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.
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CDC Threat Report: Yes, Agricultural Antibiotics Play a Role in Drug Resistance
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'
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
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?
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
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?
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
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.
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More on MRSA on Farms and in Farm Workers, and the Arguments for and Against
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
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.
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