Does Dietary Consumption of Antibiotics by Humans Promote Antibiotic Resistance in the Gut Microbiome?

Could traces of fluoroquinolones in food induce ciprofloxacin resistance in Escherichia coli and Klebsiella pneumoniae? An in vivo study in Galleria mellonella with important implications for maximum residue limits in food

We hypothesized that the residual concentrations of fluoroquinolones allowed in food (acceptable daily intake-ADIs) could select for ciprofloxacin resistance in our resident microbiota. We developed models of chronic Escherichia coli and Klebsiella pneumoniae infection in Galleria mellonella larvae and exposed them to ADI doses of ciprofloxacin via single dosing and daily dosing regimens. The emergence of ciprofloxacin resistance was assessed via isolation of the target bacteria in selective agar plates. Exposure to as low as one-tenth of the ADI dose of the single and daily dosing regimens of ciprofloxacin resulted in the selection of ciprofloxacin resistance in K. pneumoniae but not E. coli. This resistance was associated with cross-resistance to doxycycline and ceftriaxone. Whole genome sequencing revealed inactivating mutations in the transcription repressors, ramR and rrf2, as well as mutations in gyrA and gyrB. We found that ciprofloxacin doses 10-fold lower than those classified as acceptable for daily intake could induce resistance to ciprofloxacin in K. pneumoniae. These results suggest that it would be prudent to include the induction of antimicrobial resistance as a significant criterion for determining ADIs and the associated maximum residue limits in food.IMPORTANCEThis study found that the concentrations of ciprofloxacin/enrofloxacin allowed in food can induce de novo ciprofloxacin resistance in Klebsiella pneumoniae. This suggests that it would be prudent to reconsider the criteria used to determine "safe" upper concentration limits in food.

Effect of erythromycin residuals in food on the development of resistance in Streptococcus pneumoniae: an in vivo study in Galleria mellonella

Background

The use of antimicrobials to treat food animals may result in antimicrobial residues in foodstuffs of animal origin. The European Medicines Association (EMA) and World Health Organization (WHO) define safe antimicrobial concentrations in food based on acceptable daily intakes (ADIs). It is unknown if ADI doses of antimicrobials in food could influence the antimicrobial susceptibility of human-associated bacteria.

Objectives

This aim of this study was to evaluate if the consumption of ADI doses of erythromycin could select for erythromycin resistance in a Galleria mellonella model of Streptococcus pneumoniae infection.

Methods

A chronic model of S. pneumoniae infection in G. mellonella larvae was used for the experiment. Inoculation of larvae with S. pneumoniae was followed by injections of erythromycin ADI doses (0.0875 and 0.012 μg/ml according to EMA and WHO, respectively). Isolation of S. pneumoniae colonies was then performed on selective agar plates. Minimum inhibitory concentrations (MICs) of resistant colonies were measured, and whole genome sequencing (WGS) was performed followed by variant calling to determine the genetic modifications.

Results

Exposure to single doses of both EMA and WHO ADI doses of erythromycin resulted in the emergence of erythromycin resistance in S. pneumoniae. Emergent resistance to erythromycin was associated with a mutation in rplA, which codes for the L1 ribosomal protein and has been linked to macrolide resistance in previous studies.

Conclusion

In our in vivo model, even single doses of erythromycin that are classified as acceptable by the WHO and EMA induced significant increases in erythromycin MICs in S. pneumoniae. These results suggest the need to include the induction of antimicrobial resistance (AMR) as a significant criterion for determining ADIs.

Impact of Erythromycin as a Prokinetic on the Gut Microbiome in Children with Feeding Intolerance-A Pilot Study

BACKGROUND

Studies have demonstrated that the gut microbiome changes upon exposure to systemic antibiotics. There is a paucity of literature regarding impact on the gut microbiome by long-term usage of erythromycin ethyl succinate (EES) when utilized as a prokinetic.

METHODS

Stool samples from pediatric patients with feeding intolerance who received EES (N = 8) as a prokinetic were analyzed for both bacteriome and mycobiome. Age-matched children with similar clinical characteristics but without EES therapy were included as controls (N = 20).

RESULTS

In both groups, Proteobacteria, Firmicutes, and Bacteroidetes were the most abundant bacterial phyla. Ascomycota was the most abundant fungal phyla, followed by Basidiomycota. There were no significant differences in richness between the groups for both bacterial and fungal microbiome. Alpha diversity (at genus and species levels) and beta diversity (at the genus level) were not significantly different between the groups for both bacterial and fungal microbiome. At the species level, there was a significant difference between the groups for fungal microbiota, with a p-value of 0.029. We also noted that many fungal microorganisms had significantly higher p-values in the EES group than controls at both genera and species levels.

CONCLUSIONS

In this observational case-control study, the prokinetic use of EES was associated with changes in beta diversity between the groups for mycobiome at the species level. Many fungal microorganisms were significantly higher in the EES group when compared to the controls. Confirmation of these results in larger trials will provide further evidence regarding the impact of EES on gut microbiota when utilized as a prokinetic agent.

Plant Essential Oils as a Tool in the Control of Bovine Mastitis: An Update

Bovine mastitis is a major concern for the dairy cattle community worldwide. Mastitis, subclinical or clinical, can be caused by contagious or environmental pathogens. Costs related to mastitis include direct and indirect losses, leading to global annual losses of USD 35 billion. The primary treatment of mastitis is represented by antibiotics, even if that results in the presence of residues in milk. The overuse and misuse of antibiotics in livestock is contributing to the development of antimicrobial resistance (AMR), resulting in a limited resolution of mastitis treatments, as well as a serious threat for public health. Novel alternatives, like the use of plant essential oils (EOs), are needed to replace antibiotic therapy when facing multidrug-resistant bacteria. This review aims to provide an updated overview of the in vitro and in vivo studies available on EOs and their main components as an antibacterial treatment against a variety of mastitis causing pathogens. There are many in vitro studies, but only several in vivo. Given the promising results of treatments with EOs, further clinical trials are needed.

The Use of Antibiotics and Antimicrobial Resistance in Veterinary Medicine, a Complex Phenomenon: A Narrative Review

As warned by Sir Alexander Fleming in his Nobel Prize address: “the use of antimicrobials can, and will, lead to resistance”. Antimicrobial resistance (AMR) has recently increased due to the overuse and misuse of antibiotics, and their use in animals (food-producing and companion) has also resulted in the selection and transmission of resistant bacteria. The epidemiology of resistance is complex, and factors other than the overall quantity of antibiotics consumed may influence it. Nowadays, AMR has a serious impact on society, both economically and in terms of healthcare. This narrative review aimed to provide a scenario of the state of the AMR phenomenon in veterinary medicine related to the use of antibiotics in different animal species; the impact that it can have on animals, as well as humans and the environment, was considered. Providing some particular instances, the authors tried to explain the vastness of the phenomenon of AMR in veterinary medicine due to many and diverse aspects that cannot always be controlled. The veterinarian is the main reference point here and has a high responsibility towards the human–animal–environment triad. Sharing such a burden with human medicine and cooperating together for the same purpose (fighting and containing AMR) represents an effective example of the application of the One Health approach.

Antimicrobial resistomes in food chain microbiomes

The safety and integrity of the global food system is in a constant state of flux with persistent chemical and microbial risks. While chemical risks are being managed systematically, microbial risks pose extra challenges. Antimicrobial resistant microorganism and persistence of related antibiotic resistance genes (ARGs) in the food chain adds an extra dimension to the management of microbial risks. Because the food chain microbiome is a key interface in the global health system, these microbes can affect health in many ways. In this review, we systematically summarize the distribution of ARGs in foods, describe the potential transmission pathway and transfer mechanism of ARGs from farm to fork, and discuss potential food safety problems and challenges. Modulating antimicrobial resistomes in the food chain facilitates a sustainable global food production system.

Estimates of Dietary Exposure to Antibiotics among a Community Population in East China

BACKGROUND

Antibiotics are widely used in clinics, livestock farms and the aquaculture industry. A variety of antibiotics in foods and drinking water may lead to important and inadvertent dietary exposure However, the profile of dietary exposure to antibiotics in humans is not well-explored. East China is an economically developed area with a high usage of antibiotics and a high rate of antibiotic resistance (ABR). This study aimed to evaluate the total intake level of antibiotics in humans via foods and drinking water based on a community population in East China.

METHODS

A total of 600 local residents from 194 households were recruited into this study in Deqing County of Zhejiang Province since June 2019. Each subject was asked to fill a food frequency questionnaire to report their daily consumption of foods and drinking water. Tap water samples were collected from ten households and twenty-one antibiotics of five categories were selected to detect in drinking water. Data of antibiotic residues in animal-derived foods were obtained from the notification of unqualified edible agricultural products after special supervision sampling inspection in Deqing County. The human dietary exposure to antibiotics was estimated by combining the data of antibiotic contamination in foods and drinking water, and the information of dietary consumption.

RESULTS

Of twenty-one antibiotics selected, subjects were exposed to a total of sixteen antibiotics, ranging from 15.12 to 1128 μg/day via two main dietary routes (animal-derived foods and drinking water). The overall dietary exposure level varied greatly in the antibiotics detected and their sources. Compared with other antibiotics, enrofloxacin made the most contributions in terms of dietary exposure, with a median exposure level of 120.19 μg/day (IQR: 8.39-698.78 μg/day), followed by sulfamethazine (median: 32.95 μg/day, IQR: 2.77-162.55 μg/day) and oxytetracycline (median: 28.50 μg/day, IQR: 2.22-146.58 μg/day). The estimated exposure level via drinking water (at the ng/day level, median: 26.74 ng/day, IQR: 16.05-37.44 ng/day) was significantly and substantially lower than those via animal-derived foods (at the μg/day level, median: 216.38 μg/day, IQR: 87.52-323.00 μg/day). The overall dietary exposure level also showed differences in sex and age. Males and youths were more likely to be exposed to antibiotics via dietary routes than others.

CONCLUSIONS

The community population investigated in East China was extensively exposed to multiple antibiotics via dietary routes. Long-term exposure to low-dose antibiotics in animal-derived foods was the primary dietary exposure route, compared with drinking water. Enrofloxacin contributed to the major body burden of dietary exposure, based on the combination of consumption of aquatic products and considerable enrofloxacin residues in them. Although the human dietary exposure level to antibiotics via drinking water and animal-derived foods ranged from ng/day to μg/L, their chronic toxicity and the accumulation and spread of ABR may be potential hazards to humans. Therefore, long-term monitoring of antibiotic contaminations in foods and drinking water, and human dietary antibiotic exposure is warranted.

Antibiotics in aquaculture ponds from Guilin, South of China: Occurrence, distribution, and health risk assessment

Antibiotics have been widely used to prevent or treat bacterial infections in aquaculture in the past decades. However, large proportions of these compounds are excreted unchanged in feces and urine of animals, given incomplete metabolism, leading to the residual of unmetabolized compounds, and posing a potential risk to the environment. This study investigated the occurrence and distribution of seven antibiotics in surface water, sediments, fish muscle, and fish feed by high-performance liquid chromatography from the aquaculture areas in Guilin, South of China. The highest concentrations of the target antibiotics in water, sediment, fish muscle, and fish feed were 2047.53 ng/L, 13.32 μg/kg, 35.90 μg/kg, and 2203.97 μg/kg, respectively. In contrast, the most abundant antibiotic was enrofloxacin (ENR), followed by ofloxacin (OFL), sulfadimidine (SMZ), and ciprofloxacin (CIP). In this work, the concentrations of antibiotics were lower than those in other breeding areas. Correlation analyses showed significant relationships between sulfadiazine (SDZ) and TP, TN, and COD_Cr in water. In sediment, the release of SDZ was significantly related to TN, TP, and organic matter. The risk quotient (RQ) results revealed that sulfamethoxazole (SMX), CIP, and ENR were at high risk to microorganisms in water; while, SMX and NOR were at high risk in sediments. The result from the estimated daily intakes (health risk quotient, HQ < 1) suggested that the antibiotics might not pose a risk to human health by dietary exposure assessment; however, sediments may become an accumulation reservoir of antibiotics and cause secondary pollution, of which the local management should raise awareness.

Antibiotic treatments to mothers during the perinatal period leaving hidden trouble on infants

Antibiotic application during the perinatal period is unavoidable in the clinic, but the potential effects on mothers and infants remain unknown. Herein, 25 breast milk samples from mothers who received cefuroxime (CXM) or CXM + cefoxitin (CFX) treatments and fecal samples from their infants were collected to investigate the undesirable effects of antibiotics on the microbiota of mothers and neonates. Furthermore, five fecal samples of infants, whose mothers had antibiotic treatments, were collected at a 6-month postpartum follow-up visit to evaluate the long-term effects on infants' gut microbiota. Moreover, the relative abundance of antibiotic resistance genes (ARGs) in fecal samples was compared to investigate the transfer of ARGs in the infant gut microbiota. The results indicated that the antibiotic treatments had no influence on the microbiota of breast milk. The dominant bacterial phyla in the fecal samples changed to Firmicutes and Proteobacteria after antibiotic treatments, while the bacterial community showed a recuperative trend at the follow-up visits. In addition, the abundance of ARGs in the infant gut microbiota demonstrated a declining trend in the CXM- and CXM + CFX-treated groups, while ARG abundance presented a significant increasing trend after a 6-month recovery period.

CONCLUSION

Antibiotic treatments for mothers during the perinatal period disturb the gut microbiota in neonates. The infants' gut microbiota would partly return to their initial state after rehabilitation, but the transfer of ARGs would leave the hidden trouble of antibiotic resistance. Overall, the data presented here can help to guide the scientific use of antibiotics during the perinatal period and provide potential approaches to mitigate the negative consequences.

WHAT IS KNOWN

• Antibiotic application during the perinatal period is unavoidable in the clinic. • Misuse of antibiotics can cause various unintended consequences, especially for antibiotic resistance.

WHAT IS NEW

• Antibiotic treatments had no influence on the microbiota of breast milk but greatly disturbed the gut microbiota composition in infants. • The gut microbiota in infants would partly return to its initial state after rehabilitation but the transfer of ARGs would leave the hidden trouble of antibiotic resistance.

In Silico Screening and In Vitro Assessment of Natural Products with Anti-Virulence Activity against Helicobacter pylori

Helicobacter pylori is one of the most frequent human pathogens and a leading etiological agent of various gastric diseases. As stringent response, coordinated by a SpoT protein, seems to be crucial for the survivability of H. pylori, the main goal of this article was to use in silico computational studies to find phytochemical compounds capable of binding to the active site of SpoT from H. pylori and confirm the ability of the most active candidates to interfere with the virulence of this bacterium through in vitro experiments. From 791 natural substances submitted for the virtual screening procedure, 10 were chosen and followed for further in vitro examinations. Among these, dioscin showed the most interesting parameters (the lowest MIC, the highest anti-biofilm activity in static conditions, and a relatively low stimulation of morphological transition into coccoids). Therefore, in the last part, we extended the research with a number of further experiments and observed the ability of dioscin to significantly reduce the formation of H. pylori biofilm under Bioflux-generated flow conditions and its capacity for additive enhancement of the antibacterial activity of all three commonly used antibiotics (clarithromycin, metronidazole, and levofloxacin). Based on these results, we suggest that dioscin may be an interesting candidate for new therapies targeting H. pylori survivability and virulence.

Rational Pharmacotherapy in Infectious Diseases: Issues Related to Drug Residues in Edible Animal Tissues

Simple Summary

Drug use is essential to treat diseases in food-producing animals. The most widely used drugs are antiparasitics and antimicrobials. They contribute to guaranteeing good-quality food in sufficient quantity for human consumption. When using veterinary medicines, it is essential to follow the instructions on the package label. Administering the correct dose by the indicated route in the animal species for which the drug is labeled is critical. After a pharmacological treatment is administered to livestock, a period (indicated on the label) must often elapse before the tissues from the treated animals can be consumed by humans. Veterinary drug residues are controlled by taking food samples to verify that drug concentrations do not exceed the permitted limits. This allows authorities to know if the medicine use is correct or if suitable corrective measures should be taken. When label’s directions are not followed, drug residues may appear in food. The residues exceeding the permitted limits established by the authorities can produce unfavorable consequences, mainly on the consumer’s health. The food trade and even the environment can be affected by drug residues in animal tissues. Therefore, the correct use of drugs in livestock is critical, which includes respecting the rules to avoid residues in food for human consumption.

Abstract

Drugs are used in veterinary medicine to prevent or treat animal diseases. When rationally administered to livestock following Good Veterinary Practices (GVP), they greatly contribute to improving the production of food of animal origin. Since humans can be exposed chronically to veterinary drugs through the diet, residues in food are evaluated for effects following chronic exposures. Parameters such as an acceptable daily intake (ADI), the no-observed-adverse-effect level (NOAEL), maximum residue limits (MRLs), and the withdrawal periods (WPs) are determined for each drug used in livestock. Drug residues in food exceeding the MRLs usually appear when failing the GVP application. Different factors related either to the treated animal or to the type of drug administration, and even the type of cooking can affect the level of residues in edible tissues. Residues above the MRLs can have a diverse negative impact, mainly on the consumer’s health, and favor antimicrobial resistance (AMR). Drug residue monitoring programmes are crucial to ensure that prohibited or authorized substances do not exceed MRLs. This comprehensive review article addresses different aspects of drug residues in edible tissues produced as food for human consumption and provides relevant information contributing to rational pharmacotherapy in food-producing animals.

Antibiotic-contaminated wastewater irrigated vegetables pose resistance selection risks to the gut microbiome

Wastewater reuse in food crop irrigation has led to agroecosystem pollution concerns and human health risks. However, there is limited attention on the relationship of sub-lethal antibiotic levels in vegetables and resistance selection. Most risk assessment studies show non-significant toxicity, but overlook the link between antibiotics in crops and propagation of gut microbiome resistance selection. The review highlights the risk of antibiotics in treated water used for irrigation, uptake, and accumulation in edible vegetable parts. Moreover, it elucidates the risks to the adaptive resistance selection of the gut microbiome from sub-lethal antibiotic levels, as a result of dietary contaminated vegetables. Experiments have reported that bacterial resistance selection is possible at concentrations that are several hundred-folds lower than lethal effect levels on susceptible cells. Consequently, mutants selected at low antibiotic levels, such as those from vegetables, are fitter and more resistant compared to those selected at high concentrations. Necessary standardization, such as the development of minimum acceptable antibiotic limits allowable in food crop irrigation water, with a focus on minimum selection concentration, and not only toxicity, has been proposed. Wastewater irrigation offers environmental benefits and can contribute to food security, but it has non-addressed risks. Research gaps, future perspectives, and frameworks of mitigating the potential risks are discussed.

Antimicrobial resistance profiles in bacterial species isolated from fecal samples of free-ranging long-tailed macaques (Macaca fascicularis) living in Lopburi Old Town, Thailand

Background and Aim

At present, increasing in long-tailed macaques (Macaca fascicularis) population in Lopburi old town caused several problems in its community, in particular with sanitation problem. The present study aimed to explore species distribution and antimicrobial resistance patterns in bacteria isolated from feces of the free-ranging long-tailed macaques (Macaca fascicularis) in Lopburi Old Town, Thailand.

Materials and Methods

Fresh fecal samples were collected from October 2018 to July 2019 from seven troops of macaques. Bacterial colonies were identified based on Gram stain and standard biochemical techniques. Sensitivity toward eight different antibiotics, including amoxicillin, amoxicillin-clavulanate, cephalexin, clindamycin, doxycycline, enrofloxacin, erythromycin, and gentamicin, was analyzed using the disk diffusion method.

Results

A total of 1050 fecal samples were collected. Five unique bacterial species were identified, including Escherichia coli, Enterobacter spp., Proteus spp., Salmonella Group B, and Citrobacter spp. in 100%, 25.71%, 18%, 1.71%, and 0.57% of the fecal specimens, respectively. Among 70 distinct isolates of E. coli, 63 (93%) were resistant to multiple drugs, including amoxicillin, cephalexin, clindamycin, and erythromycin; one isolate (6%) was resistant to clindamycin only. Furthermore, 17 isolates (94%) of Salmonella Group B were resistant to both clindamycin and erythromycin. Five of the six Citrobacter spp. isolates (83%) were also multidrug-resistant (to cephalexin, clindamycin, and erythromycin); the one remaining Citrobacter spp. isolate (6%) was resistant to both clindamycin and erythromycin. However, a high percentage of E. coli, Salmonella Group B and Citrobacter spp. remained susceptible to amoxicillin-clavulanate, enrofloxacin, and doxycycline.

Conclusion

Our findings provide the basic information for the selection of empirical therapy and for the evaluation of the scale of antibiotic resistance associated with macaques living in Lopburi Old Town.

Microplastics Aggravate the Bioaccumulation of Two Waterborne Veterinary Antibiotics in an Edible Bivalve Species: Potential Mechanisms and Implications for Human Health

Edible bivalves are one of the major types of seafood and may be subject to antibiotic and microplastics (MPs) coexposure under realistic scenarios. However, the effect of MPs on the bioaccumulation of antibiotics in edible bivalves and subsequent health risks for consumers remain poorly understood. Therefore, the bioaccumulation of two frequently detected veterinary antibiotics, oxytetracycline (OTC) and florfenicol (FLO), with or without the copresence of MPs was investigated in the blood clam. Health risks associated with the consumption of contaminated clams were also assessed. Furthermore, the activity of GST and expression of key detoxification genes were analyzed as well. The bioaccumulation of OTC and FLO in clams was found to be aggravated by MPs. Because the estimated target hazard quotients (THQs) were far less than the critical value, direct toxic effects of consuming contaminated clams are negligible. However, the dietary exposure doses of the human gut microbiota (DEGM) to the antibiotics tested were greater than or similar to corresponding minimum selective concentrations (MSC), indicating a potential antibiotic resistance risk. Moreover, the GST activity and expression of detoxification genes were significantly suppressed by MPs, suggesting that the disruption of detoxification represents one possible explanation for the aggravated bioaccumulation observed here.

Toward Antibiotic Stewardship: Route of Antibiotic Administration Impacts the Microbiota and Resistance Gene Diversity in Swine Feces

Oral antibiotics are a critical tool for fighting bacterial infections, yet their use can have negative consequences, such as the disturbance of healthy gut bacterial communities and the dissemination of antibiotic residues in feces. Altering antibiotic administration route may limit negative impacts on intestinal microbiota and reduce selective pressure for antimicrobial resistance genes (ARG) persistence and mobility. Thus, a study was performed in pigs to evaluate route of therapeutic oxytetracycline (oxytet) administration, an antibiotic commonly used in the U.S. swine industry, on intestinal microbial diversity and ARG abundance. Given that oral antibiotics would be in direct contact with intestinal bacteria, we hypothesized that oral administration would cause a major shift in intestinal bacterial community structure when compared to injected antibiotic. We further postulated that the impact would extend to the diversity and abundance of ARG in swine feces. At approximately 3 weeks-of-age, piglets were separated into three groups (n = 21–22 per group) with two groups receiving oxytet (one via injection and the second via feed) and a third non-medicated group. Oxytet levels in the plasma indicated injected antibiotic resulted in a spike 1 day after administration, which decreased over time, though oxytet was still detected in plasma 14 days after injection. Conversely, in-feed oxytet delivery resulted in lower but less variable oxytet levels in circulation and high concentrations in feces. Similar trends were observed in microbial community changes regardless of route of oxytet administration; however, the impact on the microbial community was more pronounced at all time points and in all samples with in-feed administration. Fecal ARG abundance was increased with in-feed administration over injected, with genes for tetracycline and aminoglycoside resistance enriched specifically in the feces of the in-feed group. Sequencing of plasmid-enriched samples revealed multiple genetic contexts for the resistance genes detected and highlighted the potential role of small plasmids in the movement of antibiotic resistance genes. The findings are informative for disease management in food animals, but also manure management and antibiotic therapy in human medicine for improved antibiotic stewardship.