Maryn McKenna

Journalist and Author

News: FDA Won't Act Against Ag Antibiotic Use

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With no notice other than a holiday-eve posting in the Federal Register, the US Food and Drug Administration has reneged on its long-stated intention to compel large-scale agriculture to curb over-use of agricultural antibiotics, which it had planned to do by reversing its approval for putting penicillin and tetracyclines in feed.

How long-stated? The FDA first announced its intention to withdraw those approvals in 1977.

From the official posting:

The Food and Drug Administration (FDA or the Agency) is withdrawing two 1977 notices of opportunity for a hearing (NOOH), which proposed to withdraw certain approved uses of penicillin and tetracyclines intended for use in feeds for food-producing animals based in part on microbial food safety concerns.1 … (1FDA’s approval to withdraw the approved uses of the drugs was based on three statutory grounds: (1) The drugs are not shown to be safe (21 U.S.C. 360b(e)(1)(B)); (2) lack of substantial evidence of effectiveness (21 U.S.C. 360b(e)(1)(C)); and (3) failure to submit required reports (21 U.S.C. 360b(e)(2)(A)).)

There is a lot of background to this, but here is the takeaway: For 34 years, the FDA has been contending that administering small doses of antibiotics to healthy animals is an inappropriate use of increasingly scarce drugs — a position in which it is supported by organizations as mainstream as the American Medical Association. With this withdrawal, it backs away from the actions it took to support that assertion — which may indicate there will be no further government action on the issue until after the 2012 election.

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Antibiotics: Connected to Obesity, Diabetes and Stroke?

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In consideration of your glaze-eyed tryptophan coma — at least among those who weren’t frightened off by the MRSA-in-turkey news — today’s post is mostly composed of brightly colored pictures. (Also, speculation. You’ve been warned.)

About a week ago, a nonprofit research group called Extending the Cure published the latest in a fantastic series of maps they have been producing for several years, based on public and privately collected data. Earlier iterations have looked at the incidence of various resistant organisms over time. This time, they decided to look instead at the major drivers of resistance, and focused on national data about antibiotic prescriptions, broken down by drug type and by state between 1999 and 2007.

The graphics they produced document both a troubling growth in the use of some precious (because still effective) antibiotic classes, and also a surprising differential in the amounts of antibiotics prescribed in different parts of the country. The rate of use of antibiotics, measured by outpatient prescriptions per 1,000 inhabitants, varied from a low of 533 in Alaska to a high of 1,214 in West Virginia. [Read more…]

More MRSA Found In U.S. Retail Meat (Turkey, Too)

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There are two new studies out that confirm, once again, that drug-resistant staph or MRSA — normally thought of as a problem in hospitals and out in everyday life, in schoolkids, sports teams, jails and gyms — is showing up in animals and in the meat those animals become.

The strain of staph that shows up in farm animals, known as “livestock-associated” MRSA or MRSA ST398, first emerged in pigs in the Netherlands, and has been widely identified in retail meat in Europe. (You can find a long archive of posts on ST398 here, and more here.) But that same strain has been difficult to identify in the United States. That may be due in part to the U.S. having a uniquely massive epidemic of community-associated MRSA, far larger than in any other country, which likely both obscures any animal epidemic from detection, and possibly also fills the ecological niche that livestock-associated staph might otherwise occupy. But, it must be said, there’s also remarkably little political will to look for livestock-associated MRSA (though the U.S. Department of Agriculture has now funded a study).

Nevertheless, individual investigators keep trying, and when they look for the pathogen, they find it, such as in these studies from May and this one from April. Now, two other teams have as well.

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Running Out of Antibiotics: Europe Gets It

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In the United States, it’s been “Get Smart About Antibiotics” Week this past week, an annual observance in which the Centers for Disease Control and Prevention and its medical and public health partners try to raise awareness of antibiotic resistance. The real action this week though was in Europe, where individual researchers and the EU’s version of a CDC — the European Centre for Disease Prevention and Control — are speaking out about the problem with unusual candor.

Here’s the short version: In Europe, according to the ECDC, 25,000 people each year die as a result of multi-drug resistant infections, causing an additional cost to society of 1.5 billion Euros ($2.02 billion): 938 million Euros ($1.27 billion) in hospital and outpatient medical costs, and an additional  596.3 million Euros ($806 million) in lost productivity.

Dr. Marc Sprenger, director of the ECDC, said Friday:

This certainly is an underestimate of the true economic impact of antimicrobial resistance. In particular, the figures were based on data for just five multidrug-resistant bacteria.The estimate was also based on a conservative figure for the cost of a day in hospital… We think the real cost of treating a patient with a multidrug-resistant infection would be higher than this. My take home message is that antimicrobial resistance is one of the most serious public health challenges that we face.

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EU Parliament Votes To Oppose Most Farm Antibiotic Use

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A quick post, because I’m on a ferocious deadline, but still can’t let this news go by. In a vote that’s non-binding but high profile and influential, the European Parliament has resolved to end “prophylactic use” of antibiotics in farming, and to prevent any “last resort” antibiotics from being used in animals, in order to keep resistance from developing so that the drugs will still be effective in human medicine.

This is a significant development. The European Union has already banned “growth promotion,” the use of micro-doses of antibiotics that cause meat animals to fatten more quickly. What the Parliament is doing here is asking the European Commission, the EU’s law-making body, to add “disease prevention” use to the ban. That’s the delivery of treatment-strength doses of antibiotics to all animals on a farm in order to prevent their becoming ill as a result of the confinement conditions in which they are held. It accounts for a substantial portion of the antibiotics used in agriculture, and is a major driver of the emergence of antibiotic-resistant organisms.

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Government Health Agency Agrees Mega-Farms Are A Health Risk (In The UK)

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It’s very odd sometimes watching how the same issues play out in different parts of the world. The French environment ministry confidently ascribes the growth of seaweed choking its beaches to farm runoff. The European Parliament denounces the establishment of very large-scale “meat factories.” China (China!) enacts a ban on growth-promoting uses of antibiotics in agriculture.

Here in the United States, on the other hand, the government gropes unsuccessfully for a way to put controls on confinement agriculture, despite evidence of its environmental harm, while at the same time those farms grow by an estimated 4,600 hogs and 5,800 broiler chickens per day.

For more of that difference between Europe and the US, look this week to England, where the Health Protection Agency has just rejected the zoning application for a hog farm that was small by US standards, with a plan for only 2,500 sows producing about 20,000 piglets. The HPA said:

… those living up to 150 meters downwind of an intensive swine farming installation could be at risk of adverse human health effects associated with exposure to multi-drug resistant organisms. (this .pdf, p.30 of 44)

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Big Move: Chicago Schools To Buy Antibiotic-Free Chicken

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Big news today on several fronts: against the overuse of antibiotics in agriculture and for healthier food for school children. The Chicago Public Schools announced that its main food-service company, Chartwells-Thompson Hospitality, will begin buying and serving chicken drumsticks from birds raised in the local area without antibiotics. The deal will bring 1.2 million pounds of chicken to 473 schools per year, and represents about 25 percent of all the chicken that Chartwells-Thompson serves in the school system.

The new move was announced in a media telephone briefing that was hosted by the Pew Charitable Trusts’ Campaign on Human Health and Industrial Farming and included representatives from Chartswell-Thompson; the nonprofit organizations School Foods Focus and the Healthy Schools Campaign; Whole Foods Market, which is making it affordable to transport the birds; and Miller Amish Country Poultry, the supplier.

This is an important deal for several different reasons: [Read more…]

NDM-1 in India: Drug Resistance, Political Resistance

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It’s been more than a year since the “Indian superbug” NDM-1 — not actually a bacterium, but a gene that directs production of an enzyme — hit the news. The enzyme, whose acronym is short for New Delhi metallo-beta-lactamase-1, disables almost all antibiotics directed against it, leaving the bacteria in which the gene appears vulnerable to only two imperfect and sometimes toxic drugs.

The enzyme and its gene, blaNDM-1, were first identified in 2008 in people who had traveled in India or sought medical care in South Asia. Hence its name: Many beta-lactamases, enzymes that denature the very large class of everyday antibiotics known as beta-lactams, are named for countries and cities where they were first identified. Since its identification, NDM-1 has been discovered in patients in more than a dozen countries and has also been found to be widely harboured outside hospitals in India, and in surface waters and sewage there.

The unveiling of NDM-1 clearly caused embarrassment for India, and media and lawmakers there struck back, throwing around intemperate language and claiming the naming of the enzyme was a plot to derail the subcontinent’s medical-tourism industry — even though the Indian doctors had attempted to raise the alarm earlier and had been ignored.

So it seemed like a promising signal of openness when an international conference on antibiotic resistance opened in New Delhi a week ago. But in its wake, just what is going on in India — and whether its government is willing to face up to what might be an international crisis — is less clear than ever.

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Is China Banning Growth Promoters And Do They Mean It?

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A tantalizing prospect surfaced yesterday. The Institute for Agriculture and Trade Policy in Minneapolis tweeted a link to a Sept. 13 story from an online agricultural trade journal that said, in its entirety:

China’s Ministry of Agriculture has announced a forthcoming ban on antibiotics as growth promoters in animal feed. The ban is supported by the academic community, which believes that without antibiotics in animal feed, the health of animals will be better promoted, microbes’ resistance to antibiotics will be lowered and food will become safer to eat. Recent statistics show that in 2006 China produced 210,000 tons of antibiotics, and 97,000 tons were added to animal feed. Today it is estimated that 400,000 tons are produced annually.

So, first: If this story is accurate, it would be huge news. But, second: The story lists no sources and is almost a month old; in that month, there has been no other major coverage of this decision that I can find — which means a responsible reporter (which I try to be) needs to do some digging rather than pushing the link along.

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Antibiotic Prescribing to Kids — Down, But Still Too Much

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In the CDC’s weekly bulletin today, there’s a report: 58 percent of the antibiotic prescriptions given to kids and pre-teens during medical office visits are for conditions for which antibiotics are not necessary.

And that’s an improvement.

It’s a sign of how difficult it has become to change the trend of over-use of antibiotics in human medicine, which — along with overuse in agriculture — is one of the main drivers of the emergence of antibiotic resistance worldwide.

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Brief Promo: Superbug is at The Open Notebook

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I’m flattered to say that I’m the latest guest at the excellent site The Open Notebook, where veteran science writers Jeanne Erdmann and Siri Carpenter run deep-dive interviews with writers, bloggers and journalists about what underlies their stories.

We talk about how I got on the scary-disease beat, what journals I read, how I organize my materials — and what the emotional costs of this work are.

As bonuses, we’ve got a copy of my original pitch for The Enemy Within, my April 2011 Scientific American story on multi-drug resistance in Gram-negative bacteria; screenshots of some of the programs I use to keep track of my stuff; and — by far my favorite — a Soundslides of pictures I’ve taken in the field, overlaid with audio of me giving tips and telling stories. (It’s the first time Open Notebook has done multimedia, and we’re pretty excited about it.)

The Open Notebook is a fantastic resource; great science writers including my WiSci blog-sibling David Dobbs, Carl Zimmer, Robin Marantz Henig and Steve Silberman have all unpacked their stories there. I hope you’ll take a look.

Cost of Compassion: Drug Resistance in Military Hospitals

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Back in June, there was an unnerving report from the Centers for Disease Control and Prevention that NDM-1, the “Indian supergene” that renders common hospital-acquired infections practically untreatable, had been found in the military hospital at Bagram Air Base in Afghanistan.

The gene was being carried by a gut bacterium, Providencia stuartii, that was causing septicemia in an Afghan national who had been taken in by the military hospital. The particular strain of NDM-1 could be treated only by a single drug, aztreonam; it was resistant to everything else. Unsurprisingly, the victim died.

Though it wasn’t explicitly stated, the subtext of the CDC’s brief bulletin was clear: By extending compassion to the local resident (who was badly burned and had been treated at a hospital in Kabul), the military staff had brought into their hospital a highly resistant organism that could endanger their troops. It made me wonder, at the time, how often this happened, and what the consequences might be.

A study performed at Bagram, and published this month in Infection Control and Hospital Epidemiology, supplies an answer, and it’s a troubling one.

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Ringing the Warning Bell: Colistin-Resistant Klebsiella

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In all the latest bad news about bacteria becoming highly resistant — through carbapenem resistance, or the “Indian supergene” NDM-1 — there has been one hopeful thread: All of the organisms have remained susceptible to one very old, little-used drug called colistin.

That might be about to change. Which would be very, very bad news.

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Drug Resistance in Food — Coming From Aquaculture?

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In the midst of the giant Salmonella Heidelberg outbreak last week — now up to 107 cases in 31 states, and triggering a recall of 36 million pounds of ground turkey — it was easy to miss that a second and even more troubling strain of resistant Salmonella is on the move. As I wrote last week, that strain is called Salmonella Kentucky ST198, it is much more drug-resistant than the U.S. Heidelberg outbreak, and it has been spreading since 2002 from Egypt and north Africa through Europe, and has now been identified in the United States. Its primary vector appears to be chicken meat.

There is an interesting and troubling aspect to the spreading Kentucky strain that there wasn’t time to talk about last week, in the midst of the Heidelberg news. It’s this: The authors suspect that this enhanced resistance — to Cipro, and thus the class called fluoroquinolones that are very important in treating Salmonella — may have come into African chickens via drug use in aquaculture.

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Resistant Salmonella: Deadly Yet Somehow Not Illegal

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As the scale of the nationwide outbreak of Salmonella Heidelberg started to sink in Thursday — along with the stunningly large recall of 36 million pounds of ground turkey, much of it probably already eaten — there were a number of moments that made a careful listener need to stop and just think.

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Highly Resistant Salmonella: Poultry, Antibiotics, Borders, Risk

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If you’re a strain of Salmonella, it’s a very good week. If you’re a human, not so much.

There are two stories occurring simultaneously that underline the rising danger of drug-resistant organisms in the food supply, and the porousness of networks for detecting the dangerous bugs in time.

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Are Counterfeit Drugs Driving Antibiotic Resistance?

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A British couple have been convicted and jailed for running a black market in veterinary drugs that was so large, it earned more money than legal sales of the same drugs — 6 million pounds (almost $10 million) just in the United Kingdom where the case was brought.

(In a detail that seems made for the beleaguered UK tabloids, the wife of the couple moonlighted as a Princess Diana lookalike.)

The business — lucrative enough to pay for an 11-bedroom farmhouse in France — was based on counterfeit and falsely labeled drugs purchased primarily in India, imported covertly, and resold through a network of companies to farmers, stables and kennels, and veterinary practices. The drugs offered included anti-inflammatories, pain medications, sedatives and antibiotics. Which means that the case raises an important questions: How much counterfeit and covertly distributed drugs are contributing to the international epidemic of antibiotic resistance — in this case, not just in human medicine, but in veterinary medicine as well.

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The Clap Came Back: Multidrug-Resistant Gonorrhea

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Among the many unintended consequences of the 30-year AIDS epidemic has been a profound change in status for other sexually transmitted diseases. It feels slightly bizarre, for anyone who came of age after HIV arrived, to realize that syphilis and gonorrhea and their ilk were once as profoundly dreaded as AIDS is now, so important that they were considered major threats to military campaigns and were the first treatment targets for the earliest antimicrobial drugs.

Judging by data released Friday by the Centers for Disease Control, it might be time to take them seriously once again.

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How Much Is a Drug-Resistance Death Worth? Less Than $600

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So, antibiotic resistance: We care about it, right? The World Health Organization does: It made antimicrobial resistance the theme of this year’s World Health Day. The Centers for Disease Control and Prevention does. The journal Lancet Infectious Diseases says it’s a “global health concern.” The major association for infectious disease physicians has pleaded for attention. Two separate sets of legislators have introduced two bills in Congress.

You’d think, with all those calls for attention, that combating antibiotic resistance would be a priority in the United States. But if we can take how much we spend to research a problem as a gauge of how much we care about it, then antibiotic resistance is no priority at all.

As in: For every death from AIDS, the US federal research establishment awards approximately $69,000 in grant funds. And for every death from MRSA, it awards $570.

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