of the population carries sensitive staph and about 4 percent carries the drug-resistant form. But, the key difference: Workers from the conventional, antibiotic-using farms were many times more likely to carry staph with the specific signature of farm-drug use.

That illuminates a potential occupational risk to the workers — and it also suggests that the workers could be a channel for that farm-influenced bacterium to move off the farm.