Joint Opinion on antimicrobial resistance (AMR) focused on zoonotic infections

Prevalence, drug resistance spectrum and virulence gene analysis of Campylobacter jejuni in broiler farms in central Shanxi, China

This study collected 324 chicken cloacal swabs from 6 broiler farms in 4 different areas in Shanxi Province, China (i.e., Lvliang, Taiyuan, Jinzhong, and Yangquan), and analyzed the antimicrobial resistance and virulence-associated genes of the isolates to investigate the prevalence, drug resistance, and virulence gene data of Campylobacter jejuni in broilers. The population structure of C. jejuni and genetic evolutionary relationships among isolates from broiler farms in different regions were studied by using multilocus sequence typing. A total of 35 C. jejuni isolates with an infection rate of 10.8% (35/324) were obtained. The isolates were most resistant to ampicillin (85.7%) and were most sensitive to erythromycin (14.3%). Isolates with multidrug resistance accounted for 88.6% of the total isolates. In this experiment, 15 distinct sequence types were identified and included 9 new unique sequence types. cadF was present in all isolates, and ciaB had the lowest prevalence (51.4%). C. jejuni collected from broiler farms in central Shanxi had varied infection rates, and their overall positive rate was lower than of C. jejuni collected from other regions of the country. The isolates had high resistance to quinolones and β-lactams, and multidrug resistance was prevalent. The isolates were genotypically diverse and carried 5 virulence-associated genes at high rates. Therefore, the importance of source contamination control in broiler farms is emphasized and may have considerable effects on human and animal health.

Individual antimicrobial treatments in veal calves: Effect on the net carcasses weight at the slaughterhouse and relationship with the serostatus of the calves upon arrival to the fattening unit

In recent years, the scientific community, institutions, and public opinion have shown a growing awareness towards the problem of antimicrobial resistance. Guidelines from the European Union aim at significantly reducing (even avoiding) the antimicrobial use for prophylactic and metaphylactic purposes in veterinary medicine and this represents an important issue for several intensive farming systems, such as the veal industry. This retrospective observational cohort study analyzed net carcass weight data at the slaughter of 618 veal calves belonging to 6 batches of animals fattened in an Italian commercial farm according to the number of individual antimicrobial treatments administered during the fattening cycle. Sixty-eight percent (419 animals) of the overall sample of calves received at least one individual antimicrobial treatment due to a disease event during the fattening, and 280 of these (45 % of the overall sample) had more than one treatment. On average, the net carcass weight of calves individually treated more than once was about 10 kg lower than that of untreated calves or treated only once. Moreover, the carcasses of calves that received more than one treatment were 16 times more at risk of being severely penalized in payment at the slaughterhouse due to a net weight below 110 kg than those of untreated calves. Serum analysis data of a subsample of 105 calves belonging to 3 out of the 6 batches collected within 5 days after their arrival to the veal farm identified 3 persistently infected animals by bovine viral diarrhea (BVD) virus and a prevalence of calves with serum immunoglobulin concentration below 7.5 g/L of 37 %. The presence of specific antibodies against infectious bovine rhinotracheitis (IBR) and bovine respiratory syncytial virus (BRSV) and a serum immunoglobulin level above 7.5 g/L at the onset of the fattening were the most important factors associated with a decreased risk of multiple individual antimicrobial treatments (and thus, disease development) or with a delay in disease onset during the fattening, thus leading to better performances at the slaughter. The outcomes of this study suggested that a relationship could exist between calf serostatus upon arrival to the veal farm and the possibility to avoid multiple individual antimicrobial treatments during fattening. Further research is needed to deeply study this association, as such knowledge would allow for planning effective preventing strategies to reduce the antimicrobial use in veal calves.

Characterization of Bacteria and Antibiotic Resistance in Commercially Produced Cheeses Sold in China

ABSTRACT

The consumption of cheese in the People's Republic of China is increasing rapidly. Little is known about the microbiota, the presence of antibiotic-resistant bacteria, or the distribution of antibiotic resistance genes (ARGs) in commercially produced cheeses sold in China. This information is important for evaluating quality and safety. This study was conducted using 16S rRNA gene sequencing to assess the metagenomics of 15 types of cheese. Fourteen bacterial genera were detected, and Lactococcus, Lactobacillus, and Streptococcus were dominant based on number of sequence reads. Multidrug-resistant lactic acid bacteria (i.e., resistant to two or more types of antibiotic) were isolated from most of the types of cheese. Of these isolates, 100 and 91.7% were resistant to streptomycin and sulfamethoxazole, respectively, and genes involved in acquired resistance to streptomycin (strB) and sulfonamides (sul2) were detected with high frequency. To analyze the distribution of ARGs in the cheeses overall, 309 ARGs from eight categories and nine transposase genes were profiled. A total of 169 ARGs were detected in the 15 cheeses; their occurrence and abundance varied significantly between cheeses. Our study revealed diverse bacteria and ARGs in cheeses sold in China. The risks associated with multidrug resistance among dominant lactic acid bacteria are of great concern.

HIGHLIGHTS

Occurrence and antimicrobial resistance of zoonotic enteropathogens in gulls from southern Europe

Campylobacter spp. and Salmonella spp. are the two most frequent zoonotic bacteria involved in human enteric infections in the European Union. Both enteropathogens have been isolated from a diversity of wild birds in Northern Europe, but there is limited information about gulls as potential reservoirs in Southern Europe. A broad sampling of fledglings from nine colonies of yellow-legged gull (Larus michahellis, N = 1222) and Audouin's gull (Larus audouinii, N = 563) has been conducted in Spain and Tunisia during the late chick-rearing period. Overall, the occurrence of Campylobacter spp. and Salmonella spp. was 5.2% (93/1785, CI_95%: 4.2-6.2%) and 20.8% (371/1785, CI_95%: 18.9-22.7%), respectively. The most predominant Campylobacter species was C. jejuni (94.6%). A high diversity of Salmonella serovars was isolated and the most frequent were those also reported in human outbreaks, such as Salmonella Typhimurium. A high proportion of Campylobacter and Salmonella isolates showed resistance to at least one antimicrobial agent (20.2% and 51.5%, respectively), while 19.2% of Salmonella isolates were multidrug-resistant. These results show the relevance of gulls as reservoirs of Campylobacter and Salmonella by maintaining and spreading these bacteria, including resistant and multidrug resistant strains, in the environment. Our results suggest that gulls can serve as sentinel species for antibiotic pressure in the environment.

Antimicrobial resistance and related gene analysis of Salmonella from egg and chicken sources by whole-genome sequencing

Whole-genome sequencing (WGS) is a valuable tool in research on foodborne pathogens. In this study, a total of 143 isolates of Salmonella serotypes Enteritidis, Typhimurium, and Heidelberg sourced from eggs and chickens were analyzed for their antimicrobial resistance profiles using WGS data. The isolates carried high rate of genes resistant to aminoglycoside (70.63%), tetracycline (26.57%), fosfomycin (25.17%), sulfonamides (23.78%), and β-lactamases (15.38%); and aadA was the most frequently observed antimicrobial resistance gene (ARG). Antimicrobial resistance varies by Salmonella serotypes, with Salmonella enterica serovar Enteritidis (Salmonella ser. Enteritidis) isolates being highly resistant to aminoglycoside (particularly streptomycin); Salmonella ser. Typhimurium more resistant to aminoglycoside, tetracycline, and sulfonamides; and Salmonella ser. Heidelberg more resistant to aminoglycoside and fosfomycin. Salmonella ser. Typhimurium isolates presented more varieties of ARG than Salmonella ser. Enteritidis and Salmonella ser. Heidelberg. Our data showed that 5 isolates of Salmonella ser. Typhimurium and Salmonella ser. Heidelberg contained ARG resistant to ≥ 5 antimicrobials. In addition, 23 Salmonella isolates carried ARG resistant to 4 antimicrobials.

Food-to-Humans Bacterial Transmission

Microorganisms vehiculated by food might benefit health, cause minimal change within the equilibrium of the host microbial community or be associated with foodborne diseases. In this chapter we will focus on human pathogenic bacteria for which food is conclusively demonstrated as their transmission mode to human. We will describe the impact of foodborne diseases in public health, the reservoirs of foodborne pathogens (the environment, human and animals), the main bacterial pathogens and food vehicles causing human diseases, and the drivers for the transmission of foodborne diseases related to the food-chain, host or bacteria features. The implication of food-chain (foodborne pathogens and commensals) in the transmission of resistance to antibiotics relevant to the treatment of human infections is also evidenced. The multiplicity and interplay of drivers related to intensification, diversification and globalization of food production, consumer health status, preferences, lifestyles or behaviors, and bacteria adaptation to different challenges (stress tolerance and antimicrobial resistance) from farm to human, make the prevention of bacteria-food-human transmission a modern and continuous challenge. A global One Health approach is mandatory to better understand and minimize the transmission pathways of human pathogens, including multidrug-resistant pathogens and commensals, through food-chain.

Microarray-based detection of resistance and virulence factors in commensal Escherichia coli from livestock and farmers in Egypt

The objective of our study was to provide a molecular analysis using DNA-microarray based assays of commensal E. coli populations from apparently healthy livestock and their attendants to assess the virulence potential as well as multidrug resistance (MDR) genotypes. We randomly collected 132 fecal samples from seemingly healthy smallholder´s food producing animals [buffalo (n = 32) and cattle (n = 50)] as well as from contacting farmers (n = 50). Bacterial isolation and identification were performed using standard protocols, while E. coli isolates were characterized using a DNA microarray system targeting 60 different virulence and 47 antibiotic resistance genes of clinical importance and allowing assignment to most common H and O types. From the fecal samples examined, 47 E. coli isolates were obtained. The array predicted serotypes for 14 out of the 47 E. coli isolates. Six E. coli isolates were identified as STEC since Shiga toxin genes were detected. In summary, 36 different virulence genes were identified; of which, hemL, lpfA and iss were most prevalent. Thirty-four E. coli isolates were found to carry at least one antimicrobial resistance gene. Of these, 20 did exhibit genes allowing strain classification as MDR. More than half of the isolates contained antimicrobial resistance genes associated with beta lactam resistance 27/47 (57.5 %). The 13 remaining isolates did not contain any resistance gene tested with the array. Our study demonstrated the presence of antimicrobial resistance genes and virulence genotypes among commensal E. coli of human and animal sources.

Characterization of Biological Resistance and Successful Drug Resistance Control in Medicine

It has now been a century that drug resistance has been getting worse in human infectious diseases medicine. A similar trend is observed in veterinary medicine and agriculture. The successful control of drug resistance requires an understanding of biological resistance in general, as a phenomenon taking place in nature. Once we have understood the main characteristics of biological resistance and how it operates in nature, we can then apply that new understanding to its subset that drug resistance in human medicine is. Possession of such an edge can also lead to the successful control of resistance in veterinary medicine, in agriculture, and in other settings of resistance activity by biological organisms. Based on biological resistance data from human medicine, veterinary medicine, and agriculture, some of the fundamental characteristics of resistance as a natural process displayed by all living organisms are established. The consistent, common features characterizing the data are exploited, as is a mathematical model depicting how biological resistance strengthens in living organisms. It is found that biological resistance in general, and drug resistance in particular, is a phenomenon governed by at least two laws: the First Law of Resistance, requiring a threshold to be met before resistance can be prevented and the Second Law of Resistance, causing resistance to strengthen to infinite levels if unstopped. Inference is thereafter made as to the drug design strategy required for the successful control of resistance in medicine. To that end, the blueprint currently applied in the design of infectious diseases drugs needs revising.

The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2017

The data on antimicrobial resistance in zoonotic and indicator bacteria in 2017, submitted by 28 EU Member States (MSs), were jointly analysed by EFSA and ECDC. Resistance in zoonotic Salmonella and Campylobacter from humans, animals and food, and resistance in indicator Escherichia coli as well as meticillin‐resistant Staphylococcus aureus in animals and food were addressed, and temporal trends assessed. ‘Microbiological’ resistance was assessed using epidemiological cut‐off (ECOFF) values; for some countries, qualitative data on human isolates were interpreted in a way which corresponds closely to the ECOFF‐defined ‘microbiological’ resistance. In Salmonella from humans, as well as in Salmonella and E. coli isolates from fattening pigs and calves of less than 1 year of age, high proportions of isolates were resistant to ampicillin, sulfonamides and tetracyclines, whereas resistance to third‐generation cephalosporins was uncommon. Varying occurrence/prevalence rates of presumptive extended‐spectrum beta‐lactamase (ESBL)/AmpC producers in Salmonella and E. coli monitored in meat (pork and beef), fattening pigs and calves, and Salmonella monitored in humans, were observed between countries. Carbapenemase‐producing E. coli were detected in one single sample from fattening pigs in one MS. Resistance to colistin was observed at low levels in Salmonella and E. coli from fattening pigs and calves and meat thereof and in Salmonella from humans. In Campylobacter from humans, high to extremely high proportions of isolates were resistant to ciprofloxacin and tetracyclines, particularly in Campylobacter coli. In five countries, high to very high proportions of C. coli from humans were resistant also to erythromycin, leaving few options for treatment of severe Campylobacter infections. High resistance to ciprofloxacin and tetracyclines was observed in C. coli isolates from fattening pigs, whereas much lower levels were recorded for erythromycin. Combined resistance to critically important antimicrobials in both human and animal isolates was generally uncommon but very high to extremely high multidrug resistance levels were observed in S. Typhimurium and its monophasic variant in both humans and animals. S. Kentucky from humans exhibited high‐level resistance to ciprofloxacin, in addition to a high prevalence of ESBL.

Non-typhoidal Salmonella in the Pig Production Chain: A Comprehensive Analysis of Its Impact on Human Health

Salmonellosis remains one of the most frequent foodborne zoonosis, constituting a worldwide major public health concern. The most frequent sources of human infections are food products of animal origin, being pork meat one of the most relevant. Currently, particular pig food production well-adapted and persistent Salmonella enterica serotypes (e.g., Salmonella Typhimurium, Salmonella 1,4,[5],12:i:-, Salmonella Derby and Salmonella Rissen) are frequently reported associated with human infections in diverse industrialized countries. The dissemination of those clinically-relevant Salmonella serotypes/clones has been related to the intensification of pig production chain and to an increase in the international trade of pigs and pork meat. Those changes that occurred over the years along the food chain may act as food chain drivers leading to new problems and challenges, compromising the successful control of Salmonella. Among those, the emergence of antibiotic resistance in non-typhoidal Salmonella associated with antimicrobials use in the pig production chain is of special concern for public health. The transmission of pig-related multidrug-resistant Salmonella serotypes, clones and/or genetic elements carrying clinically-relevant antibiotic resistance genes, frequently associated with metal tolerance genes, from pigs and pork meat to humans, has been reported and highlights the contribution of different drivers to the antibiotic resistance burden. Gathered data strengthen the need for global mandatory interventions and strategies for effective Salmonella control and surveillance across the pig production chain. The purpose of this review was to provide an overview of the role of pig and pork meat in human salmonellosis at a global scale, highlighting the main factors contributing to the persistence and dissemination of clinically-relevant pig-related Salmonella serotypes and clones.

Characterization of Salmonella enterica serovars recovered from meat products legally and illegally imported into the EU reveals the presence of multiresistant and AmpC-producing isolates

BACKGROUND

Food products of animal origin brought into the EU from third countries, both legally and illegally, can harbor foodborne pathogens such as Salmonella enterica. In this study, we examined five S. enterica isolates recovered either from legally imported chicken meat (n = 3) or from meat products confiscated from air travel passengers arriving in Germany (n = 2). The isolates were serotyped and further characterized by antimicrobial susceptibility testing, PCR-detection and sequencing of genes associated with antimicrobial resistances, and macrorestriction analysis. Transferability of resistance to third-generation cephalosporins was assessed by conjugation experiments and the plasmids tested for their incompatibility groups.

RESULTS

The three isolates from legal imports were identified as S. Heidelberg or as non-flagellated. All three isolates were identified as AmpC producers carrying bla CMY-2 and as non-susceptible to ciprofloxacin. They were additionally resistant to tetracycline and sulfamethoxazole. The bla CMY-2-carrying plasmids were transferable by conjugation and belonged to incompatibility groups IncI1 or IncA/C. The two isolates from illegally imported meat belonged to the serovars Infantis or Weltevreden. The former was phenotypically resistant to five classes of antimicrobial agents while the S. Weltevreden isolate was fully susceptible to all agents tested.

CONCLUSION

The results of this study demonstrate that meat products imported from third countries, both legally and illegally, can harbor multiresistant Salmonella enterica. Consequently, these imports could constitute a source for the dissemination of antimicrobial resistant isolates, including those resistant to third-generation cephalosporins and fluoroquinolones.

Using design theory to foster innovative cross-disciplinary research: Lessons learned from a research network focused on antimicrobial use and animal microbes' resistance to antimicrobials

Dealing with the major societal and research challenges related to antimicrobial use will require cross-disciplinary research and strong relationships between researchers and stakeholders. Design theories, such as the concept-knowledge (C-K) theory, can help spur the emergence of innovation. Here, our objective was to examine how the C-K theory could promote the development of novel, cross-disciplinary research projects on antimicrobial use and animal microbes' resistance to antimicrobials. A French research network (R2A2; Réseau Recherche Antibiotiques Animal) was created whose goal was to foster cross-disciplinary research and scientific discussion on these topics. The R2A2 network hosted general meetings and thematic workshops, during which participants brainstormed using C-K diagrams. The network's performance was evaluated through the evolution of C-K diagrams, project creation, and participant interviews. R2A2 led to the creation of a minimum of eight research projects. The participants felt network events facilitated interactions and collaborations with researchers in different disciplines. The R2A2 network has opened new avenues of research into several important topics: antimicrobial use on farms, the environmental impacts of antimicrobials, animal immunity, and alternative treatments. The keys to its success were: (i) participant interest; (ii) the use of C-K design theory to encourage cross-disciplinary thinking; (iii) the aim of fostering several small projects rather than one large project; and (iv) network responsiveness to participant needs with regards to meeting and workshop topics. C-K theory served a key role in promoting cross-disciplinary thinking on topics at the interface between research and stakeholder interests.

The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2016

The data on antimicrobial resistance in zoonotic and indicator bacteria in 2016, submitted by 28 EU Member States (MSs), were jointly analysed by the EFSA and ECDC. Resistance in bacterial isolates of zoonotic Salmonella and Campylobacter from humans, animals and food, and resistance in indicator Escherichia coli as well as in meticillin-resistant Staphylococcus aureus from animals and food were addressed. 'Microbiological' resistance was assessed using epidemiological cut-off (ECOFF) values; for some countries, qualitative data on isolates from humans were interpreted in a way that corresponds closely to ECOFF-defined 'microbiological' resistance. In Salmonella from humans, the occurrence of resistance to ampicillin, sulfonamides and tetracyclines was high, whereas resistance to third-generation cephalosporins was low. In Salmonella and E. coli isolates from broilers, fattening turkeys and their meat, resistance to ampicillin, (fluoro)quinolones, tetracyclines and sulfonamides was frequently high, whereas resistance to third-generation cephalosporins was rare. The occurrence of ESBL-/AmpC producers was low in Salmonella and E. coli from poultry and in Salmonella from humans. The prevalence of ESBL-/AmpC-producing E. coli, assessed in poultry and its meat for the first time, showed marked variations among MSs. Fourteen presumptive carbapenemase-producing E. coli were detected from broilers and its meat in two MSs. Resistance to colistin was observed at low levels in Salmonella and E. coli from poultry and meat thereof and in Salmonella from humans. In Campylobacter from humans, broilers and broiler meat, resistance to ciprofloxacin and tetracyclines was high to extremely high, whereas resistance to erythromycin was low to moderate. Combined resistance to critically important antimicrobials in isolates from both humans and animals was generally uncommon, but very high to extremely high multidrug resistance levels were observed in certain Salmonella serovars. Specific serovars of Salmonella (notably Kentucky) from both humans and animals exhibited high-level resistance to ciprofloxacin, in addition to findings of ESBL.

Antimicrobial resistance: A global emerging threat to public health systems

Antimicrobial resistance (AMR) became in the last two decades a global threat to public health systems in the world. Since the antibiotic era, with the discovery of the first antibiotics that provided consistent health benefits to human medicine, the misuse and abuse of antimicrobials in veterinary and human medicine have accelerated the growing worldwide phenomenon of AMR. This article presents an extensive overview of the epidemiology of AMR, with a focus on the link between food producing-animals and humans and on the legal framework and policies currently implemented at the EU level and globally. The ways of responding to the AMR challenges foresee an array of measures that include: designing more effective preventive measures at farm level to reduce the use of antimicrobials; development of novel antimicrobials; strengthening of AMR surveillance system in animal and human populations; better knowledge of the ecology of resistant bacteria and resistant genes; increased awareness of stakeholders on the prudent use of antibiotics in animal productions and clinical arena; and the public health and environmental consequences of AMR. Based on the global nature of AMR and considering that bacterial resistance does not recognize barriers and can spread to people and the environment, the article ends with specific recommendations structured around a holistic approach and targeted to different stakeholders.

Clonal Expansion of Biofilm-Forming Salmonella Typhimurium ST34 with Multidrug-Resistance Phenotype in the Southern Coastal Region of China

To disclose the antibiotics susceptibility and wide adaptability of commonly occurring genotypes of Salmonella Typhimurium, the antibiotic resistance and biofilm formation of different multi-locus sequence typing (MLST) types of a collection of 240 S. Typhimurium isolates (33 food and 207 clinical ones) during 2010–2014 in Shenzhen were analyzed. Among these strains, 167 was ST34 (69.58%), and 57 was ST19 (23.75%), respectively. A total of 159 (95.21%) ST34 strains displayed the multidrug resistant phenotype (≥ three classes of antibiotic), whereas only 23 (40.35%) ST19 ones did (P < 0.01). Moreover, a relative high proportion (72.46%) of ST34 isolates was classified as moderate to strong biofilm-producers, while only 15.79% of ST19 (P < 0.01) was. Among the food isolates, more than half (51.52%) were from livestock products, among which 41.18% classified as moderate to strong biofilm-producers. In summary, this study highlights the expansion of S. Typhimurium ST34 of strong biofilm-forming ability and multidrug resistance in the southern coastal region of China. Therefore, monitoring the occurrence of ST34 S. Typhimurium in food sources, especially in livestock products, and taking appropriate measures to control Salmonella spp. infections via decreasing biofilm formation should be addressed.

The European Union summary report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2015

The data on antimicrobial resistance in zoonotic and indicator bacteria in 2015, submitted by 28 EU Member States (MSs), were jointly analysed by EFSA and ECDC. Resistance in zoonotic Salmonella and Campylobacter from humans, animals and food, and resistance in indicator Escherichia coli as well as meticillin‐resistant Staphylococcus aureus in animals and food were addressed. ‘Microbiological’ resistance was assessed using epidemiological cut‐off (ECOFF) values; for some countries, qualitative data on human isolates were interpreted in a way which corresponds closely to the ECOFF‐defined ‘microbiological’ resistance. In Salmonella from humans, high proportions of isolates were resistant to ampicillin, sulfonamides and tetracyclines, whereas resistance to third‐generation cephalosporins was low. In Salmonella and Escherichia coli isolates from fattening pigs and calves under one year of age, resistance to ampicillin, tetracyclines and sulfonamides was frequently detected, whereas resistance to third‐generation cephalosporins was uncommon. For the first time, presumptive extended‐spectrum beta‐lactamase (ESBL)‐/AmpC‐/carbapenemase‐production in Salmonella and Escherichia coli was monitored in humans (Salmonella), meat (pork and beef), fattening pigs and calves. Varying occurrence/prevalence rates of ESBL‐/AmpC‐producers were observed between countries, and carbapenemase‐producing Escherichia coli were detected in single samples of pig meat and from fattening pigs from two MSs. Resistance to colistin was observed at low levels in Salmonella and Escherichia coli from fattening pigs and calves under one year of age and meat thereof. In Campylobacter from humans, high to extremely high proportions of isolates were resistant to ciprofloxacin and tetracyclines, particularly in C. coli. In a few countries, a third to half of C. coli in humans were resistant also to erythromycin, leaving few options for treatment of severe Campylobacter infections. High resistance to ciprofloxacin and tetracyclines was observed in C. coli isolates from fattening pigs, whereas much lower levels were recorded for erythromycin. Co‐resistance to critically important antimicrobials in both human and animal isolates was generally uncommon.

Microencapsulation with alginate/CaCO3: A strategy for improved phage therapy

Bacteriophages are promising therapeutic agents that can be applied to different stages of the commercial food chain. In this sense, bacteriophages can be orally administered to farm animals to protect them against intestinal pathogens. However, the low pH of the stomach, the activities of bile and intestinal tract enzymes limit the efficacy of the phages. This study demonstrates the utility of an alginate/CaCO₃ encapsulation method suitable for bacteriophages with different morphologies and to yield encapsulation efficacies of ~100%. For the first time, a cocktail of three alginate/CaCO₃-encapsulated bacteriophages was administered as oral therapy to commercial broilers infected with Salmonella under farm-like conditions. Encapsulation protects the bacteriophages against their destruction by the gastric juice. Phage release from capsules incubated in simulated intestinal fluid was also demonstrated, whereas encapsulation ensured sufficient intestinal retention of the phages. Moreover, the small size of the capsules (125–150 μm) enables their use in oral therapy and other applications in phage therapy. This study evidenced that a cocktail of the three alginate/CaCO₃-encapsulated bacteriophages had a greater and more durable efficacy than a cocktail of the corresponding non-encapsulated phages in as therapy in broilers against Salmonella, one of the most common foodborne pathogen.

Risk for the development of Antimicrobial Resistance (AMR) due to feeding of calves with milk containing residues of antibiotics

EFSA was requested to: 1) assess the risk for the development of antimicrobial resistance (AMR) due to feeding on farm of calves with colostrum potentially containing residues of antibiotics; 2) assess the risk for the development of AMR due to feeding on farm of calves with milk of cows treated during lactation with an antibiotic and milked during the withdrawal period, and 3) propose possible options to mitigate the risk for the development of AMR derived from such practices. Treatment of dairy cows during the dry period and during lactation is common in the EU Member States. Penicillins, alone or in combination with aminoglycosides, and cephalosporins are most commonly used. Residue levels of antimicrobials decrease with the length of the dry period. When the interval from the start of the drying-off treatment until calving is as long as or longer than the minimum specified in the Summary of Product Characteristics of the antimicrobial, faecal shedding of antimicrobial-resistant bacteria will not increase when calves are fed colostrum from treated cows. Milk from cows receiving antimicrobial treatment during lactation contains substantial residues during the treatment and withdrawal period. Consumption of such milk will lead to increased faecal shedding of antimicrobial-resistant bacteria by calves. A range of possible options exist for restricting the feeding of such milk to calves, which could be targeting the highest priority critically important antimicrobials. β-Lactamases can reduce the concentration of β-lactams which are the most frequently used antimicrobials in milking cows. Options to mitigate the presence of resistant bacteria in raw milk or colostrum are mainly based on thermal inactivation.

Modeling and predicting drug resistance rate and strength

Drug resistance has been worsening in human infectious diseases medicine over the past several decades. Our ability to successfully control resistance depends to a large extent on our understanding of the features characterizing the process. Part of that understanding includes the rate at which new resistance has been emerging in pathogens. Along that line, resistance data covering 90 infectious diseases, 118 pathogens, and 337 molecules, from 1921 through 2007, are modeled using various statistical tools to generate regression models for the rate of new resistance emergence and for cumulative resistance build-up in pathogens. Thereafter, the strength of the association between the number of molecules put on the market and the number of resulting cases of resistance is statistically tested. Predictive models are presented for the rate at which new resistance has been emerging in infectious diseases medicine, along with predictive models for the rate of cumulative resistance build-up in the aggregate of 118 pathogens as well as in ten individual pathogens. The models are expressed as a function of time and/or as a function of the number of molecules put on the market by the pharmaceutical industry. It is found that molecules significantly induce resistance in pathogens and that new or cumulative drug resistance across infectious diseases medicine has been arising at exponential rates.

Influence of porcine circovirus type 2 vaccination on the level of antimicrobial consumption on 65 Austrian pig farms

The administration of antibiotics to farm animals is an important contemporary topic. Veterinarians, pig producers, politicians, retailers and consumers all have a vested interest in reducing antimicrobial use on farm, while ensuring adequate health and welfare of food-producing animals. Vaccination programmes may be used to reduce the overall level of clinical disease in a population, subsequently leading to a decline in antimicrobial use. In 2008, a vaccination programme against porcine circovirus type 2 (PCV-2) was initiated in Austria. In the retrospective observational study presented here, farm medication records (2008-2011) from 65 conventional pig farms were evaluated. As PCV-2 has been shown to lead to generalised immunosuppression, enabling secondary bacterial infections to occur, the authors hypothesised that PCV-2 vaccination would decrease antimicrobial consumption at farm level. Firstly, we focused on the annual antimicrobial consumption expressed as the number of administered animal daily doses per kg liveweight (nADDkg/kg/year). Secondly, a linear mixed effects model was applied to evaluate the influence of PCV-2 vaccination on the antimicrobial consumption at farm level. The interaction between farm type and PCV-2 vaccination was found to be a highly significant factor (P=0.0002) influencing antimicrobial use at farm level. The estimated impact of PCV-2 vaccination revealed a highly significant (P<0.001) decline in total antimicrobial drug use from 1.72 ADDkg/kg/year to 0.56 ADDkg/kg/year on finishing farms, whereas only a negligible decline was detectable on farrow-to-finish farms.

Salmonellosis: the role of poultry meat

Salmonellosis remains one of the most frequent food-borne zoonoses, constituting a worldwide major public health concern. Currently, at a global level, the main sources of infection for humans include meat products, including the consumption of contaminated poultry meat, in spite of the success of Salmonella control measures implemented in food-animal production of industrialized countries. In recent years, a shift in Salmonella serotypes related to poultry and poultry production has been reported in diverse geographical regions, being particularly associated with the spread of certain well-adapted clones. Moreover, antimicrobial resistance in non-typhoidal Salmonella is considered one of the major public health threats related with food-animal production, including the poultry production chain and poultry meat, which is an additional concern in the management of salmonellosis. The circulation of the same multidrug-resistant Salmonella clones and/or identical mobile genetic elements encoding antibiotic resistance genes from poultry to humans highlights this scenario. The purpose of this review was to provide an overview of the role of poultry meat on salmonellosis at a global scale and the main problems that could hinder the success of Salmonella control measures at animal production level. With the increasing globalization of foodstuffs like poultry meat, new problems and challenges might arise regarding salmonellosis control, making new integrated intervention strategies necessary along the food chain.

Antimicrobial-resistant and extended-spectrum β-lactamase-producing Escherichia coli in raw cow's milk

The occurrence of antimicrobial-resistant bacteria is an important public health issue. The aim of this study was the monitoring of resistant Escherichia coli in raw cow's milk with a focus on the detection of extended-spectrum β-lactamase (ESBL)-producing strains. In total, 263 samples of raw milk from 40 farms were collected and investigated in 2010 to 2013 in the Czech Republic. Detection of E. coli was performed and evaluated according to ISO 16649-2, and antibiotic resistance was screened by the disk diffusion method. The presence of E. coli was detected in 243 (92.4%) samples. In total, 270 isolates were obtained. Resistance to β-lactam (31.8%) and tetracycline (13.0%) antibiotics was detected most often and also multiresistant strains (5.5%) were observed. E. coli isolates found to be resistant to β-lactam, tetracycline, and quinolone antibiotics were assayed by PCR to detect selected genes encoding those resistance mechanisms. In isolates in which any bla genes were detected, a double-disk synergy test was performed. ESBL production was confirmed in 2 (0.7%) isolates. The genetic analysis identified the presence of the blaCTX-M gene and other resistance genes (tet(B) and qnrB). Both ESBL-positive isolates originated from the same farm and had an identical pulsed-field gel electrophoresis profile. The findings of our study indicate that milk can be a reservoir of bacteria carrying resistance genes with a potential for spreading through the food chain.

Comparative phenotypic and genotypic analyses of Salmonella Rissen that originated from food animals in Thailand and United States

Salmonella enterica serovar Rissen has been recognized as one of the most common serovar among humans and pork production systems in different parts of the world, especially Asia. In the United States, this serovar caused outbreaks but its epidemiologic significance remains unknown. The objectives of this study were to compare the phenotypic (antimicrobial susceptibility) and genotypic attributes of Salmonella Rissen isolated in Thailand (Thai) and the United States (US). All the Thai isolates (n = 30) were recovered from swine faecal samples. The US isolates (n = 35) were recovered from swine faecal samples (n = 29), cattle (n = 2), chicken (n = 2), dog (n = 1) and a ready-to-eat product (n = 1). The antimicrobial susceptibility of isolates was determined using the Kirby-Bauer disk diffusion method with a panel of 12 antimicrobials. Pulse-field gel electrophoresis (PFGE) was used to determine the genotypic diversity of isolates. All Thai isolates showed multidrug resistance (MDR) with the most frequent antibiotic resistance shown against ampicillin (100%), sulfisoxazole (96.7%), tetracycline (93.3%), streptomycin (90%) and chloramphenicol (30%). About half of the isolates of USA origin were pan-susceptible and roughly 30% were resistant to only tetracycline (R-type: Te). Salmonella Rissen isolated from Thailand and the USA in this study were found to be clonally unrelated. Genotypic analyses indicated that isolates were clustered primarily based on the geographic origin implying the limited clonality among the strains. Clonal relatedness among different host species within the same geography (USA) was found. We found genotypic similarity in Thai and US isolates in few instances but with no epidemiological link. Further studies to assess propensity for increased inter-regional transmission and dissemination is warranted.

Pork meat as a potential source of Salmonella enterica subsp. arizonae infection in humans

Salmonella enterica subsp. arizonae was isolated from 13 of 123 slaughtered pigs in central Greece. The samples cultured were feces, ileum tissue, mesenteric lymph nodes, and gallbladder swabs. A total of 74 isolates from 492 samples were identified as Salmonella spp. by use of standard laboratory culture media and two commercial micromethods and by use of a polyvalent slide agglutination test for the detection of O and H antigens. Among them were 19 (25.68%) suspected to be S. enterica subsp. arizonae according to analysis with standard laboratory culture media. Of those, 14 were identified as S. enterica subsp. arizonae by the API 20E (bioMérieux, France) and the Microgen GnA+B-ID (Microgen Bioproducts, Ltd., United Kingdom) identification systems. All the isolates were tested for resistance to 23 antimicrobials. Strains identified as S. enterica subsp. arizonae were resistant to 17 (70.8%) antibiotics. The highest proportions of resistance were observed for sulfamethoxazole-trimethoprim (71.4%), tetracycline (71.4%), ampicillin (64.3%), and amoxicillin (57.1%). Two isolates were resistant to aztreonam (7.1%) and tigecycline (7.1%), used only for the treatment of humans. Thus, pork meat may play a role in the transmission of antibiotic-resistant S. enterica subsp. arizonae to human consumers. This is the first report of S. enterica subsp. arizonae isolation from pigs.

Antimicrobial resistance of Campylobacter jejuni and Campylobacter coli from poultry in Italy

This study was aimed at assessing the antimicrobial resistance (AMR) of Campylobacter isolates from broilers and turkeys reared in industrial farms in Northern Italy, given the public health concern represented by resistant campylobacters in food-producing animals and the paucity of data about this topic in our country. Thirty-six Campylobacter jejuni and 24 Campylobacter coli isolated from broilers and 68 C. jejuni and 32 C. coli from turkeys were tested by disk diffusion for their susceptibility to apramycin, gentamicin, streptomycin, cephalothin, cefotaxime, ceftiofur, cefuroxime, ampicillin, amoxicillin+clavulanic acid, nalidixic acid, flumequine, enrofloxacin, ciprofloxacin, erythromycin, tilmicosin, tylosin, tiamulin, clindamycin, tetracycline, sulfamethoxazole+trimethoprim, chloramphenicol. Depending on the drug, breakpoints provided by Comité de l'antibiogramme de la Société Française de Microbiologie, Clinical and Laboratory Standards Institute, and the manufacturer were followed. All broiler strains and 92% turkey strains were multidrug resistant. Very high resistance rates were detected for quinolones, tetracycline, and sulfamethoxazole+trimethoprim, ranging from 65% to 100% in broilers and from 74% to 96% in turkeys. Prevalence of resistance was observed also against ampicillin (97% in broilers, 88% in turkeys) and at least three cephalosporins (93-100% in broilers, 100% in turkeys). Conversely, no isolates showed resistance to chloramphenicol and tiamulin. Susceptibility prevailed for amoxicillin+clavulanic acid and aminoglycosides in both poultry species, and for macrolides and clindamycin among turkey strains and among C. jejuni from broilers, whereas most C. coli strains from broilers (87.5%) were resistant. Other differences between C. jejuni and C. coli were observed markedly in broiler isolates, with the overall predominance of resistance in C. coli compared to C. jejuni. This study provides updates and novel data on the AMR of broiler and turkey campylobacters in Italy, revealing the occurrence of high resistance to several antimicrobials, especially key drugs for the treatment of human campylobacteriosis, representing a potential risk for public health.

Emerging antimicrobial resistance in commensal Escherichia coli with public health relevance

In 2009, 1462 Escherichia coli isolates were collected in a systematic resistance monitoring approach from primary production, slaughterhouses and at retail and evaluated on the basis of epidemiological cut-off values. Besides resistance to antimicrobial classes that have been extensively used for a long time (e.g. sulphonamides and tetracyclines), resistance to (fluoro)quinolones and third-generation cephalosporins was observed. While in the poultry production chain the majority (60%) of isolates from laying hens was susceptible to all antimicrobials tested, most isolates from broilers, chicken meat and turkey meat showed resistance to at least one (85-93%) but frequently even to several antimicrobial classes (73-84%). In the cattle and pig production chain, the share of isolates showing resistance to at least one antimicrobial was lowest (16%) in dairy cows, whereas resistance to at least one antimicrobial ranged between 43% and 73% in veal calves, veal and pork. Resistance rates to ciprofloxacin and nalidixic acid in isolates from broilers were 41.1% and 43.1%, respectively. Likewise, high resistance rates to (fluoro)quinolones were observed in isolates from chicken meat and turkey meat. In contrast, ciprofloxacin resistance was less frequent in E. coli isolates from the cattle and pig production chain with highest rate in veal calves (13.3%). Highest resistance rates to cephalosporins were observed in broilers and chicken meat, with 5.9% and 6.2% of the isolates showing resistance. In dairy cattle and veal, no isolates with cephalosporin resistance were detected, whereas 3.3% of the isolates from veal calves showed resistance to ceftazidime. Resistance to (fluoro)quinolones and cephalosporins in E. coli isolates is of special concern because they are critically important antimicrobials in human antimicrobial therapy. The emergence of this resistance warrants increased monitoring. Together with continuous monitoring of antimicrobial usage, management strategies should be regularly assessed and adapted.

Antibiotic-resistant bacteria: a challenge for the food industry

Antibiotic-resistant bacteria were first described in the 1940s, but whereas new antibiotics were being discovered at a steady rate, the consequences of this phenomenon were slow to be appreciated. At present, the paucity of new antimicrobials coming into the market has led to the problem of antibiotic resistance fast escalating into a global health crisis. Although the selective pressure exerted by the use of antibiotics (particularly overuse or misuse) has been deemed the major factor in the emergence of bacterial resistance to these antimicrobials, concerns about the role of the food industry have been growing in recent years and have been raised at both national and international levels. The selective pressure exerted by the use of antibiotics (primary production) and biocides (e.g., disinfectants, food and feed preservatives, or decontaminants) is the main driving force behind the selection and spread of antimicrobial resistance throughout the food chain. Genetically modified (GM) crops with antibiotic resistance marker genes, microorganisms added intentionally to the food chain (probiotic or technological) with potentially transferable antimicrobial resistance genes, and food processing technologies used at sub-lethal doses (e.g., alternative non-thermal treatments) are also issues for concern. This paper presents the main trends in antibiotic resistance and antibiotic development in recent decades, as well as their economic and health consequences, current knowledge concerning the generation, dissemination, and mechanisms of antibacterial resistance, progress to date on the possible routes for emergence of resistance throughout the food chain and the role of foods as a vehicle for antibiotic-resistant bacteria. The main approaches to prevention and control of the development, selection, and spread of antibacterial resistance in the food industry are also addressed.

An approach for mapping the vulnerability of European Union soils to antibiotic contamination

Release of antibiotics into the environment through the agricultural reuse of animal manure is considered a cause of chronic environmental exposure that often leads to adverse ecotoxicological effects, as well as to the introduction of antibiotic-resistant bacteria into the environment. The vulnerability of soil to antibiotic contamination plays a major role in determining the extent of the contamination and the likelihood of the emergence of antibiotic resistance and the appearance of ecotoxicological effects. It depends on soil characteristics, which vary across Europe, and antibiotic characteristics, which vary across drug classes. Understanding how soil vulnerability varies geographically for different veterinary medicinal products would be very useful for resource allocation among surveillance programmes. This paper performs risk analysis of the EU region for 12 antimicrobials using a spatial assessment performed in four steps. First, antibiotic release was estimated based on livestock density. Then exposure was estimated based on antimicrobial soil contamination. Third, consequences were modelled based on soil uses. Finally, risk was estimated by combining release, exposure and consequences using spatial multicriteria decision analysis. A final risk value for soil vulnerability was calculated for each antibiotic studied and displayed in chloropletic maps (ArcGIS 9.3). Furthermore, the Getis-Ord Gi statistic was used to identify clusters of areas at high risk for antibiotic soil contamination. Enrofloxacin was the highest-risk antibiotic in the European Union, followed by tetracyclines, tylosin and sulfodiazine. The highest risk values were found in Belgium, Ireland, Netherlands, Switzerland, Denmark, Germany and the UK. The results suggest that this methodology can be used successfully for evaluating the contamination potential of antibiotics over large areas with limited input data. This work is a preliminary step towards prioritising the use of veterinary medicinal products (VMPs), orientating monitoring studies and antimicrobial surveillance programmes, and informing sustainable decision-making for interventions designed to mitigate the risk of VMPs.

[Prudent use of antimicrobial agents and proposals for improvement in veterinary medicine]

The alarms that have sounded in the last two decades of the 20(th) century in the feld of antimicrobial resistance in livestock farming have led to the development of various measures that have substantially improved the use of antimicrobial agents in veterinary medicine. These measures mainly involve the implementation of new pharmaceutical legislation and the hygiene package provisions. Even though awareness of the regulations is high, surveillance systems have been implemented and the promotion of appropriate use has begun to show results, it is necessary to maintain these measures while promoting alternatives to the use of antimicrobials. In particular, alternatives are needed for those agents used for prevention of bacterial diseases, either specifically, through vaccination and improvement of biosafety (use of insecticides, disinfectants and insect repellents), or generally by improving farm facilities and animal welfare. All of these alternatives would reduce the need to use antimicrobial agents in animals. These actions should be complemented by training for all those players involved (veterinarians, farmers, the pharmaceutical industry, veterinary medicines suppliers and food retailers), and by establishing more effective cooperation between human and veterinary medicine.

Harmonisation of resistance monitoring programmes in veterinary medicine: an urgent need in the EU?

Antimicrobial surveillance systems in Denmark (DANMAP), The Netherlands (MARAN), Spain (VAV) and Sweden (SVARM) as well as the European Antimicrobial Susceptibility Surveillance in Animals (EASSA) were reviewed. Data have been considered for extended-spectrum cephalosporins, fluoroquinolones and macrolides against food-borne and commensal bacteria. The greatest challenge arises from the lack of agreement between programmes on what is meant by resistance through the use of different interpretive criteria. Indeed, it is shown here that the extent of the differences depends on the antibacterial compound being investigated, the methodology and the interpretive criteria used. This emphasises a need to agree a definition for resistance and for epidemiological cut-off values and to consider harmonising the antimicrobials used in surveillance. This analysis of the data highlights the usefulness of using both epidemiological cut-off values and clinical resistance breakpoints for the purpose of detection of decreased susceptibility and development of clinical resistance, respectively. It is concluded that harmonisation in resistance monitoring programmes is needed since there is potential for data to be appropriately used within risk analysis, providing the opportunity to implement appropriate risk management steps as a response to the public health issues arising from changes in antibiotic resistance in food-borne pathogens and commensal organisms.

Increasing trend of resistance to nalidixic acid and emerging ceftriaxone and ciprofloxacin resistance in Salmonella enterica serovar Typhimurium in Slovakia, 2005 to 2009

A 5-year survey from 2005 to 2009 revealed an increasing trend of resistance to nalidixic acid (from 0% in 2005 to 11% in 2009) among 858 clinical isolates of Salmonella Typhimurium. In addition, 10 ceftriaxone-resistant and 3 ciprofloxacin-resistant Salmonella Typhimurium isolates were detected over the period of study.

Antimicrobial resistance ofEscherichia coliandEnterococcus faecalisin housed laying-hen flocks in Europe

The aim of this study was to determine the potential association between housing type and multiple drug resistance (MDR) inEscherichia coliandEnterococcus faecalisisolates recovered from 283 laying-hen flocks. In each flock, a cloacal swab from four hens was collected and produced 1102E. coliand 792E. faecalisisolates. Broth microdilution was used to test susceptibility to antimicrobials. Country and housing type interacted differently with the MDR levels of both species. In theE. colimodel, housing in a raised-floor system was associated with an increased risk of MDR compared to the conventional battery system [odds ratio (OR) 2·12, 95% confidence interval (CI) 1·13–3·97)]. In theE. faecalismodel the MDR levels were lower in free-range systems than in conventional battery cages (OR 0·51, 95% CI 0·27–0·94). In Belgium, ceftiofur-resistantE. coliisolates were more numerous than in the other countries.

Evaluation of scenarios for reducing human salmonellosis through household consumption of fresh minced pork meat

Nontyphoidal salmonellosis is the second most frequently reported zoonotic disease in the European Union (EU) and is considered to be a major threat to human health worldwide. The most reported Salmonella serovar in the EU is S. Enteritidis, mainly associated with egg contamination, followed by S. Typhimurium, with the latter being the most predominant serovar isolated from pork. These findings suggest that reducing the Salmonella contamination in the pork production might be a good strategy to prevent and control human salmonellosis in the EU. Recently, a quantitative microbial risk assessment (QMRA) has been developed to assess the risks for human salmonellosis due to home consumption of fresh minced pork meat in Belgium. The newly developed risk model is called the METZOON model. In the current study, the METZOON model was used to evaluate the effectiveness of different hypothetical Salmonella mitigation strategies implemented at different stages of the minced pork production and consumption chain by means of a scenario analysis. To efficiently evaluate the mitigation strategies, model results were obtained by running simulations using the randomized complete block design. The effectiveness of a mitigation strategy is expressed using point and interval estimates of the effect size for dependent observations, expressed as the standardized difference in population means. The results indicate that the most effective strategies are taken during the slaughter processes of polishing, evisceration, and chilling, and during postprocessing, whereas interventions in the primary production and at the beginning of the slaughter process seem to have only a limited effect. Improving consumer awareness is found to be effective as well.