Tag Archives: antimicrobial resistance

Strengthening vet oversight of antimicrobial use in food animals: reducing antibiotics in meat — Part II

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Ron Doering, former president of the Canadian Food Inspection Agency and current counsel in the Ottawa offices of Gowlings (Ronald.doering@gowlings.com), reports with part II of his take on antimicrobiasl in food animal production:

While the medical commu­nity recognizes that the emergence and spread of antimicrobial resistance (AMR) in hu­mans is a potential disaster for humanity and that it is the overuse of antimicrobi­als in human medicine that is the largest contributor, there is a broad consensus that the use of antibiotics in animals contributes to the problem, though the scale is still unclear. This uncertainty is due mainly to a failure to adequately control and monitor the use. Health Canada (HC) lacks the authority to control and monitor use because the practice of veterinary medicine falls under provincial juris­diction. Recognizing that almost all practical efforts to reduce the level of antibiotics in meat depend on the more active participation of veterinarians, HC announced recently that it wanted “to develop options to strengthen the veterinary oversight of antimicrobial use in food animals.”

44755363What can veterinarians and their provincial regulatory licensing bodies do now to reduce the threat of AMR? Here are four suggestions:

1. Enhance awareness among members .

While the Canadian Veterinary Medical Association (CVMA) has developed vol­untary Prudent Use Guide­lines, I’m told that many vets are hardly aware of the issue and may not even know of the Guidelines. Concerned enough about this, Ontario’s regulatory body, the Col­lege of Veterinarians of Ontario, just an­nounced that it was launching a project to study the use of antibiotics among food animal veterinarians and to determine if they use the CVMA’s Guidelines in daily practice. Quebec requires a manda­tory day-long AMR program and a test. All provinces should follow Quebec and develop mandatory continuing education programs on antimicrobial stewardship.

2. Fill the regulatory gaps.

As long as vets continue to prescribe off label use and the use of Active Pharma­ceutical Ingredients (APIs) in production medicine, it’s impossible to know the level of antibiotic use. Own Use Importation (OUI) by animal owners is another avenue for which use information is un­available. As one recent report stressed: “The gap in reliable usage data makes it difficult to state with confidence which antimicrobials are used, in what quantities, and for what purposes.” The recent critical assessment by a group of experts, titled “Stewardship of antimicrobial drugs in animals in Canada: How are we doing in 2013?” (Canadian Veterinary Journal, March 2014), highlighted the absolute importance of improving Canada’s monitoring of antimicrobial usage.

3. Conflict of interest issue.

This issue has been flagged by several reports going back to the landmark McEwen Report of 2002. Veterinarians obtain income from the profitable sale of antimicrobials. Decoupling veterinary prescribing from dispensing raises several issues because the current veterinary prac­tice business model is based on an income stream from antimicro­bial sales. Veterinarians should lead a dialogue on this important issue that clearly needs closer examination.

ab.res.prudent.may.144. Antibiotics for disease prevention.

The real issue is not the use of antibiotics for growth promotion or the treating of disease, but whether they should continue to be used for disease prevention. While some antibiotics of very high importance to human health should only be used to treat infection, there are several arguments that some of high or medium importance to human health (what HC calls Category ll and lll, for example tetracyclines) should still, with closer veterinarian oversight, be used for disease prevention. Because major retailers, processors and consumers increasingly demand meat with “raised without antibiotic” claims, the marketplace is forcing changes in practice. But we mustn’t lose sight of the fact that while there are risks to using antimicrobials in animal production, there are also risks with non-use.

Two-thirds of animal diseases are zoo­notic, meaning the disease is transferable to humans. For this and other reasons, I have been a long-time proponent of strengthening the connections between human and animal medicine — the concept known as One Health. In this context, AMR represents an historic opportunity for vets to step up and provide greater leadership. 

Ron Doering: reducing antibiotics in meat

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Ron Doering, the first and only president of the Canadian Food Inspection Agency anyone can remember, and current counsel in the Ottawa offices of Gowlings (Ronald.doering@gowlings.com), writes in his monthly Food Law column that:

Health Canada (HC) and the Canadian Animal Health In­stitute (CAHI), the trade asso­ciation representing Canadian veterinary drug manufacturers, are to be com­mended for their decision on April 10 to follow the American initiative to address the growing concern over antimicrobial resistance in humans by introducing measures to promote the more prudent use of antimicrobials in animal produc­tion. HC announced its intention (1) “to work towards the removal of growth promotion and/or production claims of medically important antimicrobial drugs” and (2) “to develop options to strengthen the veterinary oversight of antimicrobial use in food animals.”

ab.res.prudent.may.14Contrary to many mainstream media reports, this does not mean that Canada is phasing out antibiotic use in meat production. Moreover, both initiatives face several difficult barriers to implementa­tion. This month we look at the difficulties associated with the first proposal, leaving next month for an analysis of why the oversight role by veterinarians must be strengthened if we are ever going to make real progress on what may be the most serious public health problem of our time.

First some law. The licensing and sale of antimicrobials fall under the jurisdic­tion of the federal government and its Food and Drugs Act, but the authority to manage their “use” lies with the provinces. The provinces also have the exclusive authority over the practice of veterinary medicine. What this means is that HC can require that a vet drug no longer have “growth promotion” as an indicated use on its label, but under the current regime it has limited power to actually determine how the drugs are used.

The issue of preventing growth promotion claims, and whether such a step will actually make a real difference, is a complex one. To begin with, most antibiotics are not actually used directly for growth promotion purposes but rather for disease prevention and control, what is often called disease prophylaxis. Removal of growth promotion claims will not prevent drugs to claim and be used for disease prevention. Farmers can continue to give their animals low doses of antibiotics to keep them from getting sick. The Public Health Agency of Canada, estimating that 90 per cent of the medication on farms is used for disease prevention, argues that antimicro­bials should not be used in this way and should be “limited to treating infection and not long-term mass medication for growth promotion or guarding against disease.” Others argue that there is insuf­ficient science to support the conclusion that low doses given to animals contrib­ute to antimicrobial resistance in humans and that outlawing the practice would result in more animal disease and the need for more drugs for disease treat­ment, possibly exacerbating the problem of antimicrobial resistance. When the science is uncertain, policy development is always difficult.

What is clear is that the proposal will not even apply to a large amount of anti­biotic use because of regulatory loopholes that result in part from our jurisdiction­ally fragmented regulatory framework. Our provinces still allow veterinarians to prescribe drugs for purposes not indicated on the product label (extra-label use). Unapproved drugs may be used on ani­mals because it is still legal for drugs to be imported for livestock production “own use” (OUI) if the drug is not offered for resale and it is not a prescrip­tion drug. As well, Active Pharmaceutical Ingredients (APIs) can still be imported by livestock producers to be mixed into feed on farm. None of these unregulated antibiotics are covered by the proposal. The latest Canadian Medical Association Journal contains a critical assessment of Canada’s performance in enhancing antimicrobial stewardship in agriculture and veterinary medicine, but it does state that HC has recently proposed measures to address OUI and API so, hopefully, reforms may be imminent.

As we shall see next month, none of the barriers described above can be adequately tackled without Canada’s veterinarians and their provincial regula­tory bodies taking a greater leadership role in combating the serious and growing problem of antimicrobial resistance in humans. Nowhere is the concept of One Health more compelling.

Australian livestock industries in ‘favorable position’ on antibiotic use

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Australia’s first national survey suggests livestock industries have, according to the Bush Telegraph, done a relatively good job of limiting the use of antibiotics.

The survey of 2,600 samples collected through 22 veterinary laboratories around Australia shows a low level of resistance to antibiotics.

ab.use.pigs.austThe labs tested for antibiotic resistance within two types of pathogens – E. coli and Golden Staph (Staphylococcus).

The survey found no resistance to carbapenems, an antibiotic class of last resort in human medicine used against infections when other antibacterial treatments have failed.

However the study identified ‘very low’ frequencies of resistance to other critically important human antimicrobials including fluoroquinolones and 3rd generation cephalosporins.

Professor John Turnidge, senior medical adviser on the Australian Commission on Safety and Quality in Health Care, says “what’s encouraging is the levels of resistance to the critical antibiotics for human health are close to zero.

“In part it’s due to the fact that by good foresight, good management, or good luck about 20 years ago for one particular class of antibiotics, we made a decision at a federal level that these shouldn’t be available for use in food animals and I think we’re reaping the benefit of that now.

“I’m embarrassed to say they (livestock industries) have been doing a better job than the human side.”

Canada’s chicken farmers ban injections that trigger resistance

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Canadian chicken farmers are putting an end to controversial egg injections, which provided the world with a “textbook” example of the perils of mass medication.

By injecting eggs at hatcheries with ceftiofur, a medically important antibiotic, the farmers triggered the rise of resistant microbes that showed up in both chickens and in Canadians creating a “major” public health concern.

double-facepalm1The case  – documented by federal and provincial sleuths who track microbes at farms, slaughterhouses and retail meat counters – is held up as powerful evidence of resistant superbugs moving from farm to fork.

“It is going to be in medical textbooks for as long as there are textbooks around,” says John Prescott, a professor with the Ontario Veterinary College at the University of Guelph.

On May 15 injecting eggs with ceftiofur will be banned as part of a new antibiotics policy adopted by Chicken Farmers of Canada, representing the 2,700 poultry farmers across the country.

“The industry has gone ahead and done this voluntarily, but it is not a voluntary program,” says Steve Leech, the association’s national programs manager.  He says the ban is mandatory with penalties and fines for violators.

While the ban is better late than never, Prescott says government should have stopped the injections years ago.

Microbe trackers working with the Public Health Agency of Canada first reported in 2003 that they were picking up higher rates of ceftiofur resistance in Quebec.  In 2004, they reported resistance was just as high in Ontario “in both humans and chicken.”

A strain of bacteria called Salmonella Heidelberg, that can cause food poisoning, had armed itself with the biochemical machinery needed to resist ceftiofur. Ceftiofur belongs to a class of antibiotics known as cephalosporins, which are often used on hard-to-cure infections in people.

FunkyChickenHiThe scientists soon linked the rise of the resistant Salmonella to chicken hatcheries that were injecting  ceftiofur into eggs prophylactically to try prevent infections in chicks.

The way Canadian hatcheries were allowed to keep using ceftiofur highlights the “inability” of  Canadian health officials to stop inappropriate use of  antibiotics, says Prescott.

“There was clear evidence of an adverse effect on public health,” he says, but dealing with the issue fell between the “gaps” in federal and provincial regulations.

Ceftiofur was never approved by Health Canada for use in chickens or eggs but hatcheries used it “extra-label,” which falls under the provincial jurisdiction.

Is grass-fed and organic beef microbiologically safer than conventional? No

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There are any number of agricultural production systems out there, each with their own way of making a buck and each with a certain level of hucksterism involved. I focus on whether the system and the end product are microbiologically safe. The best producers use techniques – regardless of political ideology – that fit best in their production system in their geographic location.

A new study in Foodborne Pathogens and Disease compared bacterial contamination rates and antimicrobial resistance in bacteria from 50 grass-fed and 50 conventionally produced beef products. The researchers from Purdue University and China concluded there was no safety advantage for either group.

The abstract is below:

Contamination rates and antimicrobial resistance in bacteria isolated from “grass-fed” labeled beef products
Foodborne Pathogens and Disease
Jiayi Zhang, Samantha K. Wall, Li Xu, Paul D. Ebner
http://www.liebertonline.com/doi/abs/10.1089/fpd.2010.0562
Abstract
Grass-fed and organic beef products make up a growing share of the beef market in the United States. While processing, animal handling, and farm management play large roles in determining the safety of final beef products, grass-fed beef products are often marketed as safer alternatives to grain-finished beef products based on the potential effects of all-forage diets on host microbiota. We conducted a series of experiments examining bacterial contamination rates in 50 beef products labeled as “grass-fed” versus 50 conventionally raised retail beef products. Coliform concentrations did not differ between conventional and grass-fed beef (conventional: 2.6 log10 CFU/mL rinsate; grass-fed: 2.7 log10 CFU/mL rinsate). The percentages of Escherichia coli positive samples did not differ between the two groups (44% vs. 44%). Enterococcus spp. were frequently isolated from both grass-fed beef products (44%) and conventional beef products (62%; p=0.07). No Salmonella or E. coli O157:H7 isolates were recovered from any of the meat samples. Enterococcus spp. isolates from conventional beef were more frequently resistant to daptomycin and linezolid (p<0.05). Resistance to some antimicrobials (e.g., chloramphenicol, erythromycin, flavomycin, penicillin, and tetracyline) was high in Enterococcus spp. isolated from both conventional and grass-fed beef. There were no differences in the percentages of antimicrobial resistant E. coli isolates between the two groups. Taken together, these data indicate that there are no clear food safety advantages to grass-fed beef products over conventional beef products.
 

Safe food is food that doesn’t make you barf; don’t like it, make your own definition

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“Just when I thought I was out, they pulled me back in.”

That’s from the truly terrible movie, The Godfather III (see below), but I prefer Sil’s impersonation on the truly terrific television series, The Soprano’s (right).

Safe food is food that doesn’t make you barf.

At least that’s my definition. Food safety has come to mean all things to all people, but to me, food safety is about minimizing the chemical, physical and especially microbial risks that can be found in food. The risks that make up to 30 per cent of all people in all countries barf every year (or at least that’s the number the World Health Organization says; when are those updated U.S. numbers coming out?)

Animal welfare, genetic engineering, local/organic/natural, trans fat and fat kids, these are all bandied about under the rubric of food safety, but have little or nothing to do with safety. These issues are valid on their own but are primarily about lifestyle choices and food porn. Americans love choice.

And to talk.

Reminds me of that scene from Monty Python’s, The Meaning of Life, when death visits the dinner party:

“Shut up. Shut up you Americans. You always talk, you Americans. You always talk and you talk and you say, ‘Let me tell you something,’ and ‘I just wanna say this.’ Well you’re dead now, so shut up.”

(Python food safety note: The dinner guests all died at the same time from presumably botulism in the salmon mousse. “Darling, you didn’t use canned salmon, did you?”)

Every time I focus on core food safety issues, someone tries to pull me back in to lifestyle debates. Sure I dabbled in genetic engineering and food production systems – doesn’t everyone in college – but I got enough to do focusing on the things that make people barf.

For the past week, the Intertubes have been pneumonically spewing out messages about the risks of antimicrobials in animal husbandry since a CBS News so-called special report aired on the issue.

Antimicrobial resistance is one of those persistent ag issues where — like me crossing the border into the U.S. – every journalist or customs officer thinks she’s discovered something no one else has yet.

They’re always wrong.

Antimicrobial resistance has been on the public agenda since the Swann report of 1969. It’s a risk, it needs to be managed, just like any other risk, to maximize benefits and minimize risk.

But leave it to Whole Foods to go over-the-top, in a blog post entitled, Our meat: No antibiotics, EVER!

(The capitalization and exclamation marks are from the Whole Foods original blog post, the authors and editors who apparently think their readers have disorders and need to be bashed with punctuation and capitalization)

Theo Weening, the national meat buyer for Whole Foods Market, says he “can assure our customers that our standard is: No antibiotics, EVER! We work very hard to make sure that the people who produce our meat have raised their animals without the use of antibiotics, growth hormones* or animal byproducts in the feed.”

Meat-buyer Weening fails to distinguish between the routine use of antibiotics as growth promotants and the use of antibiotics to treat animals that are sick. Should sick animals be deprived antibiotics? Wouldn’t that go against animal welfare standards?

And note the asterick beside the no growth hormone BS. At the end of the blog post, there is an asterick with the comment, “*Federal regulations prohibit the use of growth hormones in raising pigs, veal calves, bison and poultry.”

Tyson already tried this line of labeling. Didn’t work. Whole Foods is hopeless.

What I really want to know is if the Whole Foods or any other steak has been needle tenderized or not so I can adjust my cooking temperature (as verified by a tip-sensitive digital thermometer). Those are the kinds of things that make people barf.