Hello from Nashville! I’m here for the gigantic, annual Food and Nutrition Conference & Expo (FNCE) to get my learn on about all the new happenings in Nutrition Science, and share the relevant material with YOU.

First up is antibiotic use in food animals and it’s (potential) contributions to antibiotic resistance in humans. I say potential because although research shows that resistant bacteria exists on farms and in food animals, we have few, if any, reliable systems in place to track bacteria from farm to fork. However, the reality is that people are getting sick from food-borne pathogens and these pathogens are often resistant to one or more antibiotics. The Centers for Disease Control and Prevention (CDC) estimates that annually, at least two million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States alone.

This post is my attempt to lay out why antibiotic resistance is an issue, where the nation is with addressing it, and what you can do to keep your family safe from resistant bacteria.

Alexander Fleming - The Father of Penicillin

In a 1945 interview with The New York Times, Fleming warned that misuse of penicillin could lead to the propagation of mutant forms of bacteria that would resist the new miracle drug. Before long, Levy writes, Fleming’s predictions came true; an estimated 14 percent of the staphylococcus strains isolated from patients in a London hospital had developed resistance to penicillin by 1946, just three years after the miracle drug was introduced.

-New York Times Magazine

We should have listened. Decades of our misuse and overuse of antibiotics has contributed to the emergence and spread of resistant bacteria. How?

• Physicians overprescribe and/or misperscribe antibiotics
• Patients do not finish the entire course of their antibiotic prescription
• There is little veterinary oversight of antibiotic prescription and use in food animals on the farm
  • Low dose, long term use for disease prevention and growth promotion
• Possible overuse and misuse of antibiotics in pets (by fault of the veterinarian and/or pet owner)

All of these factors cause “selection pressure” in bacteria which pressure the bacteria to adapt to their surroundings and survive; aka, resist the antibiotic. These resistant bacteria can then replicate and/or transfer resistance genes to other bacteria to pass on resistance, growing the resistant community. Fascinating, but scary, because if you get sick with a resistant bacterial infection, the necessary antibiotics may no longer work.

A few helpful tid bits of what we know and do not know about the spread of resistance from farm to fork:

To date, there is no farm to fork evidence that antibiotic resistance on the farm causes antibiotic resistance in humans. This doesn’t mean it isn’t possible, it just means that there is no research to say one thing over another. Last year at the Medical University of South Carolina I worked on a systematic literature review seeking to determine the types of evidence that exist for antibiotic resistance spreading from farm to fork. Of the bacteria we looked at, zero studies appropriately studied bacteria from farm to fork. We need better documentation and tracking systems of antibiotic use and bacterial infections so that we have actual data on which to base conclusions.

There IS evidence however, of food animals on the farm harboring antibiotic resistant bacteria, which could likely spread to humans. Appropriate cooking temperatures will kill these bacteria, but poor food sanitation practices won’t —> cross contamination in the kitchen.

There IS evidence that humans acquire bacterial resistant food borne infections. However, we don’t always know which food the bacteria came from, and if we did, we often times don’t know which farm that food came from.

There is a hugely unique relationship between type of antibiotic, bacteria, and animal that we haven’t fully grasped. If antibiotic use on the farm is a contributing factor to human resistance, the answer is not as easy as simply removing the use of antibiotics from the farm. This only works for specific antibiotics in specific animals so this practice cannot be standardized to all farms.

We are running out of working antibiotics and new ones are not being developed. It takes years, decades even to develop new drugs. Unfortunately, there are no new antibiotics on the horizon.

What are we doing about it?

In September 2014, the president released a National Strategy to Combat Antibiotic Resistance which outlines five interrelated goals for action by the US Government in collaboration with partners in healthcare, public health, veterinary medicine, agriculture, food safety, and academic, Federal, and industrial research:

1. Slow the Emergence of Resistant Bacteria and Prevent the Spread of Resistant Infections
2. Strengthen National One-Health Surveillance Efforts to Combat Resistance
3. Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria
4. Accelerate Basic and Applied Research and Development for New Antibiotics, Other Therapeutics, and Vaccines
5. Improve International Collaboration and Capacities for Antibiotic Resistance Prevention, Surveillance, Control, and Antibiotic Research and Development.

(to be achieved by 2020)

What can you do to slow the spread of resistance and keep your family safe from resistant food-borne infections?

• Practice good food safety measures at home
  • Fully cook your meat, poultry and eggs to kill any possible bacteria
  • Avoid cross contamination: thoroughly wash all surfaces that were exposed to raw meat (cutting boards, utensils, kitchen counter, areas that were splattered, etc). Also, use different cutting boards for raw meat and fresh produce preparation; or, thoroughly wash the cutting board and knife you used for the raw meat before using it on frehs produce.
• Reduce your risk of exposure by consuming less animal meats. You don’t need meat at every meal, every day. Plus, plant based diets are significantly healthier for you and the environment.
• Don’t treat your viral infection with an antibiotic. Antibiotics kill bacteria, not viruses, and taking an antibiotic when you don’t need one creates selective pressure on bacteria in your body, selecting for resistant bacteria.
• If you are prescribed an antibiotic, take the whole bottle. Don’t stop just because you’re feeling better. You’ve got to take it all.
• If you work in hospital or on a food animal farm, adopt an antibiotic stewardship program.
• Ensure that your veterinarian is judiciously prescribing antibiotics for your pet. Express your concern about giving your pet an antibiotic unless they really need it.

There is so much more to discuss on this topic but I’ll stop here.

What have you heard about antibiotic resistance? Have you ever been effected by it?