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Inside the FDA:
Food Safety in 2010
by Michael Taylor
Saying goodbye to 2009 won't be too difficult for those of us in the
food safety arena. The last year illustrated that the fight against
foodborne illness has not yet been won. With headline outbreaks involving
Salmonella in peanut butter and alfalfa sprouts and E. coli O157:H7
in cookie dough, we still have our work cut out for us.
But I believe the next decade will be different. This nation is at an
historic tipping point when it comes to food safety. Congress is on
the verge of passing legislation to usher in a new era of food safety
in this country, with the fundamental goal of preventing food contamination
and illness. The president, the public, and the industry have united
in support for a stronger FDA. And our commissioner, Dr. Margaret Hamburg,
has created a new Office of Foods to help unify and be accountable for
all FDA foods efforts.
From those in the field, to the lab, to the office, we are working together
to modernize our food safety program.
This may well be the Agency's greatest opportunity for real change to
improve food safety in 100 years.
So I believe 2010 will be-must be-a groundbreaking year, which is why,
within FDA, we are doing everything possible to prepare. Earlier this
month, we launched the "One Mission, One Program" Initiative
to design a unified FDA Foods Program. We want to be sure we are working
cohesively together and making the best possible use of our resources
and talents to improve food safety. This effort involves nearly 100
experts from throughout FDA who are charged with tackling cross-cutting
issues critical to our success. It is not easy to change the way an
organization operates. And for that change to be effective and sustainable,
it must be shaped by those who actually do the day-to-day work.
From those in the field, to the lab, to the office, we are working together
to modernize our food safety program. We're tackling fundamental questions
that will lead to fundamental changes in the way we work within FDA
and with partners outside FDA to prevent foodborne illness and outbreaks.
- As industry implements preventive food safety control systems, how
can our headquarters and field staff work together and with industry
to ensure that food-safety best practices increasingly become common
- How can FDA work with importers and foreign governments to better
ensure the safety of food imports in our vast, global food supply-
- How can we work with the Centers for Disease Control and Prevention
and other partners to better target and prevent significant food safety
risks- Do we have the data and analytical tools we need-
- How can we work with others to learn from outbreaks so we can keep
them from happening again-
- How can FDA integrate its emergency preparedness and response roles
with other federal, state, and local agencies-Through this process,
we are working to answer the tough questions and create a new operating
norm for the FDA Foods Program, one in which our work will be seamless
and collaborative, unified by the common goal of protecting public health.
As one of our top enforcement officials, Steve Solomon, has said, "What
I've found is that our employees come together like never before to
work on public health emergencies. But too frequently, when an immediate
emergency has passed, we go back to business as usual. What I find really
exciting about the 'One Mission, One Program' initiative is to be able
to change that so we are working collaboratively all the time."
We have a lot of work ahead of us in 2010 and beyond. I will keep you
up-to-date on our progress and look forward to hearing from you about
how we are doing.
Not Fully Confident in Food Safety
Posted by Brian Montopoli
This poll was taken
as part of CBS News' "Where America Stands" series, an in-depth
look at where the country stands today on key topics and an outlook
for the future decade.
Just one in three Americans
are very confident that the food they buy is safe, a new CBS News poll
finds although the vast majority are at least somewhat confident that
their food is safe.
Thirty-two percent say they are "very confident" about the
safety of the food they buy, while 52 percent are "somewhat confident."
The remaining 16 percent say they are not too confident or not at all
confident in the safety of their food.
These results are reflected in the grades Americans give the country
on ensuring the safety of the food supply. The most commonly offered
grades were C, chosen by 34 percent of those surveyed, and B, chosen
by 33 percent.
Just seven percent gave the country an A when it comes to keeping the
food supply safe. Eighteen percent offered a D, and six percent served
up a failing grade.
A person's faith in the food
supply may have something to do with the food they can afford. Those
with high incomes are more confident in the safety of the food supply
than those who earn comparatively less.
Forty-two percent of Americans who make more than $100,000 are very
confident the food they buy is safe. Just 24 percent of those who make
less than $30,000 say the same.
Men are more likely than women to be very confident that the food they
buy is safe, and college graduates are more likely that those with less
education to say so.
The region where Americans have the most trust in the food supply is
the Midwest. Americans in the South have the least trust in the food
COMMITTEE HOLDS HEARING ON FOOD SAFETY; CONSUMERS UNION URGES CONGRESS
TO TAKE ACTION ON FOOD SAFETY ENHANCEMENT ACT
Posted on January 10, 2010 by Bill Marler
Concerns that the Bill Will
Unduly Impact Small and Organic Farmers Unfounded
Washington, D.C.-Consumers Union, nonprofit publisher of Consumer Reports,
urges Congress to take swift action on the Food Safety Enhancement Act
of 2009 (FSEA), H.R. 2749, before its August recess. Today the Committee
on Agriculture of the U.S. House of Representatives will hold a hearing
on current issues in food safety. Consumers Union supports the testimony
of Carol Tucker-Foreman of the Consumer Federation of America (CFA)
and commends the committee for holding a hearing to explore current
congressional efforts to address the serious food safety problems that
confront the country.
¡°Our current food safety system is broken and has been in need of reform
for more than a decade,¡± said Jean Halloran, Director of Food Policy
Initiatives at Consumers Union. ¡°Last week, the White House announced
new food safety recommendations which represent an important step forward,
but which can only work within existing, outdated food safety laws.
In order to have real food safety reform and give FDA the enforcement
power and resources it needs, Congress must move promptly to pass the
FSEA. This is a strong bill that can only be weakened by delay and every
day without action means more lives needlessly lost to food contamination.¡±
Each year, 76 million Americans are sickened from consuming contaminated
food and 5,000 of these people die. Continued outbreaks of food contamination
over the last several years-from spinach to peppers to peanuts, pistachios
and cookie dough-have demonstrated that these outbreaks are not random,
unpreventable occurrences, but are due to widespread problems with our
food safety system.
The FSEA contains several provisions long advocated by Consumers Union.
It would require facilities to have written food safety plans, give
FDA authority to recall contaminated products and require FDA to inspect
high risk facilities at least once a year. Consumers Union has pushed
hard for one of the bill¡¯s important provisions: requiring high-risk
food processors to test for contaminants and tell the FDA when they
find them in a finished product. ¡°Had this provision already been in
place, it is possible that the deadly peanut product debacle of early
2009 could have been avoided,¡± said Halloran.
Speculation that FSEA could ¡°destroy¡± small farms and organic growers
has circulated online and elsewhere, focusing primarily on provisions
that direct FDA to develop on-farm standards for produce to prevent
problems like deadly E. coli in spinach. The FSEA has sought to address
small-scale and organic farmer concerns by requiring FDA to take into
account the impact the regulations would have on small-scale and diversified
farms, wildlife habitat, conservation practices, watershed protection
efforts, and organic production methods.
¡°The provisions of the FSEA that direct FDA to address on-farm food
safety practices, such as whether workers have bathroom facilities,
are not as comprehensive as the sections for food processing,¡± said
Halloran. ¡°The FSEA stipulates that food processors must be inspected
within certain time periods, but does not set any requirements for FDA
inspection of farms. Nevertheless, we think this is a very good bill
overall that will address the most important causes of contamination
of food with deadly bacteria.¡±
Consumers Union urges the House of Representatives not to delay further,
and to pass H.R. 2749 before Congress adjourns for the August recess.
revamps cookie dough amid E. coli concern
Wed Jan 13, 2010 4:11pm EST
* Will start using heat-treated
* Production to be suspended
for 12 days for overhaul
CHICAGO, Jan 13 (Reuters) - Nestle USA will begin using heat-treated
flour in its Toll House refrigerated cookie dough, months after the
company temporarily pulled the product off of store shelves after the
Food and Drug Administration found evidence of E. coli contamination.
The unit of Nestle SA (NESN.VX) said it will halt production at its
Danville, Virginia, plant from Wednesday until Jan. 25 in order convert
the plant to use heat-treated flour.
In June, Nestle recalled the cookie dough after the FDA said it was
investigating possible E.coli related illnesses that might have been
related to the eating of raw cookie dough.
The company resumed production at the plant using standards that included
testing ingredients before they enter the facility, rigorous environmental
sampling throughout the facility and testing of finished product before
it is shipped to customers.
On Monday, two samples of cookie dough tested positive for E. coli,
Nestle said. The contaminated product was discovered before it was shipped
and dough on store shelves is not affected, it added. (Reporting by
Brad Dorfman; editing by Andre Grenon)
deputy to lead food-safety mandate
By Lyndsey Layton
Washington Post Staff
Thursday, January 14, 2010
A year ago, Michael Taylor
was sitting in his office at George Washington University, considering
a basic mission of the federal government: making sure food is safe.
He'd devoted his career to food safety, working in and out of government,
and he was finally in academia where he could think deeply about what
was wrong and how to fix it.
And then the call came.
The Obama administration wanted Taylor to implement the solutions he
had been designing. A string of food poisoning outbreaks nationally
had sickened thousands and killed dozens. Both parties in Congress were
calling for tough new laws. The president promised the public that he
would strengthen food safety.
In July, Taylor became an adviser to Margaret Hamburg, commissioner
of the Food and Drug Administration, and Wednesday he was named deputy
commissioner for foods, a new position that elevates food in an agency
long criticized for placing greater emphasis on drugs and medical devices.
Congress is moving ahead with legislation to grant vast new authority
to the FDA to ensure food safety -- the House passed a bill last year
and the Senate is expected to take up its version soon -- and Taylor
will be responsible for implementing new laws aimed at preventing outbreaks
instead of merely reacting after they occur.
"We are at an historic tipping point -- a moment when the forces
have aligned like never before; the president, Congress, industry and
the public have stepped up their support for our mission," Taylor
told a gathering of FDA staff members last month.
Taylor is a familiar figure at the FDA. He began his career as a staff
attorney at the agency in 1976. Then he worked for a decade at King
& Spaulding, which represented Monsanto Corp., the agribusiness
giant that developed genetically engineered corn, soybeans and bovine
He returned to the FDA in 1991 as deputy commissioner for policy and
pushed through requirements that producers of seafood and juices adopt
measures to prevent bacterial contamination. During the same period,
the FDA approved Monsanto's bovine growth hormone, and Taylor was partly
responsible for a controversial policy that said milk from BGH-treated
cows did not have to be labeled as such.
In 1994, Taylor went to the U.S. Agriculture Department to run its food-safety
program. He required meat and poultry producers to take measures to
prevent bacterial contamination, despite strong opposition from those
industries. Observers expect Taylor to impose those same kinds of preventive
controls on all the foods regulated by the FDA.
After the USDA, Taylor went to work for Monsanto as a vice president
for public policy. He moved on to a think tank and then a teaching stint
"He is the quintessential revolving door," said Marion Nestle,
a professor of nutrition, food studies and public health at New York
University. Taylor's support for BGH and Monsanto's other genetically
modified products at the FDA was "questionable," she said.
"On the other hand, when he went to USDA, what he did there was
absolutely heroic. He's been very strong on food safety."
It's one thing to recognize the weak spots and craft a strategy for
change; it's another to make it happen and persuade 3,000 FDA employees
who work on food issues to follow suit.
"This is really about building a new system," he said. "It's
about rethinking how we do everything -- from inspections to rulemaking
-- so that we're acting in real time in a way that is preventive."
To that end, Taylor has been bringing together divisions to make the
agency more nimble. Food regulation is split among the Center for Food
Safety and Applied Nutrition, where much of the scientific research
takes place; the Center for Veterinary Medicine, which regulates the
manufacture and sale of food additives and drugs for animals; and the
Office of Regulatory Affairs, which handles inspections of domestic
and imported products and works with state and local officials.
Traditionally, the three sections were managed separately. Any proposed
policy change had to be approved by each division and then was sent
for review by the general counsel in the commissioner's office. It took
years to get anything done, Taylor said.Now, Taylor has pulled together
a senior leadership team that cuts across the three divisions and has
created similar cross-sectional teams to work on core issues. "The
idea is to get the best thinking on the table early," he said.
Taylor has already taken some steps that suggest a new, more muscular
approach to regulation. The agency has been cracking down on nutrition
claims on processed foods, saying that some food makers have overstated
the health benefits of their products.
In the first real political test of the new leadership, Taylor tried
to ban the sale of raw oysters harvested from the Gulf Coast between
April and October unless they are treated to kill a potentially lethal
bacterium. Sen. Mary Landrieu (D-La.) and others vigorously protested
the move. The FDA agreed to put off action to study the issue. Taylor
said the agency is not backing down, just regrouping.
Call for Prosecution of PCA Exec
by Zach Mallove | Jan 14,
It has been over a year since
the Peanut Corporation of America (PCA) sickened hundreds and killed
9 with Salmonella-tainted peanuts. Many victims and their families are
growing antsy. Millions of dollars have been awarded in civil suits,
but those affected will not settle until the people responsible are
Calls for a criminal investigation came after internal emails among
the highest-ranking PCA employees demonstrated a flagrant degree of
negligence. In February 2009, a hearing conducted by the House Subcommittee
on Oversight and Investigations exposed a string of emails from Stewart
Parnell, the president of PCA, to his plant manager that suggested Parnell
knowingly shipped contaminated peanuts to sellers across the country.
"Turn them loose," said one email from Parnell to his plant
manager. The e-mail referred to products that once were deemed contaminated
with Salmonella but were cleared in a questionable second test.
Another email released by the House panel showed Parnell ordering products
identified as contaminated with Salmonella to be shipped and quoted
his complaints that tests discovering contaminated peanuts were "costing
us huge $$$$$."
The House panel grilled Parnell during the hearing, demanding explanations.
But Parnell refused, citing his Fifth Amendment right against self-incrimination:
"I respectfully decline to answer your questions based on the protection
afforded to me under the United States Constitution."
A federal criminal investigation is currently pending against Parnell,
but no criminal convictions have been issued. The hundreds of sickened
people want him held accountable for his actions.
"As someone who testified in front of the House subcommittee last
February, I saw the emails that Parnell had sent out," said Lou
Tousignant, whose father, Clifford Tousignant, died from eating the
tainted product. "I saw that he knowingly shipped contaminated
product to high-risk areas (nursing homes and schools). If there can
be a precedent of criminal charges for those that knowingly commit an
act that can cause harm to society, maybe someone like Parnell would
think twice before shipping contaminated products that sickened hundreds
and killed 9 people, including my father."
Larry Andrew, whose wife was severely sickened by the Salmonella outbreak,
"We think his actions were akin to a personal invasion of our home
to assault Karen," he said. "He killed people! If a similar
methodology were to be undertaken by a cell of terrorists, the country
would be outraged and the federal government would immediately arrest
and prosecute the perpetrators."
Bill Marler, the Seattle-based attorney who is representing many of
the victims, is similarly incredulous. "In 17 years of litigating
every major foodborne illness outbreak in the U.S., I have not seen
a clearer situation that demanded criminal prosecution," he said.
"If not this case, when-"
Even if Parnell and his plant manager were convicted, however, the punishment
would hardly be stiff. According to CNN, Parnell would face a maximum
of 1 year in prison and a $1,000 fine.
To many, this highlights a fundamental problem with the government's
food safety network.
In an effort to address this, the House introduced a food safety bill
in early 2009 that would overhaul the entire system. The legislation
focuses on prevention rather than reaction, requiring food processors
to enact safety plans and increasing inspections of plants.
Despite measures taken, Earlene Carter, whose mother tragically died
from a Salmonella infection, said she won't be satisfied until Stewart
Parnell is behind bars. Mr. Parnell "...should face the consumers
under criminal law--not civil--to answer for the crimes he committed.
After depriving families of their loved ones (who are gone to soon),
he should not be shielded. This should never happen again."
JANUARY 13, 2010, 11:47 A.M.
China Prosecutors Take Dairy Case
By JAMES T. AREDDY
A criminal case against managers of a Shanghai dairy accused of spiking
milk products with high levels of the industrial chemical melamine will
proceed, Chinese state media said early Wednesday.
Shanghai police have concluded their investigation into alleged production
of contaminated milk by Shanghai Panda Dairy Co. and handed the case
to local prosecutors, the state-run Xinhua news agency reported. That
step is required in China's legal system before a trial can begin.
The report said tainted products were discovered in April. It didn't
identify the individuals but said they included top management.
"The government shut down the company and sealed up all its stocks,"
Xinhua quoted a police statement as saying. "No damages were caused
in the society as all the products were recalled."
Authorities have offered few details about the case, which is similar
to a nationwide 2008 scandal in which six infants died and 300,000 people
were made ill by tainted milk.
No recall was publicly announced after word of the latest case was initially
reported by Xinhua on Dec. 31. In that report, Xinhua said officials
had been dispatched from Shanghai to other provinces to handle a product
Last week, a local district prosecutor in Shanghai said the probe of
Shanghai Panda began last February, around 11 months before the company's
closure was announced in a New Year's Eve news dispatch by Xinhua.
Officials have made no other public statements.
In the earlier case, around the time China hosted the Olympic Games,
the Chinese dairy industry, its regulators and other authorities were
found to have initially suppressed evidence that spiking milk with melamine
was a widespread practice-and starting to cause health problems, particularly
Melamine has a variety of industrial uses, and it was added to milk
products to make substandard products appear to have more protein. It
can cause liver problems when ingested by humans.
It is Time (past time) for the FSIS to deem both Shiga-Toxin E. coli
and Antibiotic Resistant Salmonella Adulterants
As most might know (perhaps
from a previous post), the Food Safety and Inspection Service¡¯s (FSIS)
stated mission renders it ¡°responsible for ensuring that the nation's
commercial supply of meat, poultry, and egg products is safe, wholesome,
and correctly labeled and packaged.¡± FSIS operates as part of the United
States Department of Agriculture (USDA). To promote its mission, FSIS
has the power-under the Federal Meat Inspection Act (FMIA)-to, among
other things, seek the recall of products that have been deemed ¡°adulterated.¡±
FSIS drastically shifted how it interpreted and enforced the FMIA in
1994 when, following the Jack in the Box outbreak, the agency declared
E. coli O157:H7 to be an adulterant. This marked a dramatic change from
its previous stance that pathogens in raw meat were not adulterants.
Given that there are other bugs, namely Enterohemorrhagic Non-E. coli
O157:H7, that cause human illness and death, I petitioned the FSIS to
deem these pathogens as adulterants. I have followed up, once and twice
with FSIS and intend to seek intervention in the courts in March if
FSIS refuses to act.
As I also said in an earlier post, ¡°with several recent recalls of Salmonella-tainted
beef in 2009 and recent reports of Salmonella-tainted chicken, getting
a better understanding of Salmonella - especially Antibiotic Resistance
in Salmonella - is a good way to start off the New Year.¡± Perhaps the
FSIS should consider these nasty bugs (antibiotic-resistant Salmonella)
adulterants as well- Perhaps another petition is on order- Keep reading
below and give me your thoughts.
Salmonella is a leading cause of foodborne illness worldwide, with an
estimated 1.4 million cases each year in the United States alone (1).
Salmonella infections are typically due to consumption of food products
of animal origin. Several lines of evidence indicate that antibiotic-resistance
among human Salmonella infections results from the use of antimicrobial
agents in food animals (2). Below is an overview of antibiotic-resistance
and Salmonella and what it means for human health.
Antibiotics and drug-resistance
Many bacterial species have the ability to produce antimicrobial compounds.
This ability is needed to give the bacteria an ¡°edge¡± in microorganism-rich
environments. Many of the antibiotics used today originated from bacterial
species such as Pennicillium, Cephalosporium, and Streptomyces. Antibiotic-resistance
likely also emerged as bacteria began producing compounds in order to
survive in their environment, and competing species found ways to counteract
these compounds (3).
Antimicrobial agents are currently used for three main reasons: (1)
to treat infections in humans, animals, and plants; (2) prophylactically
in humans, animals, and plants; and (3) subtherapeutically in food animals
as growth promoters and for feed conversion (2). When antibiotic use
became the norm in both human and animal medicine, selection pressure
increased the bacterial advantage of maintaining and developing new
resistance genes that could be shared among bacterial populations (3).
The first suggestion that antibiotic use in livestock led to antibiotic-resistant
bacteria was in 1951. Starr and Reynolds reported streptomycin resistance
in generic intestinal bacteria from turkeys that had been fed that antibiotic
The use of antibiotics not only selects for antimicrobial-resistant
bacteria, but may also increase the likelihood of disease transmission.
In 2006, Bauer-Garland et al. researched the transmission of multidrug-resistant
(MDR) Salmonella Typhimurium in broiler chicks under selective-pressure.
An MDR S. Typhimurium strain had significantly increased transmission
when chicks were treated with tetracycline, demonstrating that antimicrobial
use influences transmission of antimicrobial-resistant pathogens in
Antibiotics and Salmonella
Although most Salmonella infections are self-limited, causing acute
gastrointestinal illness in humans, antimicrobial agents are commonly
prescribed to those seeking medical attention. Severe infections that
spread to the bloodstream, meningeal linings of the brain, or other
deep tissue can also occur. The selection of effective antibiotics is
critical for the treatment of invasive infections, but has become more
difficult as antibiotic-resistance has increased (2).
In the 1980¡¯s and 90¡¯s, a particular strain of MDR Salmonella, known
as Salmonella Typhimurium DT104 (DT104), emerged in the U.S. This strain
is typically resistant to at least five drugs: ampicillin, chloramphenicol,
streptomycin, sulfisoxazole, and tetracycline (6). Since 1996, the National
Antimicrobial Resistance Monitoring System (NARMS) has identified increasing
numbers of Salmonella isolates resistant to nine of the 17 antimicrobial
agents tested: amoxicillin/clavulanate, ampicillin, cefoxitin, ceftiofur,
cephalothin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline.
These isolates also have decreased susceptibility or resistance to ceftriaxone,
an antimicrobial used to treat serious infections in children (7). Salmonella
isolates with this resistance pattern carry a gene that produces AmpC-type
enzymes that cause much of the drug-resistance; thus they are referred
to as MDR-AmpC.
Salmonella Enteritidis is
one of the most common types of Salmonella causing human illness, and
is associated with consumption of egg-containing products and chicken
(8). Since 1996, an increasing number of S. Enteritidis isolates submitted
to NARMS have been resistant to nalidixic acid (a drug closely related
to ciprofloxacin, or cipro, the most commonly prescribed antibiotic
for Salmonella infections). Of these resistant isolates, 90% also showed
decreased susceptibility to cipro (7).
Use of antibiotics in agriculture
Antibiotics are used in food animals for several reasons: treatment
of sick animals, prophylaxis to prevent illness during times of increased
risk of disease (e.g. transport or weaning), a combination of treatment
of sick animals and preventative care for other animals in the herd
or flock, and for growth promotion and improved feed utilization. The
total amount of antibiotics used in food production animals in the U.S.
is not known (3).
Antimicrobial agents have played an important role in animal production
since the 1950¡¯s. As livestock and poultry farms have grown and animal
density on those farms has increased, the demand for better disease
management has increased. The use of antimicrobial agents in animal
production has improved animal health and led to higher yields. However,
this practice has also contributed to the increased prevalence of antibiotic-resistant
bacteria significant to human health (3).
The rising prevalence of MDR Salmonella complicates the treatment of
Salmonella infections in both humans and animals. A call for prudent
use of antibiotics in both human and animal medicine has been issued
for years, with some positive results. In 2005, the U.S. Food and Drug
Administration (FDA) placed a ban on the use of enrofloxacin (a drug
closely related to cipro) in poultry because of the risk that it promotes
drug-resistant bacteria that are harmful to human health (9). Opponents
to banning antibiotic use in animal agriculture have pointed out that
bans like these have, in some cases, led to increased animal morbidity
and mortality, and have sometimes contributed to a greater use of antibiotics
to treat ill animals. These other antibiotics may come from drug families
of greater relevance to human medicine than the drugs that were banned
New data also suggests that use of cephalosporins in the poultry industry
could be impacting clinical use in humans. In July, 2008, the FDA proposed
a ban of veterinary use of cephalosporins for unapproved methods (such
as injection of eggs in hatcheries) due to the likely emergence of cephalosporin-resistant
strains of foodborne bacterial pathogens (10). Since cipro is not approved
for treatment of Salmonella infections in children under 18 years of
age, cephalosporins are an important treatment option for severe infections
(11). The American Veterinary Medical Association (AVMA), which represents
both public and private sector veterinarians, argued that the FDA¡¯s
proposal was unjustified. FDA withdrew the proposal in November, 2008
in order to reconsider all available data on the subject (10).
Antibiotic-Resistant Salmonella in the Food Supply
have been isolated from various food products. In 1998, 20% of ground
meat samples were positive for Salmonella, and 84% of these were resistant
to at least one antibiotic in the Washington, D.C. area (12). From 1999
to 2003, 18% of Salmonella isolates from various food products tested
by the FDA were resistant to two or more antimicrobials (13).
A case-control study of Salmonella
Newport infections in the U.S. found that MDR-AmpC infections are acquired
through the U.S. food supply from bovine and possible poultry sources
(14). Between 2004 and 2005, processed poultry from the mid-Atlantic
area of the U.S. was positive for Salmonella in high numbers. Eighty
percent of positive samples were resistant to at least one antimicrobial
and 53% were resistant to three or more antimicrobials (15). In 2005,
Salmonella was detected on 72% of broiler chicken carcasses prior to
evisceration and on 20% of carcasses postchill in a sample of 20 U.S.
processing plants. Only 15% of the S. Typhimurium var. 5- isolates were
pan-susceptible, and more than half of these isolates were resistant
to three or more antibiotics (16). In 2006, 22% of raw and ready-to-eat
turkey meat purchased in a Midwestern U.S. city was positive for Salmonella.
Of these isolates, 62% were multidrug-resistant (17). These results
clearly show that MDR Salmonella are present in the food supply, and
continued monitoring and research is necessary to track these alarming
Several studies have been
published focusing on the severe health consequences from multidrug-resistant
Salmonella infections. In 2002, Helms et al. reported on a study in
Denmark looking at antibiotic-resistant S. Typhimurium. Patients with
MDR infections were 4.8 times more likely to die than the general population,
and patients with quinolone-resistant infections were 10.3 times more
likely to die (18). In 2004, Helms also reported that patients with
quinolone-resistant S. Typhimurium infections had a two-fold increased
risk of invasive illness or death within 90 days of infection compared
to patients with pan-susceptible infections (19).
Also in 2004, Martin et al. reported on Canadians with MDR S. Typhimurium
infection. Hospitalization was more likely in those with MDR infections,
and the majority of these hospitalizations were directly attributed
to the resistance patterns of the infections (20).
In 2005, Varma et al. published data on bloodstream infections and hospitalizations.
Patients infected with a Salmonella isolate resistant to one or more
clinically important antibiotic were three times more likely to be hospitalized
with a bloodstream infection than patients with pan-susceptible infections
Several outbreaks of multidrug-resistant
Salmonella infections have been documented in the United States, including
an outbreak associated with unpasteurized Mexican-style aged cheese
(22), ground beef outbreaks (23, 24, 25, 26), and an outbreak associated
with pasteurized milk (27).
In one investigation, hamburger was traced back through meat processing
to well beef cattle that had been fed antibiotics (23). In another investigation,
chloramphenicol-resistant S. Newport was traced through processing of
contaminated ground beef to a dairy farm area. Chloramphenicol-resistant
Salmonella was found in manure lagoons, abattoirs, ill dairy cattle,
and ground beef. Isolation of chloramphenicol-resistant Salmonella was
correlated with chloramphenicol use on the farms (24).
Outbreaks like these can result in multiple hospitalizations and death
among individuals with the most severe infections. The multidrug-resistant
nature of these organisms makes treatment failure more likely. Antimicrobial
agents, particularly fluoroquinolones like cipro, are lifesaving for
approximately 2,000 people each year in the U.S. If even 10% of Salmonella
isolates in the United States were to become resistant to cipro, and
5% of persons with invasive cipro-resistant infections were to die,
the result would be an increase of 10 deaths per year. If 50% of strains
became resistant, an additional 100 deaths per year would be expected
There are several reasons to conclude that antibiotic-resistance among
human Salmonella isolates are the result of the use of antimicrobial
agents in food animal production: (1) tracebacks from foodborne disease
outbreaks have shown food animals as the ultimate source of infection
(outbreak refs), (2) antimicrobial resistance patterns and genetic fingerprints
have shown strong correlation between animal and human Salmonella (2,
6), and (3) antibiotic-resistance in human Salmonella isolates have
shown more correlation with antibiotic use in animals than with antibiotic
use in humans (2).
Dissemination of MDR Salmonella appears to contribute to changes in
resistance patterns. In the U.S., there aren¡¯t restrictions on movement
of animal herds positive for S. Typhimurium, though the purchase of
infected animals is known to be a risk factor for dissemination. Routine
surveillance and intervention (including traceback and quarantine) has
reduced the incidence of salmonellosis in food animals in Europe, specifically
Norway and Sweden. Biosecurity measures, including protection of feed
from rodents and birds, limiting human traffic, disinfection, and separation
of newly purchased animals from the larger herd or flock, in addition
to testing and quarantine would reduce the risk of introducing MDR Salmonella
into a herd or flock. Addressing this issue would subsequently help
prevent the unimpeded spread of MDR Salmonella through food animals
with consequent human foodborne infection (28).
Some of the same farm management strategies that could help to prevent
foodborne disease could also help prevent MDR Salmonella from circulating
in the food supply. It ultimately comes down to cost vs. benefit at
every step in the chain of responsibility among food producers. Farmers
and their veterinarians should be responsible for judicious use of antibiotics
in the animal industry just as physicians should be judicious in their
use of antibiotics in human medicine. Farmers also need to implement
biosecurity measures as outlined above to address problem of dissemination
of MDR Salmonella in addition to other infectious agents. In an ideal
world, slaughter and food manufacturing facilities would also follow
suit, using the best possible practices to minimize foodborne disease
transmission to consumers, and federal regulatory agencies would monitor
each step in the overall process to ensure the best food safety practices
possible. If the problem of antibiotic-resistance is not controlled,
larger outbreaks with more severe consequences can be expected. Considering
MDR Salmonella to be an official ¡°adulterant¡± in foods would be a prudent
step in helping to curb this emerging foodborne disease threat.
1. Swaminathan B, Gerner-Smidt P, and Barrett T. 2006. Foodborne Disease
Trends and Reports: Focus on Salmonella. Foodborne Path and Dis. 3(2):154-156.
2. Angulo F, Johnson K, Tauxe R, and Cohen M. 2000. Origins and Consequences
of Antimicrobial-Resistant Nontyphoidal Salmonella: Implications for
the Use of Fluoroquinolones in Food Animals. Microbial Drug Resist.
3. Matthew A, Cissell R, and Liamthong S. 2007. Antibiotic Resistance
in Bacteria Associated with Food Animals: A United States Perspective
of Livestock Production. Foodborne Path and Dis. 4(2):115-133.
4. Starr MP and Reynolds DM. 1951. Streptomycin resistance of coliform
bacteria from turkeys fed streptomycin. Am J Public Health. 41:1375-1380.
5. Bauer-Garland J, Frye JG, Gray JT, Berrang ME, Harrison MA, and Fedorka-Cray
PJ. 2006. Transmission of Salmonella enterica serotype Typhimurium in
poultry with and without antimicrobial selective pressure. J Appl Micro.
6. Wedel SD, Bender JB, Leano FT, Boxrud DJ, Hedberg C, and Smith KE.
2005. Antimicrobial-drug Susceptibility of Human and Animal Salmonella
Typhimurium, Minnesota, 1997-2003. EID. 11(12):1899-1906.
7. CDC. National Antimicrobial Resistance Monitoring System for Enteric
Bacteria (NARMS): Human Isolates Final Report, 2006. Atlanta, Georgia:
U.S. Department of Health and Human Services, CDC, 2009.
8. Voetsch AC, Poole C, Hedberg CW, Hoekstra RM, Ryder RW, Weber DJ,
et al. 2009. Analysis of the FoodNet Case-Control Study of Sporadic
Salmonella serotype Enteritidis Infections Using Persons Infected with
Other Salmonella Serotypes as the Comparison Group. Epidemiol Infect.
9. CIDRAP: University of Minnesota Center for Infectious Disease Research
and Policy. 2005 News release available at: http://www.cidrap.umn.edu/cidrap/content/fs/food/news/july2905baytril.html
10. Webster, P. 2009. Poultry, Politics, and Antibiotic Resistance.
Lancet. 374(September 5):773-774.
11. American Academy of Pediatrics. Salmonella Infections. In: Pickering
LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book 2009 Report of the
Committee on Infectious Diseases. 28th Ed. Elk Grove Village, IL: American
Academy of Pediatrics; 2009:(584-588).
12. White DG, Zhao S, Sudler R, Ayers S, Friedman S, Chen S, et al.
2001. The Isolation of Antibiotic-Resistant Salmonella from Retail Ground
Meats. NEJM. 345(16):1147-1154.
13. Kiessling CR, Jackson M, Watts KA, Loftis MH, Kiessling WM, Buen
MB, et al. 2007. Antimicrobial Susceptibility of Salmonella Isolated
from Various Food Products, from 1999 to 2003. J Food Prot. 70(6):1334-1338.
14. Varma JK, Marcus R, Stenzel SA, Hanna SS, Gettner S, Anderson BJ,
et al. 2006. Highly Resistant Salmonella Newport-MDRAmpC Transmitted
through the Domestic U.S. Food Supply: A FoodNet Case-Control Study
of Sporadic Salmonella Newport Infections, 2002-2003. JID. 194(15 July):222-230.
15. Parveen S, Taabodi M, Schwarz JG, Oscar TP, Harter-Dennis J, and
White DG. 2007. Prevalence and Antimicrobial Resistance of Salmonella
Recovered from Processed Poultry. J Food Prot. 70(11):2466-2472.
16. Berrang ME, Bailey JS, Altekruse SF, Shaw Jr WK, Patel BI, Meinersmann
RJ, and Fedorka-Cray PJ. 2009. Prevalence, Serotype and Antimicrobial
Resistance of Salmonella on Broiler Carcasses Postpick and Postchill
in 20 U.S. Processing Plants. J Food Prot. 72(8):1610-1615.
17. Khaitsa ML, Kegode RB, and Doetkott DK. 2007. Occurrence of Antimicrobial-Resistant
Salmonella Species in Raw and Ready to Eat Turkey Meat Products from
Retail Outlets in the Midwestern United States. Foodborne Path and Dis.
18. Helms M, Vastrup P, Gerner-Smidt P, and Molbak K. 2002. Excess Mortality
Associated with Antimicrobial Drug-Resistant Salmonella Typhimurium.
19. Helms M, Simonsen J, and Molbak K. 2004. Quinolone Resistance is
Associated with Increased Risk of Invasive Illness or Death during Infection
with Salmonella serotype Typhimurium. JID. 190(1 November):1652-1654.
20. Martin LJ, Fyfe M, Dore K, Buxton JA, Pollari F, Henry P, et al.
2004. Increased Burden of Illness Associated with Antimicrobial-Resistant
Salmonella enterica serotype Typhimurium Infections. JID. 189(1 February):377-384.
21. Varma J, Molbak K, Barrett T, Beebe J, Jones T, Rabatsky-Ehr T,
et al. 2005. Antimicrobial-Resistant Nontyphoidal Salmonella Is Associated
with Excess Bloodstream Infections and Hospitalizations. JID. 191(15
22. CDC. 2008. Outbreak of Multidrug-Resistant Salmonella enterica serotype
Newport infections associated with consumption of unpasteurized Mexican-style
aged cheese - Illinois, March 2006-April 2007. MMWR. Apr 25;57(16):432-5.
23. Holmberg SD, Osterholm MT, Senger KA, and Cohen ML. 1984. Drug-resistant
Salmonella from Animals Fed Antimicrobials. NEJM. 311:617-622.
24. Spika JS, Waterman SH, Soo Hoo GW, St. Louis ME, Pacer RE, James
SM, et al. 1987. Chloramphenicol-resistant Salmonella Newport Traced
through Hamburger to Dairy Farms. A Major Persisting Source of Human
Salmonellosis in California. NEJM. 316:565-570.
25. CDC. 2006. Multistate Outbreak of Salmonella Typhimurium Infections
Associated with Eating Ground Beef - United States, 2004. MMWR. Feb
26. Dechet AM, Scallan E, Gensheimer K, Hoekstra R, Gunderman-King J,
Lockett J, et al. 2006. Outbreak of Multidrug-Resistant Salmonella enterica
serotype Typhimurium Definitive Type 104 Infection Linked to Commercial
Ground Beef, Northeastern United States. CID. Mar 15;42(6):747-52.
27. Olsen SJ, Ying M, Davis MF, Deasy M, Holland B, Iampietro L, et
al. 2004. Multidrug-resistant Salmonella Typhimurium Infection from
Milk Contaminated after Pasteurization. EID. May;10(5):932-5.
28. Davis MA, Hancock DD, and Besser TE. 2002. Multiresistant Clones
of Salmonella enterica: The Importance of Dissemination. J Lab Clin
Posted on January 15, 2010
by Bill Marler
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