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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. For example:
- 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 practices-
- 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.

Poll: Most 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 supply.

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.

Nestle revamps cookie dough amid E. coli concern
Wed Jan 13, 2010 4:11pm EST

* Will start using heat-treated dough

* 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)

New FDA deputy to lead food-safety mandate
By Lyndsey Layton
Washington Post Staff Writer
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 growth hormone.
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 at GWU.
"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.

Victims Call for Prosecution of PCA Exec

by Zach Mallove | Jan 14, 2010

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 criminally prosecuted.
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, agreed.
"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. ET
China Prosecutors Take Dairy Case
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 recall.
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 in babies.
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 (4).
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 poultry (5).
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 (3).
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

Antibiotic-resistant Salmonella 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 trends.

Human Infections

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 (21).

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 (2).

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. 6:77-83.
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. 101:1301-1308.
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.
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Posted on January 15, 2010 by Bill Marler

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